January-February 2002

S A E M

NEWSLETTER

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

Newsletter of the Society for Academic Emergency Medicine

January/February 2002 Volume XIIII, Number 1

PRESIDENT’S MESSAGE Projecting SAEM 2010

Want A Second Opinion?

Call for Your Non-Funded Grant Application(s)

SAEM has had a rich and fruitful history. It was my great fortune to be a member of the University Association of Emergency Medicine (UAEM) and the Society for Teachers of Emergency Medicine (STEM). These organizations were the forerunners of SAEM and the Council of Emergency Medicine Residency Directors (CORD). From SAEM’s beginning as an organization in 1989 to now I have witnessed marvelous

Marcus Martin, MD progress.

The SAEM family has grown with increased membership, diversity, and Annual Meeting attendance. We have developed outstanding regional and Annual Meetings and we have pursued our mission of improving patient care through advancing education and research very strongly. We have accomplished much including development of our own journal (hardcopy and on-line), purchase of a building headquartered in Michigan, multiple grants for fellowships, sabbaticals and other awards including national recognition through the Council of Academic Societies. How often do we as individuals look back at something that we have done and then "beat ourselves up" because we should have done it a different way. My wife is always saying to me that I "beat myself up" because I "could have", "should have" or "would have" done something in a different way but I didn’t. I am constantly reminding myself to go forward and not backwards and use events of the past as a lesson but not as a hindrance for progress. I say this not to infer that SAEM should have done something differently in the past but this statement is made to encourage us to review where we have been (i.e., what have we accomplished with 5 year goals and annual objectives, etc.). It is easy to recap SAEM’s history by looking back at the many accomplishments. But in this message I am writing about the future.

Projecting SAEM into the year 2010 is a Board initiative developed during my president-elect year with the work planned to take place during my presidential term.

What will SAEM look like by the year 2010? I am not a futurist but it is important to plan for the future. Just as we set aside retirement funds, kids' college funds and various nest eggs and trusts, so should we plan the future for SAEM. What will be our communications, financial, staffing, and building needs? How do we improve upon our mission? How do we compare with other organizations? Do we know or should we even care about 2010? My answer is yes. We should care and we should project for the future. We should look at what our projected membership numbers, publications and meetings needs will be. "Our country is (continued on page 24)

Jeff Kline, MD SAEM Research Committee The Research Committee has implemented a review process to provide peer-review of grant applications that have been submitted and were not funded. We are seeking applications that have already been submitted and reviewed by a federal agency, a private or non-profit organization or a foundation that issues grants. The purpose of this forum is to constructively evaluate the application in a limited public forum and to give feedback to the applicant about how the grant application could be strengthened.

The intention for the atmosphere to be informal and supportive. A panel of three reviewers who have reasonably extensive experience in the grant-review process will prereview a 2-page written summary and at the conference will hear a five to ten-minute oral presentation of the grant.

The panel will then give feedback about how the application could be strengthened. The feedback will focus on how the hypothesis and specific aims can be clarified, sharpened and focused for increased impact and chance of success. The feedback process will include dialogue between the applicant and the review panel. The review critique will be summarized in written form and forwarded to the applicant.

The Research Committee wishes to initiate this forum at the 2002 Annual Meeting. The forum will occur on the evening of May 20 (tentative). It will be open only to the applicant and the reviewers and take approximately 90 minutes. During that time, we plan to evaluate two or three grant applications. We are seeking to have a two-page submission which can be essentially a cut-and-paste of a previously submitted grant that contains the following information: ● title and the authors with their affiliations ● abstract of the work, ● hypothesis, ● specific aims, ● short summary of previous criticisms by other extramural reviewing committees, and ● if necessary, a one-paragraph synopsis of any methods or statistical methods that warrant explanation in view of the comments of prior review. ● names of agencies that have previously reviewed the application.

The two-page application should be sent electronically to saem@saem.org. The deadline for receipt of applications is April 15, 2002. For questions, contact Jeff Kline at jkline@carolinas.org.

Medical Student Interest Group Grant Recipients Announced John Duldner, MD SAEM Grants Committee Akron General Medical Center SAEM is pleased to announce the recipients of the medical student interest group grants. Eighteen applications were received and reviewed by members of the Undergraduate Education Committee and coordinated by the Grants Committee. Each grant will be funded in the amount of $500 dollars.

The Board of Directors approved the funding for the following recipients: Louisiana State University – Corey J. Pitre, Class of 2002 and faculty advisor, Peter DeBlieux, MD, have planned a series of clinical workshops with a "nuts and bolts" application to emergency medicine. They are expanding upon previous success with studenttaught courses using case-based scenarios and complementing these experiences with teaching labs and hands-on exposure to clinical aspects of emergency medicine.

Wake Forest University – Kim Lee Askew and faculty advisor, David E. Manthey, MD, have developed an innovative educational program that has coordinated integration into the medical school curriculum. Using an organ system-based curriculum, clinical presentations related to each organ system will be presented by emergency physicians while incorporating the basic science and clinical aspects of the emergency patient.

University of Colorado – Alison Sheets, Class of 2004 and faculty advisor, Kerry Broderick, MD, have planned a series of lectures to be incorporated within the first year curriculum using imaging studies including radiographs, ultrasound and MRI to correlate with the classroom topics. In addition, a library of images will be made available through the student group’s website as well as on compact disc.

University of Connecticut – Jill Ripper and faculty advisor Thomas Regan, MD, submitted an educational workshop proposal that expands the strengths of their established Emergency Medicine Interest Group. In addition to workshops on suturing, airway and central venous access, a unique lumbar puncture workshop has been added utilizing special manikins.

The medical student interest group grants were developed to recognize and assist in development of medical student interest groups for medical students interested in a career in emergency medicine. The applications focus on educational activities or projects related to undergraduate education in emergency medicine and the funds may be used for supplies, consultation and seed money to support activities such as skills laboratories, lectures or workshops.

Emergency Medicine Training, Competency and Professional Practice Principles Position Statement The concept for this position statement was discussed during a meeting of the ACEP and SAEM officers in mid-October. It was agreed that Marcus Martin, Robert Schafermeyer, and Don Yealy would develop the position statement and that it would be offered to all organizations for consideration. A draft was submitted to the organizations and input was solicited. A revised position statement, based on the input received from the organizations was sent and by November 30 all of the listed organizations had endorsed it. This position statement will be published in the April issue of AEM and may be published in other journals.

Emergency Medicine is recognized as a specialty by the American Board of Medical Specialties and the American Osteopathic Association. Responsibilities of specialty status include accrediting graduate medical education training programs and credentialing physicians as certified specialists.

These responsibilities require creating standards for competency and defining professional practice principles.

Emergency physicians provide care and make treatment decisions based on real time evaluation of patients’ history, physical findings and many diagnostic studies, including the interpretation of electrocardiographs, imaging studies and laboratory tests. Emergency physicians possess a wide range of skills to treat injuries and illnesses and perform many interventions including but not limited to resuscitative procedures and trauma stabilization in patients of all ages.

It is the combined role and responsibility of the specialty organizations and the accrediting and certifying bodies in emergency medicine to set and approve the training standards, assess competency through board certification processes and establish the professional practice principles for emergency physicians.

Endorsed by: American Academy of Emergency Medicine American College of Emergency Physicians Association of Academic Chairs of Emergency Medicine Council of Emergency Medicine Residency Directors Society for Academic Emergency Medicine

Start Thinking About the Annual Meeting!

May 19-22, 2002 • Adams Mark Hotel • St. Louis, Missouri Check the SAEM web site for details.

May 18 (pre-day) CPC Semi-Final Competition Chief Resident Forum Medical Student Forum Association of Academic Chairs of Emergency Medicine (AACEM) Meeting AEM Consensus Conference: Assuring Quality May 19 Papers/Posters/Exhibits Plenary Session

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May 20 Papers/Posters/Exhibits CORD Meeting CORD New Program Directors’ Workshop Banquet May 21 Papers/Posters/Exhibits AEM Reviewers Workshop CORD Board of Directors May 22 Papers/Posters/Exhibits

Letter to the Editor: www.aemj.org [Editor’s comment: This letter was addressed to James Adams, MD, Senior Associate Editor for Academic Emergency Medicine, and has been reformatted for the Newsletter.]

Jonathan A. Handler, MD Northwestern University I was pleased to see this month's publication of the first article I have reviewed for AEM, and I wanted to comment on the website. I think it is extremely well done and quite seamless.

When I clicked on the article link from my AEM Table of Contents autoemail, I was taken to the abstract and pleased to see that the system had stored a cookie on my system so that I was instantly recognized on arrival.

That meant I was not forced to do an annoying login to read the full text of the article. That made for a very smooth and positive experience.

I like the design of the site, particularly the "Small Caps" font of the headings (e.g. "Methods"). The frequently dispersed navigation boxes would seem wasteful of space were I to have considered implementing it for a site, but in actual practice I think it really works well and is unobtrusive and well-placed. The speed of display is excellent.

The main site navigation is not split between navigation both at the top and on the left side, which many sites do, and which I think is confusing. Rather, it all occurs at one place (the top), which is good. In addition, the organization of the navigation links at the top, with sitespecific links on the top line and user-

specific links on the next line immediately adjacent to my name, is very clear and very clean. Frankly, I am a bit jealous of its simplicity and effectiveness.

I am pleased to see that we have implemented a lot of the utilities I found useful and cool at the BMJ site, such as downloads to citation managers and alerts when this article is cited. I was most stunned to see that I can access the full text of articles cited in the references section. As I think about it, I believe we talked about that at the editorial board meeting, but I forgot about that and it is extremely positive that it has been implemented. I think it would be great if there was a note letting users know that the full text was made available by AEM to these articles. I wasn't sure when I clicked on the "Full Text" links whether or not I would be forced to sign in to that journal and be allowed in only if I were a subscriber to it. I tried it anyway and it worked, but it wasn't clear that I would not need a separate login to the outside journal. Given that this is such a great resource, I would "advertise" it a bit at the top of the references section in some way.

Anyway, I just wanted to let you know that I think this is an incredibly cool and well done site. I would offer advice and suggestions, but unfortunately right now I have none because the things I would have suggested have already been done.

SAEM Position Statement on Filming of Emergency Patients The following position statement was approved by the SAEM Board of Directors on October 14, 2001 and will be published in the March 2002 issue of AEM. It will be accompanied by a manuscript developed by the Ethics Committee, chaired by Catherine Marco, MD. Patients seeking emergency care are entities does not provide benefit to the vulnerable to intrusions of their privacy patient and should not occur in either and confidentiality. Commercial filming the prehospital or Emergency includes all recording of images used for Department setting. Re-enactment of any purpose other than continuous the care process using skilled actors or quality improvement or education of even the patient at a time remote from medical personnel. Such activities the actual emergency provides a viable afford no direct benefit to the involved alternative for education of the lay public patient. Individuals filming can hinder or for marketing purposes. the care, privacy and confidentiality of Image recording should undergo a emergency patients, and may be dual consent process.

The first disruptive to the healthcare providers. addresses privacy issues associated For these reasons, SAEM makes the with the actual recording of the image. following recommendations.

The second addresses confidentiality Image recording by commercial issues associated with distribution and 3

CPC Competition Submissions Sought Submissions are now being accepted from Emergency Medicine residency programs for the 2002 Semi-Final CPC Competition to be held May 18, the day before the SAEM Annual Meeting in St. Louis. The deadline for submission of cases is February 1, 2002 and there is an entry fee of $200. Case submission and presentation guidelines are on the CORD website at www.cordem.org.

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. 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 discussants 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 of the five tracks. The Best Presenter and Best Discussant recipients will receive a certificate and $250.

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 Seattle. 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 CORD at cord@cordem.org, 517-4855484, or via fax at 517-485-0801.

use of those images. The consent process should mirror those for other actions or procedures in the Emergency Department.

Image recording for quality improvement or education of medical personnel associated with the workplace is acceptable if the dual consent process is maintained. Images obtained for medical education should undergo full disclosure to the patient if they are to be utilized in endeavors beyond the training institution, or for commercial purposes such as textbooks or paid didactic sessions.

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

However, in person meetings are held in May during the Annual Meeting, in the fall at either the ACEP Scientific Assembly or the AAMC Annual Meeting, and in the winter, usually in conjunction with an SAEM Regional Meeting or the CORD Navigating the Academic Waters Conference. This article will highlight the Board’s activities during the period of September through November, 2001.

The next Board meeting will be held on March 3 during the CORD Navigating the Academic Waters Conference and the CORD Best Practices Conference in Washington, DC. All SAEM members are invited to attend the SAEM Board meetings.

The Board decided not to endorse the document “Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography” that was developed by the American College of Cardiology and the American Heart Association. A letter outlining the Board’s concerns with the document was sent to the American College of Cardiology and published in the September/October 2001 issue of the SAEM Newsletter. In addition, the Board developed a letter to the editor that was submitted to the Journal of the American College of Cardiology. The letter was not accepted for publication and was revised and submitted to Academic Emergency Medicine (AEM). The Board asked William Brady, MD, and Edward Michelson, MD, to write a commentary that was submitted to AEM. Lastly, during an officers meeting between ACEP and SAEM in midOctober, it was agreed that Marcus Martin, MD, Robert Schafermeyer, MD, and Don Yealy, MD, would draft a position statement entitled, “Training, Competency, and Clinical Practice Principles” (published in this Newsletter).

The position statement was subsequently endorsed by the Association of Academic Chairs of Emergency Medicine (AACEM), the American Academy of Emergency Medicine (AAEM), the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), and SAEM. The position statement, letter to the editor, and manuscript will be published in the April issue of Academic Emergency Medicine.

The Board agreed that a major initiative of the Society was the development of the Research Endowment. Roger Lewis, MD, PhD, Marcus Martin, MD, Susan Stern, MD, Don Yealy, MD, and Brian Zink, MD, will serve as a Board working group to develop a vision state-

ment, principles, descriptions and funding goals for the Research Endowment.

The working group is expected to report to the Board before the end of 2001. The Board agreed that SAEM will require the assistance of a professional fund raiser to develop the Fund and allow SAEM to continue to expand the number of grants that are funded each year.

The Board developed and approved a position statement entitled, “Filming of Emergency Patients” (published in this Newsletter). In addition, the Board approved a manuscript on the topic that was developed by the Ethics Committee.

The manuscript and the position statement are expected to be published in the March issue of AEM. The Board provided comments to draft guidelines developed by the Association for the Accreditation of Human Research protection. The Board approved a letter written by the National Affairs Task Force that was sent to Congress (and published in the November/December issue of the SAEM Newsletter) commenting on the Medicare Education and Regulatory Fairness Act. The Board agreed to provide representation to the EMS Errors Reduction Conference sponsored by the National Highway Transportation Safety Administration. The Board asked the Patient Safety Task Force to recommend a representative to attend the Conference. Dr. Douglas Kleiner, PhD, University of Florida, Jacksonville represented SAEM at the conference and a report will be distributed to the Board and published in the next issue of the Newsletter.

The Board approved Linda Spillane, MD, University of Rochester, to serve as chair of the Consulting Service Task Force, upon the resignation of Louis Binder, MD, who has been appointed to the Residency Review Committee. The Board elected Glenn Hamilton, MD, to serve as the Board member on the Nominating Committee.

The Board approved increasing active dues to $365 and associate dues to $350 per year. The Board agreed not to increase resident, fellow, and medical student dues. Details regarding the dues increase were published in the November/December 2001 issue of the Newsletter.

The Board approved the appointment of Robert Neumar, MD, to serve as one of two SAEM representatives to the Emergency Medicine Foundation. Dr. Neumar and Dr. Yealy will represent SAEM at the twice a year EMF Board of Trustees meetings.

The Board approved the proposal from the National Affairs Task Force, 4

developed by Jim Hoekstra, MD, to convene educational sessions at the AAMC Annual Meeting on November 4 in Washington, DC. The Association of Academic Chairs of Emergency Medicine also convened a meeting at the AAMC Annual Meeting.

The Board approved the applications submitted for the 2002 Western, Southeastern, New England, and MidAtlantic Regional Meetings.

Advertisements for the regional meetings in the SAEM Newsletter and Academic Emergency Medicine have been provided by SAEM. The Board approved a request from the American Board of Emergency Medicine to amend the ABEM Bylaws to expand the number of members of the ABEM Nominating Committee.

The Board approved the National Hospital Ambulatory Medical Care Survey and sent a letter of support. In response to a request for information from the National Heart, Lung, and Blood Institute the SAEM Board requested and subsequently approved the development of a response. That response was published in this Newsletter.

The Board accepted ACEP’s invitation to participate in the ACEP Rural Workforce Task Force. Dr. Marcus Martin attended the inaugural meeting in October and Janet Williams, MD, West Virginia University, has been appointed to represent SAEM on the Task Force.

The Board approved a slate of nominees for submission to the American Board of Emergency Medicine for consideration of election. ABEM will be electing two new ABEM directors.

The Board approved funding to support Dr. Carlos Camargo, chair of the SAEM Public Health Task Force, to attend a Healthy People 2010 conference. A report on the conference was published in the November/December issue of the Newsletter.

The Board approved a policy that outlines the responsibilities of SAEM representatives to other organizations.

The policy will be posted on the SAEM web site.

The Board discussed the status and progress of the committees, task forces, and interest groups. Board members are assigned to serve as liaisons to each committee, task force, and interest group.

The Board approved minor revisions to the Journal Operational Guidelines.

The Board approved the posting of PDF versions of the SAEM Newsletter on the web site. The Board approved final versions of the Research Training Grant and the Institutional Training Grant applications.

Report of the First Contact, First Response: Ensuring Physician Readiness Conference Hernan F. Gomez, MD University of Michigan It was my pleasure and honor to have served as the Emergency Medicine representative for SAEM and ACEP for the AAMC conference, "First Contact, First Response Ensuring Physician Readiness for Biological, Radiation and Chemical Terrorism" which took place November 28, 2001.

As may be discerned by the title of the conference – representation in this conference was clearly in our area of interest. The meeting may be summarized as follows: Partial List of Participants Jordan J. Cohen, MD, President, AAMC, Edward Baker, Jr., MD, MPH, Director, Public Health Practice Program office, CDC, Mohammad Akhter, MD, MPH, Executive director, American public Health Association, Colonel William Duncan, MD, Chairman, Department of Medicine, Walter Reed Army Medical Center, Michael Goldberg, PhD, Executive Director, American Society for Microbiology, David B. Hoyt, MD, FACS, Chair, Committee on Trauma, American College of Surgeons, Scott Lillibridge, MD, Special Assistant for National Security and Bioterrorism, Office of Secretary Thompson, Department of Health and Human Services, Stephen H. Miller, MD, Executive Vice President, American Board of Medical Specialties, Frances M. Murphy, MD, PhD, Deputy Under Secretary for Health Veterans Health Administration, Robert

Perelman, MD, Director, Department of Education, American Academy of Pediatrics, Thomas R. Russell, MD, FACS, Executive Director American College of Surgeons, Barbara Schneidman, MD, PPH, Interim Vice President, Medical Education, American Medical Association, Susan Scrimshaw, PhD, Dean, School of Public Health, University of Illinois at Chicago, Harrison Spencer, MD, MPH, President and CEO, Association of Schools of Public Health, Douglas L. Wood, DO, PhD, President American Association of Colleges of Osteopathic Medicine, Michael Whitcomb, MD, Senior Vice President, Division of Medical Education, AAMC. In addition, Senator William Frist, U.S. Senator (Tennessee) was present during the primary portion of the meeting.

Meeting Summary The meeting began with introductory remarks by Dr. Cohen & Dr. Whitcomb, of the AAMC. The leaders of AAMC remarked that as representatives of this country’s 125 medical schools and 400 teaching hospitals, the AAMC believes a key priority is to prepare tomorrow’s doctors with the information and tools to respond immediately and effectively to terrorist attacks. It was expressed that more needs to be done to be prepared to deal with terrorist attacks caused by biological agents, or chemical and radiation exposure. The AAMC is in the process of building on a cooperative agreement with the Centers for Disease

Control and Prevention. It is clear that AAMC will be working closely with the CDC’s expert staff on an ongoing basis to identify ways to better prepare the physician workforce with bioterrorism.

Senator Frist arrived during the opening remarks by the leadership of AAMC and asked for support from the medical community of the Frist, Kennedy Bipartisan Bioterrorism Response Bill. This bipartisan legislation was introduced to greatly strengthen America’s preparedness and response to bioterrorist attacks. The bill builds on the efforts of last year’s "Public Health Threats and Emergencies Act of 2000," which was authored by Frist and Kennedy and signed into law last November. Senator Frist stated that, "The best way to protect Americans from these threats is to enhance our preparedness at the national, state and local levels." The "Bioterrorism Preparedness Act of 2001" is designed to address existing gaps in our nation’s biodefense and surveillance system, as well as our public health infrastructure.

It authorizes approximately $3.2 billion in fiscal year 2002 and includes the administration’s priorities. The bill focuses on four critical areas: providing federal assistance to state and local governments in the event of a biological attack; improving public health, hospital, laboratory, communications and emergency response preparedness and responsiveness at the state and local levels; increasing incentives for the rapid devel(continued on page 23)

News from the Emergency Medicine Foundation Donald M. Yealy, MD SAEM Board of Directors University of Pittsburgh Robert Neumar, MD University of Pennsylvania On October 15, 2001 at the ACEP Scientific Assembly in Chicago, the EMF Board of Trustees met. Dr. Michael Rapp currently serves as Chair of the Foundation, with Robert Schaefermeyer serving as Chair-Elect. The EMF mission, values, board members, grant applications and awardees are available online (www.acep.org); these remain intact and serve to guide all decisions.

At this meeting, two new initiatives were approved in addition to review of the previous fiscal cycle of revenues, expenses and grant awards. First, the EMF has decided to retain the service of a professional fund raising consultant

organization to aid with delivering the financial resources needed to maintain and grow the programs. To date, EMF has done well with both corporate and individual contributions; however, the opportunity to enhance these streams is clearly present, and the partnership will aim toward this goal. Marijean Hall from Tripoints, Inc. will head these efforts, which will be closely monitored by EMF leadership. Because ACEP pays the administrative expenses for EMF, the consultant is actually retained by the College.

Secondly, a motion was made and approved to increase the EMF Fellowship Award from $35,000 to $75,000 for each funded year.

Investigator/board members cited the need for funding that truly offset the costs of such fellowships, and that this 5

funding amount was both commonly offered by various organizations involved in training support and adequate in today’s academic environment.

The EMF recognizes that increased expenditures require increased revenues, ‘dove-tailing’ this decision with the previous initiative to enhance contributions. The goal is to draw the best applicants and then offer optimal support, leading to a deeper pool of funded emergency medicine investigators.

The EMF remains committed to funding academic emergency physicians and related health care providers.

SAEM offers support through joint sponsorship of the Innovations in Medical Education and Medical Student Grants, and participation of two members (Drs. Robert Neumar and Donald M. Yealy).

Is Your Project On This List?

Clifton Callaway, MD, PhD SAEM Research Committee University of Pittsburgh This year, the SAEM Research Committee undertook to identify investigators in emergency medicine who currently receive NIH or other federal funding. The long-term goal of generating such a list is to provide the membership with a guide to the various experts within our specialty, and to help delineate what areas of expertise are available.

As a first step towards identifying federally funded investigators in emergency medicine, we conducted a search of the NIH database of extramural research support: CRISP (Computer Retrieval of Information on Scientific Projects).

This database can be reached through the NIH web page (www.nih.gov), and allows several

search strategies. The CRISP database contains principal investigator names, project titles, dates, study sections, and abstracts for all funded projects. Using CRISP, a prospective investigator can see what type of projects have received awards in the past and where in NIH these projects were reviewed. In addition, the database lists the department within each institution to which a grant was awarded.

We encountered several problems while compiling this list. In particular, we focused first on the Department field in the search, hoping to capture all awards from within a Department of Emergency Medicine. Unfortunately, many awards list another department in this field (such as when Emergency Medicine is a Division of Medicine or Surgery), or in some cases the field was left blank altogether. Broadening our search to

include the word “emergency” in any field captured many more awards, including many that were clearly unrelated to the specialty. In the end, we took the list from this latter search, and examined all of the abstracts and principal investigators to determine if the project was the work of an emergency medicine investigator. In some cases we included projects where the investigator has appointment in another field, but the work was inseparable from the specialty (as in Dr. Hallstrom’s projects).

To supplement the results of the CRISP search, we received several responses to our advertisement in the Newsletter for information about federally funded investigators. In addition, the Research Committee had personal knowledge of several projects not other(continued on next page)

Principal Investigator Award Title

Institution

Award Number

Career Development Grants Becker, Lance Bunney, E.B. Callaway, Clifton Klawitter, Paul Neumar, Robert Quinn, James Rothman, Richard VandenHoek, Terry Younger, John Zink, Brian

Metabolic inhibition of oxidant stress in reperfusion Electrophysiology of cocaine, ethanol and cocaethylene Brain ischemia and MAP kinase activation Redox regulation of metabolism in hypoxic diaphragm Brain ischemia - Mu-calpain activation and eIF4e degradation A network of research sites to study clinical wound care ED guidelines for evaluation of febrile intravenous drug users Oxidants in myocardial preconditioning Lung injury, perfluorocarbons and hemorrhagic shock Alcohol and brain injury

U Chicago University of Illinois, Chicago U Pittsburgh Ohio State University U Penn UCSF The Johns Hopkins University U Chicago U Michigan U Michigan

5K08 HL003459-05 5K01 DA000285-05 5K02 NS002112-03 5F32 HL10216-02 5K08 NS001832-06 5K23 AR002137-02 1K23 RR00052-395 S-1 5K08 HL003779-04 5K08 HL003817-02 5K08 AA000184-05

Project Grants Baraff, Larry Brown, Michael Camargo, Carlos Chan, Ted Crain, Ellen D’Onofrio, Gail Eisenberg, Mickey Gorelick, Marc Green, Gary Hallstrom, Alfred Hallstrom, Alfred Hallstrom, Alfred Hoffman, Stuart Kellerman, Arthur Krause, Gary Li, Gouhua Li, Gouhua Maitra, Subir Neumar, Robert Olson, James Olson, James Rothman, Richard Stein, Donald Sullivan, Jonathon Thom, Stephen Thom, Stephen Yealy, Donald

Commercial telephone triage vs physician on-call advice Asthma surveillance and intervention in hospital EDs Diet and chronic obstructive pulmonary disease Impact of oleoresin capsicum spray on respiratory function Improving EMS for children through outcomes research Emergency physicians’ brief intervention for alcohol Community Heart Action Project PEAT: pediatric emergency assessment tool Coronary thrombosis and risk in the ED Technology of CPR strategies: a randomized trial Early access to defibrillation for vitims of OOH-CA Clinical trial of an implantable cardiac defibrillator Effects of dihydroepiandrosterone on brain injury Progesterone treatment of blunt traumatic brain injury Suppression of protein synthesis in reperfused brain Alcohol and general aviation Pilot aging and aviation safety GLU6PASE and 6P2K/FBASE gene regulation in sepsis Calpain-mediated injury in post-ischemic neurons Mechanisms of gene dysregulation in HD Mechanisms of cellular taurine transport in brain edema Eval of febrile IV drug users guidelines for emer mgmt Progesterone after traumatic brain injury Cell survival in brain reperfusion Specialized center of research in hyperbaric oxygen therapy CO poisoning in the context of a reperfusion injury An empiric risk stratification rule for heart failure

UCLA-Harborview Michigan State CDC Brigham and Women’s (Harvard) UCSD National Institute of Justice Columbia University Yale University of Washington Children’s Hospital of Wisconsin The Johns Hopkins University U Washington U Washington U Washington Emory University Emory University Wayne State University The Johns Hopkins University The Johns Hopkins University SUNY, Stony Brook U Penn Wright State University Wright State University The Johns Hopkins University Emory University Wayne State University U Penn U Penn U Pittsburgh

3R01 HS010604-01S1

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5R01 HL063841-02 1R12 HS010942-01 1R01 AA012417-01A1 5U01 HL053141-05 R03 HS11395-02 1R01 HL069746-01 5R01 HS008197-04 3N01 HC095177-001 3N01 HC025117-04 1R03 HD040295 1R01 NS39097 5R01 NS033196-06 5R01 AA009963-08 5R01 AG013642-05 5R01 GM058047 5R01 NS039481-02 1R01 NS042157 5R01 NS037485-03 2M01 RR00052 1R01 NS038664-01A2 1R01 NS041919 5P50 AT000428-02 5R01 ES005211-10 1R01 HS010888-01

Lynne Richardson, MD, Embarks on EMPATH Roland C. Merchant, MD SAEM Research Committee Brown University The Robert Wood Johnson Foundation recently granted $108,000 to a new study that will examine access to healthcare in U.S. emergency departments. Lynne Richardson, MD, Mount Sinai School of Medicine Emergency Department’s Vice-Chair and Residency Director, will direct the Emergency Medicine Patient’s Access to Health Care (EMPATH) research project, which will attempt to categorize both the medical conditions and health care access problems that compel some patients to seek medical care from the ED. EMPATH is a pilot study that involves a 24-hour snapshot of over 30 ED’s across the United States. Dr. Richardson and her investigators will collect data through patient interview and ED record abstraction in late 2001 and early 2002.

Through the EMPATH study, Dr. Richardson seeks the answer to two main questions. (1) Why do patients seek care from the ED instead of another health care facility? (2) For ED patients, what medical conditions are secondary to a lack of access to other health care facilities and providers? Dr. Richardson believes the answer to the first question will be obvious for some patients (e.g., compulsory EMS protocol for trauma victims), but for others, the reasons may be more complicated.

Primarily, though, it may be due to an inability to gain access to other forms of health care. Such inabilities may

include no primary care provider, no opportunity or means of getting an appointment at another health care source, a lack of insurance or funds for an insurance copayment, the inconvenience of scheduled appointments or too long of a delay until an appointment, etc.

As for the second question, Dr. Richardson believes that some ED visits can serve as a marker for changes in health care access. She notes that some medical problems, such as diabetic ketoacidosis, severe asthma attacks, decompensated congestive heart failure, may occur because of healthcare access problems. Dr. Richardson says the overall purpose of EMPATH is not to show that health care access is a problem, EMPATH is meant to serve as a means to develop a tool to measure access to health care. For example, when a state changes its Medicaid eligibility requirements, patterns of ED utilization will likely be impacted. Dr. Richardson hopes to create an algorithm to monitor these patterns.

In the 1990s, an unfunded volunteerbased study looked at the problem of healthcare access and the turn to EDs for primary care. EMPATH arose from an SAEM Public Health Task Force objective of examining access and utilization of EDs. In 1999, while a representative of the Public Health Task Force, Dr. Richardson wrote a brief letter to the Robert Wood Johnson Foundation, explaining the EMPATH concept. After the foundation expressed interest, Dr. Richardson followed her initial letter with an expanded proposal, then a complete grant request when the

Project List (Continued) wise listed. What results is a list of 37 projects with an emergency medicinebased principal investigator. Of these projects, 10 are career development grants. In addition, we became aware of a number of projects for which an emergency medicine investigator was a co-investigator. Because the coinvestigator role cannot be systematically searched through public databases, we feel that our knowledge of coinvestigators is too preliminary to be meaningful. We have elected not to include those awards for this presentation.

The lack of federal funding for emergency medicine research is an often-heard complaint. However, the

breadth and diversity of research that relates to emergency medicine would probably thwart any attempt to lump “EM research” into one bin. Supporting this conclusion, the Table indicates how funded investigators in our specialty have focused projects, and draw support from the appropriate specific institutes within NIH. The Research Committee hopes to continue highlighting these projects, and to expand this list to be more inclusive. If you are conducting, or are part of a project that this search missed, we apologize, and ask that you please update the Research Committee (c/o Clifton Callaway, University of Pittsburgh, callawaycw@msx.upmc.edu).

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foundation solidified their support. The grant request process took about one year to complete. Dr. Richardson said she deliberately approached the Robert Wood Johnson Foundation because of their demonstrated interest in health care access. She hopes EMPATH will serve as a pilot for an eventually federally-funded larger study that will include more United States Eds, as well as help establish a more definitive algorithm.

Dr. Richardson credits her research endeavors to a serendipitous luncheon encounter. When serving as Chief of Emergency Services at Harlem Hospital and a Health Services Research fellow of the Association of American Medical Colleges in 1992, she met a representative of the Agency for Healthcare Research and Quality (AHRQ). The AHRQ representative needed someone familiar with the ED to review a grant request from a cardiologist who wanted to perform an ED study. Her work on that project led to increasing involvement with AHRQ in reviewing grants and later, an appointment to an AHRQ study section. Dr. Richardson says that she learned a great deal about research design, the funding process, and grantsmanship from her work with AHRQ, and that these experiences served her well when she applied for the Robert Wood Johnson Foundation grant. Dr. Richardson believes that other ED researchers can obtain funding like hers, and as a member of the AHRQ Healthcare Research Training Section, she encourages more emergency physicians to investigate AHRQ grants to facilitate their research and training.

Information Sought on Federally Funded Projects If you are a Principal or CoInvestigator for a current program or project grant supported by NIH, AHRQ, CDC or other federal funding, we invite you to notify the Research Committee of your project on an ongoing basis. The Research Committee activity will try to publicize new projects in Emergency Medicine research to acknowledge success in achieving funding, and to point out resources for members seeking expertise in particular fields. Send information to Clifton Callaway, MD, PhD at callawaycw@msx.upmc.edu.

Academic Announcements SAEM members are encouraged to submit Academic Announcements on promotions, research funding, and other items of interest to the SAEM membership. Submissions should be sent to saem@saem.org by March 1 for publication in the March/April issue of the Newsletter.

Jean Abbott, MD, University of Colorado, Frank Counselman, MD, Eastern Virginia University, and Peter DeBlieux, MD, Louisiana State University, have been nominated by the Organization of Resident Representatives for the 2001 AAMC Humanism in Medicine Awards.

Nominations were based on: positive mentoring skills, collaboration, compassion/sensitivity, community service activity, and observance of professional ethics. The award honors medical school faculty who embody the finest qualities in a healer who teaches healing.

Clifton Callaway, MD, PhD, University of Pittsburgh, and Peter B. Richman, MD, Morristown Memorial Hospital, have been named Outstanding Reviewers by Academic Emergency Medicine.

Dr. Callaway and Dr. Richman, as well as all AEM reviewers from July 2000 through July 2001, are acknowledged in the December issue of 2001.

S A E M

David Cone, MD, has been appointed to the position of Senior Associate Editor of Academic Emergency Medicine by Editor, Michelle Biros, MD. Dr. Cone is Associate Professor and Chief, Division of EMS and EMS Fellowship Director at Yale University.

At the University of Colorado, Richard Dart, MD, has been promoted to Professor of Surgery, Benjamin Honigman, MD, has been promoted to Professor of Surgery, Steven Lowenstein, MD, MPH, has been promoted to Professor of Surgery and Medicine, and Peter Pons, MD, has been promoted to Professor of Surgery.

All surgery promotions are in the Division of Emergency Medicine. In addition, Dr. Lowenstein has been appointed Associate Dean for Faculty Affairs at the School of Medicine.

Terry Kowalenko, MD, has been selected as the emergency medicine residency director at the University of Michigan. Dr. Kowalenko previously served as the residency director at the Wayne State University/Sinai-Grace Hospital program in Detroit.

Robert Neumar, MD, has been appointed as one of two SAEM representatives to the Emergency Medicine Foundation.

Dr. Neumar is an Assistant Professor of

Emergency Medicine at the University of Pennsylvania.

Steven A. Seifert, MD, has been appointed Medical Director of the Poison Center at Children’s Hospital in Omaha, Nebraska. The Poison Center at Children’s Hospital (along with the Arizona Poison and Drug Information Center and the Rocky Mountain Poison and Drug Center) was awarded a $375,000 DHHS/HRSA grant for a multicenter study of medical error in poison center settings.

Rebecca Smith-Coggins, MD, has been appointed to the Residency Review Committee for Emergency Medicine. Dr. Smith-Coggins is the emergency medicine residency director at Stanford University.

Vincent Verdile, MD, has been named Dean of Albany Medical College and Executive Vice President for Health Affairs at Albany Medical Center. Dr. Verdile has served as interim dean for the past year.

In February 2002, Keith Wrenn, MD, will be awarded one of ten inaugural Parker J. Palmer “Courage to Teach” awards by the Accreditation Council on Graduate Medical Education. Dr. Wrenn is the emergency medicine residency program director at Vanderbilt University.

Call for Submissions Innovations in Emergency Medicine Education Exhibits 2002 Annual Meeting Deadline: February 15, 2002

The Program Committee is accepting applications for review for the Innovations in Emergency Medicine Education (IEME) Exhibits at the 2002 SAEM Annual Meeting, May 19-22 in St. Louis. Submitters are invited to complete an application describing an innovative new educational methodology that they have designed, or an innovative educational application of an existing product. The exhibit should not be used to display a commercial product that is already available and being used in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teaching setting.

Commercial support of innovations is permitted but must be disclosed. IEME exhibits will not be published in Academic Emergency Medicine with other abstracts, but will be listed in the on-site program. However, if submitters have conducted a research project on or using the innovation, the project may be written up as a scientific abstract and submitted for scientific review in the appropriate subject category by the January 8 deadline.

The deadline for submission of IEME Exhibit applications is Tuesday, February 15, 2002 at 5:00 pm Eastern Time and will be strictly enforced. Only electronic submission via email attachment to saem@saem.org will be accepted. The application form and instructions will be available on the SAEM web site at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Society for Academic Emergency Medicine • 901 North Washington Avenue • Lansing, MI 48906 8

Report on the AAMC Annual Meeting Jim Hoekstra, MD Chair, SAEM National Affairs Task Force and Representative to CAS/AAMC Ohio State University On November 2-7, in Washington, DC, the Association of American Medical Colleges held their annual meeting. The topic of the meeting was "Facing the Future," with emphasis placed on the present crisis in academic medicine’s abilities to deal with the pressures of a growing and aging population, declining medical college applicant pools, shrinking resources, and the recent challenges of disaster medicine and bioterrorism. Jordan Cohen, president of the AAMC, addressed the participants and called for a renewed emphasis on humanism and professionalism in medicine and medical education. George Sheldon, MD, referred to the crisis in our emergency departments and called for an increase in medical school output to face the increasing demand for medical care in this country.

In concordance with the AAMC’s agenda for the annual meeting, SAEM sponsored and organized an educational program on "Preserving the Emergency Medicine Safety Net." Dr. Lynne Richardson from Mt. Sinai Hospital (NYC) and Dr. Jim Gordon from Harvard co-presented a synopsis of the AEM-sponsored consensus conference on the EM safety net that convened in May, 2001. Dr. Richardson presented the emergency medicine view of the Institute of Medicine Report on patient safety, with emphasis on the report’s recommendations of continual monitoring and federal support of the medical safety net. The IOM report was aimed primarily at primary care as the medical safety net, but it describes emergency medicine is the "floor" which supports the primary care safety net. As such, emergency medicine is the "ultimate safety net." Dr. Richardson eloquently outlined the crisis in emergency medicine with staggering statistics on increasing emergency department visits, increasing charity care, nursing shortages, increasing EMS diversion, and decreasing hospital bed availability.

The consensus conference identified input, system, and output problems as the possible causes of ED overcrowding. Of these three factors, the consensus was that output, with inability to either admit patients to the hospital or discharge patients to appropriate outpatient facilities, was by far the major con-

tributor to ED overcrowding. Dr. Gordon followed with a call for research into the causes of ED overcrowding. He outlined the need for more research into the public health effects of the loss of the EM safety net. The EMPATH study, which seeks to identify the patient characteristics in overcrowded EDs, is among the many safety net research projects sponsored by the AHRQ and other governmental agencies, which are crucial to identifying the nature of ED overcrowding and ambulance diversion.

In addition, Dr. Gordon challenged the academic emergency medicine community to expand our research into safety net care. We have administered tetanus shots as a public health initiative for years. Why shouldn’t we expand our involvement into preventive care, disease risk factor analysis and intervention, alcohol and drug rehabilitation referrals, vaccinations, and identification of patients eligible for federal and state aid programs? It’s obvious from both Dr. Richardson and Dr. Gordon’s presentations that EM needs to take the lead in research and public advocacy issues surrounding the medical safety net.

Only EM can outline the problems that need to be addressed and recommend the appropriate changes that will preserve the ultimate medical safety net.

The program was well received, and attended by representatives of the AAMC. The safety net program was followed by an AACEM-sponsored session on NIH funding opportunities. Belinda Seto, PhD presented the funding opportunities available at the NIH, including all the R and K awards, with emphasis on the awards that were most applicable to EM. Statistics were presented regarding the percentage of awards granted for new versus established investigators. The student loan payback program for NIH sponsored investigators was also presented. The need for categorization of the awards given out to emergency medicine investigators, and the need for an NIH study section for EM, were discussed at length. Emergency medicine has begun to make inroads into NIH funded trials. At present, over $6 million in NIH and AHRQ dollars are awarded each year to emergency medicine investigators.

The AACEM educational program was followed by a luncheon, co-sponsored by SAEM and AACEM. Tony Mazzaschi from the Council of Academic Societies and the AAMC was 9

the featured speaker. He outlined the relationship between the AAMC and the academic societies, including SAEM and AACEM. He presented a number of opportunities for interaction and influence between SAEM and organized academic medicine. The AAMC has been challenged to take a leadership role in the organization of educational responses to bioterrorism. It has partnered with the CDC to begin to organize a "tool box" of educational materials on bioterrorism that can be used throughout the academic medical community.

In addition, it is leading the efforts to organize medical responses to disasters and bioterrorism. Its involvement with organized emergency medicine will be crucial to the success of these educational and communications programs.

AAMC values input from academic emergency medicine on issues that are common, both internally, as well as in the political advocacy arena.

The AAMC meeting was a great success for emergency medicine. The programs were well advertised, well organized, and well attended. Emergency medicine continues to grow in its visibility and influence in the academic medicine community. Given our future challenges, this growth is crucial to our success as a specialty.

More on the AAMC Meeting David P. Sklar, MD SAEM Representative to CAS/AAMC University of New Mexico I attended the AAMC Annual Meeting as the other SAEM representative and add a few a comments to Dr. Hoekstra’s excellent report.

The meeting was overshadowed by events in Afghanistan and the bio-terrorism issues concerning anthrax.

However, the various groups at the meeting focused on a few issues of importance.

The AAMC has decided to support an 80-hour workweek for residents.

Although this will not affect emergency medicine residencies which already had mandated less than 80 hours, it will affect surgery, medicine, and therefore indirectly all residents rotating on those services. The surgeons in particular appear to be most distressed at the (continued on page 23)

Nominations Requested for Resident Member of the SAEM Board of Directors

AEM Call for Papers “Assuring Quality” The Editors of Academic Emergency Medicine announce the next AEM Consensus Conference on “Assuring Quality” to be held on May 18 in St. Louis. The conference will aim to describe means of defining, assessing, measuring, and researching the delivery of quality emergency care in the clinical setting. We believe the conference is a logical progression in our consensus series, which has included “Errors in Emergency Medicine,” and “The Unraveling Safety Net.” We therefore issue this call for papers related to the topic of Assuring Quality. Submitted manuscripts are due on March 1, 2002. Accepted papers will be published in the late fall of 2002, along with Proceedings from the consensus conference.

Please submit eligible papers to the AEM editorial office in Lansing at aem@saem.org. Electronic submission of the original and a blinded copy are preferred. Submit also a cover letter clearly indicating that your submission is for the Assuring Quality Consensus Conference. General instructions for authors appear at www.saem.org/ inform/journal.htm.

Any questions regarding this call for papers on the AEM Consensus Conference can be directed to Michelle Biros, MD, at biros001@maroon.tc.umn.edu or Jim Adams, MD, at: jadams@nmh.org.

Nominations are sought for the resident member of the SAEM Board of Directors. The resident Board member is elected to a one-year term and is a full voting member of the Board. The deadline for nominations is February 1, 2002.

Candidates must be a resident during the entire one year term on the Board (May 2002-May 2003) and be a member of SAEM. Candidates should demonstrate evidence of strong interest and commitment to academic emergency medicine. Nominations (preferably sent via e-mail) should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter. Nominations should be sent to saem@saem.org or 901 N. Washington Ave., Lansing, MI 48906. Candidates are encouraged to review the Board of Directors orientation guidelines on the SAEM web site at www.saem.org or from the SAEM office.

The election will be held via mail ballot in the Spring of 2002 and the results will be announced during the Annual Business Meeting in St. Louis.

The resident member of the Board will attend four SAEM Board meetings; in the fall, in the winter, and in the spring (at the 2002 and 2003 SAEM Annual Meetings). The resident member will also participate in monthly Board conference calls.

Call for Nominations

S A E M

Deadline: February 1, 2002

Nominations are sought for the Hal Jayne Academic Excellence Award and the Leadership Award. These awards will be presented during the SAEM Annual Business Meeting in St. Louis. Nominations for honorary membership for those who have made exceptional contributions to emergency medicine are also sought. The Nominating Committee wishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or any SAEM member. Nominations should include a copy of the candidate’s CV and a cover letter describing his/her qualifications.

Nominations can be sent to saem@saem.org or 901 N. Washington Ave., Lansing, MI 48906. The awards and criteria are described below:

Academic Excellence Award

B. Other research publications (e.g., review articles, book chapters, editorials) C. Research support generated through grants and contracts D. Peer-reviewed research presentations E. Honors and awards

The Hal Jayne Academic Excellence Award is presented to a member of SAEM who has made outstanding contributions to emergency medicine through research, education, and scholarly accomplishments. Candidates will be evaluated on their accomplishments in emergency medicine, including: 1. Teaching A. Didactic/Bedside B. Development of new techniques of instruction or instructional materials C. Scholarly works D. Presentations E. Recognition or awards by students, residents, or peers 2. Research and Scholarly Accomplishments A. Original research in peer-reviewed journals

Leadership Award The Leadership Award is presented to a member of SAEM who has demonstrated exceptional leadership in academic emergency medicine. Candidates will be evaluated on their leadership contributions including: 1. Emergency medicine organizations and publications.

2. Emergency medicine academic productivity.

3. Growth of academic emergency medicine.

SAEM • 901 N. Washington Ave., Lansing, MI 48906 • www.saem.org

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Medical Student Virtual Advisor Program Presented Felix Ankel MD SAEM Board of Directors Regions Hospital SAEM's virtual advisor's program was presented at the 26th annual Innovations in Medical Education exhibits in Washington DC, on November 4-6 during the AAMC Annual Meeting. The Virtual Advisor program was developed by the SAEM Undergraduate Education Committee under the direction of Wendy Coates, MD. It electronically pairs EM-interested medical students with volunteer faculty advisors and provides web based resources to them. The virtual advisor program serves over 200 students and 80 faculty since going "live' at the SAEM Annual Meeting in May 2001.

AAMC members, including deans of students and medical student advisors familiarized themselves with SAEM and the Virtual Advisor program during the three day exhibit.

Feedback was positive and many planned to distribute virtual advisor information to their medical students. Others planned to incorporate the general concepts of the virtual advisor program to develop local on-line advising and mentoring systems.

The AAMC medical careers web page for Emergency Medicine www.aamc.org/medcareers/specorgs/emermed.html has a direct link to SAEM's virtual advisor home page www.saem.org/advisor/index.htm.

We anticipate an increased student participation with AAMC meeting publicity.

Please sign up as a virtual advisor at w w w. s a e m . o r g / advisor/advapp.htm to meet this need.

An assessment of the Virtual Advisor program is currently underway.

Both students and faculty who were involved are being asked to evaluate the program and suggest ways to improve it. Results will be shared with SAEM members and the program modified as needed.

Thanks to all of you have volunteered your time.

SAEM Medical Student Educators Interest Group Annual Meeting David Manthey, MD Wake Forest University Douglas Ander, MD Emory University In an effort to better support medical student educators in their endeavor to develop the best Emergency Medicine Rotation, the interest group will offer a 2-hour seminar. This seminar will consist of a panel discussion showcasing various methods for educating, evaluating, and grading medical students. It will be followed by presentations on how to apply for monetary assistance and what resources are already available to make the process easier.

ii) Resources Available (1) Virtual Advisor (2) EMMSE Page (3) Innovative Educational Ideas 2) Business Meeting (1 hour) a) Review of last years activities b) Growth of web site c) Ideas for next year’s educational program. d) Growth of the interest group.

AGENDA: 1) Educational Component ( 2 hours) a) PANEL DISCUSSION AND QUESTION / ANSWER SESSION i) Curriculum development (1) Goals and Objectives (2) Lecture versus Case Series (3) Self-study Modules ii) Evaluation and grading (1) How to evaluate successful completion of your objectives (2) Standardized Grading (3) Test (National versus Individual) b) PRESENTATIONS i) Budget issues (1) What monies are needed (2) How to obtain money from the Medical Schoo/ Department

The date and time of this meeting are to be determined. The speaker’s list will be forthcoming soon. Please feel free to access our site at http://www.saem.org/inform/emmse.htm for more information about this interest group and updated information on this meeting.

All interest groups are invited to submit their proposed interest group meeting agendas for publication in the March/April Newsletter.

The deadline for receipt is February 15.

Electronic submission to saem@saem.org is preferred.

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Medicare Physician Payment Fairness Act Support Below is the text of a letter that was developed by the National Affairs Task Force. The letter was sent to U.S. Senators in late November The Society for Academic Emergency Medicine (SAEM) represents approximately 5500 academic emergency physicians practicing emergency medicine in academic medical centers and teaching hospitals throughout the U.S. SAEM welcomes the opportunity to lend our support to the “Medicare Physician Payment Fairness Act of 2001” (S.1707) that has been introduced by Senator Jim Jeffords and Senator John Breaux. The principles set forth in this Act are essential to ensure that the Emergency Medicine Safety Net remains viable in times of true crisis in our nation’s health care system.

Prior to the events of September 11, emergency departments had been subject to a crisis of nation-wide overcrowding (See Newsweek, September 10, 2001). Emergency department visits continue to rise at a rate of approximately one million visits per year. An expanding population, nursing shortages, hospital closures, and an everincreasing geriatric population have led to a national shortage of hospital beds.

The business model of financial incentives that favor admission of elective patients over emergency admissions have resulted in reduced inpatient capacities for emergency patients and have turned emergency departments into extensions of inpatient and ICU wards. As a result, emergency departments everywhere are filled beyond capacity with admitted patients who are waiting for inpatient beds. Ambulances are asked to divert from one hospital to another due to hospital and ED crowd-

ing. An ever-increasing uninsured population continues to use the emergency departments as the primary source for all levels of care, adding to financial strain. Managed care has made concerted efforts to drive patients away from the emergency department, but these efforts have been ineffective. The Institute of Medicine Report on Errors in Medicine described the emergency department as the “floor” upon which the medical safety net is built. This safety net is in crisis.

Since the events of September 11, Emergency Medicine has been asked to increase its role to combat bioterrorism.

Emergency Medicine provides an integral role in disaster planning and medical care during mass casualty events.

Emergency departments have been flooded with patients asking for testing for anthrax. This is a time when the public is terrorized that they may have a bioterrorist infection, and occupation history taking and careful review of flu like illness is essential to maintain the public trust. The people are turning to their local emergency departments for care. To date, we have been dealing with anthrax, which is not communicable. Imagine the state of readiness that would be needed to combat a communicable disease such as small pox or plague, for which we are preparing today. Hazardous materials training, drills, equipment, and system organization are a top priority for emergency departments and EMS providers everywhere. Emergency medicine organizations provide input and resources in our national response to terrorism. This we

have done gladly, but not without a price in manpower and financial resources.

In the face of this crisis, the Center for Medicare and Medicaid Services has reported that physician payments for the 2002 year will be cut 5.4% across the board. In addition, emergency medicine will receive another 2.6% reduction due to the final year phase-in of the practice expense methodology (a methodology which was flawed from the beginning, and which was opposed by emergency medicine). This totals an 8% reduction in physician payments for Medicare patients in 2002 compared with 2001.

In addition, the nation’s emergency departments must be staffed with highly trained professionals who can meet future terrorist threats and at the same time provide care to over 100 million patient visits per year. In the face of this crisis in our emergency departments, we feel the proposed reduction in payments is unjustified and medically dangerous. Further reductions in Medicare payments will be devastating and will have serious effects on the viability of our nation’s medical safety net. We ask that you support the “Medicare Physician Payment Fairness Act (S. 1707).” This bill will provide some relief from the proposed cuts in physician payments by CMS. It would reduce the across the board cuts from 5.4% to 0.9%. It would also direct MEDPAC to review the practice expense calculation methodology that we believe is flawed.

SAEM thanks you for the opportunity to express our views. We welcome the opportunity to discuss this issue with you at any time.

CORD Best Practices Conference CORD is sponsoring a consensus conference, to be held on March 2-3, 2002 in Washington, DC, to present and discuss "best practice" models in emergency medicine residency education. The conference will highlight models to incorporate the six new ACGME core competencies into educational programs and will also explore "best practices" in other important areas of the emergency medicine residency curriculum. We will focus particularly on topics related to resident evaluation and assessment. The conference will include general discussion sessions as well as small group breakout sessions. We have invited educational leaders from the ACGME and other academic organizations to participate with us. We also plan to publish the results of the conference work in a special issue of Academic Emergency Medicine.

CORD is excited about the potential for emergency medicine, with this consensus conference, to provide a leadership role among the specialties in medicine in developing effective educational models for resident competency. The success of this conference, however, depends largely on the contributions of those in the academic emergency medicine community.

To that end, we invite members of CORD and SAEM to participate in this conference and to share your experience and ideas about these important and timely issues. Please set aside these dates in your calendar to attend this important conference. For more information contact CORD at cord@cordem.org

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Comments on the Development of a Resuscitation Research Consortium The National Heart, Lung, and Blood Institute (NHLBI) is considering establishment of a research consortium to improve clinical resuscitation outcomes from cardiopulmonary and traumatic and posted a Request for Information (RFI) on September 6. SAEM is grateful to Mark G. Angelos, MD, Michelle H. Biros, MS, MD, and Terry Vanden Hoek, MD, for writing the SAEM response that was submitted to NHLBI and is published below.

As the national organization for academic Emergency Medicine, encompassing approximately 5,500 members, the Society for Academic Emergency Medicine (SAEM) aims to improve patient care through the advancement of patient centered research and medical education. Our mission and vision are driven by our roles as emergency clinicians, continuously confronted with patients suffering from life threatening medical and traumatic conditions, including cardiopulmonary and traumatic cardiac arrest. The frustration of ineffective, inefficient and poorly studied but traditional resuscitation interventions have strongly influenced the developing resuscitation research base of our specialty.

Our members are actively involved in many aspects of resuscitation research, including basic science mechanistic studies, evaluation of prehospital EMS systems, and effectiveness of new interventions in the pre-hospital, emergency department and inpatient settings. Our members are also involved in the teaching of CPR to our communities and to hospital staffs, and serve as providers of medical oversight for Emergency Medical Systems and for communities where automated external defibrillators are deployed. We have also provided leadership in a wide range of multidisciplinary efforts geared toward the advancement of acute resuscitation and critical care research, including the development of the Coalition of Acute Resuscitation Researchers, development of the PULSE Workshop, and the Emergency Cardiac Care Committee of the American Heart Association.

SAEM is supportive of the development of a resuscitation research consortium, and provides these suggestions on behalf of the Board of Directors.

Organization, Structure, and Governance of the Consortium Sudden global ischemia, whether resulting from cardiac, hypoxemic or traumatic arrest remains a major challenge for all health care professionals who attempt successful resuscitation of these patients. Mortality is uniformly high, and together these diseases of global ischemia/reperfusion constitute a leading cause of death among children and adults. As emphasized by the recent NIH-sponsored Workshop on

Post-Resuscitative and Initial Utility in Life Saving Efforts (summary report published in Circulation 2001; 103:11821184), over 1,000 fully functioning human lives each day in the United States are cut short and lost as a result of poor cardiopulmonary and trauma resuscitation outcomes. The mortality rate alone for cardiac arrest outside the hospital is well above 90% on average, and over 98% in our largest cities.

Despite the likelihood that there are many common pathophysiologic pathways underlying the cause of death in these patients, the optimal treatment for such global ischemia emergencies is clearly inadequate. There are too few survivors at any one institution each year to critically assess different means of diagnosing underlying pathophysiology and testing new treatments. Thus, a collaborative consortium of clinical centers dedicated to improving survival from cardiac, hypoxemic and traumatic arrest is sorely needed to gather standardized data that will include adequate numbers of survivors. Such a consortium would then facilitate new research and generate hypotheses on the pathogenesis and optimal treatment modalities of sudden global ischemia.

SAEM strongly supports initiatives such as PULSE, which recognize that encouraging resuscitation research will require a multi-agency approach and the promotion of multidisciplinary communications. Our hope would be that governance of a research consortium to improve clinical resuscitation outcomes from cardiopulmonary and traumatic arrest would further the spirit of the PULSE initiative, and will learn from models of clinical consortiums already put in place with the help of the NIH, such as those focusing on cancer, AIDS, and other clinical challenges such as biliary atresia. The objectives of this particular consortium should be to establish and maintain the infrastructure required for accrual of sufficient numbers of patients affected by cardiac and traumatic arrest to do adequately powered clinical studies. As with other consortiums, a number of Clinical Centers and likely Data Coordinating Centers or Data Registries will be necessary to meet this objective.

This consortium should include representation of principal investigators 13

from involved clinical centers and Data Coordinating Centers already responsive to RFA’s regarding resuscitation research and NIH project scientists from each of the agencies involved in the resuscitation consortium (including many if not all of those agencies already involved in the PULSE process).

Governance should also reflect the interdisciplinary input encouraged by the PULSE Workshop, including investigators from the basic, translational, and device development sciences. In addition, given the importance of bystander CPR, representation of the social and educational sciences will be important in determining how to change our current public lack of CPR training. Inclusion of clinical centers will likely change with time, depending on the research question being asked and protocols studied.

Developing, Prioritizing and Implementing Clinical Protocols Development of clinical protocols is closely tied to basic and translational research efforts in the field of resuscitation research. Thus an important aspect of the consortium has to include involvement in these non-clinical research arenas. Communication between clinical investigators, basic science investigators and consortium investigators is critical.

The best forums for this are scientific meetings. Sections of resuscitation research could be fostered within various societies, which interact in this area e.g. the Society for Academic Emergency Medicine, American Heart Association, Society of Critical Care, and the American College of Surgeons.

Additional consensus conferences in the format of the recent PULSE Workshop would allow prioritizing future research directions for the Consortium. NIH involvement in these conferences is critical.

Directed research funding which reflects the specific action items put forth in the PULSE Workshop Summary (Circulation 2001; 103:1182-1184) will be critical. Specific research directions were highlighted in the Pulse Workshop Summary, which can be used to formulate initial priorities. For establishing future priorities, mechanisms that encourage development of translational resuscitation research centers which (continued on next page)

Resuscitation Research Consortium (Continued) focus on multi-center small and large animal resuscitation questions could be quite helpful to the clinical consortium.

Data Management Data Coordinating Centers or National Registries will likely be critical to support the study of clinical resuscitation. Unfortunately, important clinical information including injury severity, time of ischemia (down time), underlying cardiac rhythms or waveform analysis, and treatments attempted is often lost to further analysis as there are few incentives and many challenges to integrate this information into standardized databases. Data which will likely be critical to asking good research questions include cardiac arrest events and outcomes (as recorded according to the Utstein template for both out of hospital and in-hospital cardiac arrests), possibly serum and tissue samples, newly developed biosensor data from cardiac and traumatic arrest patients, and cardiac rhythms as recorded by monitoring equipment or automated external defibrillators (AED’s). Such registries are consistent with the highest priority needs identified by the PULSE Workshop. The executive summary emphasizes the need for national registries on clinical cardiac and trauma research, with an emphasis on the uniformity of pre-hospital data collection and the characterization of injuries, severity, initial management, and outcomes. SAEM applauds efforts such as the American Heart Association in working to establish the National Registry of Cardiopulmonary Resuscitation (NRCPR), designed to collect data on in-hospital resuscitation.

Efforts to continuously improve such databases and facilitate their use by investigators could rapidly accelerate our understanding of what happens during cardiac and traumatic arrest.

Obtaining Consent for Clinical Resuscitation Protocols SAEM recognizes that clinical resuscitation research is unique in that during most resuscitation events, it may be difficult if not impossible to obtain patient consent for participation in research protocols designed to either study the events of global ischemia/reperfusion, or to actually improve the currently poor survival rates. This is an extremely important issue since most research

conducted by any clinical consortium established will have to face this reality.

Clinical research in acute resuscitation by necessity involves critically ill and/ or injured patients. In most circumstances, the patient’s unpredictable and devastating clinical condition will preclude their ability to provide meaningful prospective informed consent for research participation. Additionally, proxy consent from a legally authorized representative is usually not possible, given the sudden onset and rapidly progressing nature of the critical pathology, and the short therapeutic windows of most acute experimental interventions.

In life threatening situations for which current treatment is unproven or unsatisfactory, the individual patient, as well as general medical knowledge, would likely benefit from enrollment into specific resuscitation research protocols, even if prospective consent cannot be obtained.

While SAEM believes it critical to find new ways to improve the care of our patients by improving the currently unacceptable survival rates from sudden global ischemia, we emphasize the foremost imperative that the human rights of these vulnerable patients continue to be safeguarded by strict state and federal research regulations. Under very narrowly prescribed circumstances, prospective informed consent can be waived for emergency resuscitation research (21 CFR Part 50; 45 CFR part 46; Informed Consent and Waiver of Informed Consent Requirements in Certain Emergency Research; Final Rules, Federal Register, Oct 2, 1996; 61(192): 51498-51533).

However, because of the limited research circumstances that qualify for waiver of informed consent, few investigators have experience in developing a reasonable approach to satisfying the conditions of the regulations. Concerns about the public’s reaction to local research efforts that enroll patients without their consent, possible liability for research performed without prospective consent, and a lack of understanding of the regulations themselves have made IRBs reluctant to advance these projects, or unrealistic in their expectations of the investigator’s means of meeting the requirements of the regulations.

These concerns of public reaction and differences in understanding of current Waiver of Consent Requirements have

the potential to become one of the largest obstacles to future resuscitation research in the United States, and thereby delay potentially significant improvement in the care of our patients.

Thus, it will be important for any future clinical resuscitation research consortium that issues of consent be handled with the utmost of clarity, protection of patient rights, and involve continued representation from the public and researchers. This issue also emphasizes the need for public outreach by the clinical consortium to educate the American people to what is at stake.

Any consortium for clinical resuscitation research must therefore include in its infrastructure, a system to ensure proper adherence to existing federal research regulations and provide guidance to investigators and IRBs on appropriate implementation of the regulations. Also needed would be an organized communication to allow feedback for investigators, IRBs and federal regulators about the practical aspects of applying the current regulations in the day-to-day performance of research.

To achieve these ends, the research consortium might develop a panel or committee of experts, available from the start of the planning of a protocol, to suggest and monitor issues of informed consent appropriate to the protocol at hand. This group would be responsible for knowing the regulations, critiquing the methods suggested to meet the requirements of the regulations, and providing surveillance on the implementation of the regulations. In addition, the group would monitor problems encountered with implementing the regulations, determine the impact of the regulations on the performance of resuscitation research, and provide input to federal agencies as they periodically reassess and revise the regulations.

For maximum patient protection, the group would not replace local IRBs, who could evaluate the suitability of a proposed study in terms of the local research and cultural environment.

Instead the group would serve as an advisory body for all IRBs considering the same resuscitation protocol. This in fact would allow a better application of the regulations, in that problems encountered after ethical scrutiny by one IRB could be easily communicated to other IRBs, and thus be addressed more readily. (continued on next page)

14

Resuscitation Research Consortium (Continued) Needed Personnel, Equipment and Supplies To date, there has been little emphasis on research training in resuscitation.

In order to advance the knowledge and care,, it is important to develop training and funding opportunities for future investigators. Fellowship training grants for physicians interested in developing their research skills in the area of resuscitation research will greatly enhance interest and opportunities in this important field. In addition to postdoctoral fellowship programs, physician/scientist training programs will supply support and opportunities for additional training for physicians already working in the field. Areas of study might include public health, epidemiology, working with EMS systems in areas of trauma and cardiac arrest, as well as basic science training in areas pertinent to acute resuscitation.

An important component of research training would include a tracking mechanism of physician-scientists in resuscitation science and outcomes to track their careers including resuscitation funding and new science creation.

Support of basic science is a critical aspect of training and development of independent investigators in the field of resuscitation research. Basic science is able to pose mechanistic questions and use models, which allow a deeper prob-

ing and understanding of acute resuscitation pathophysiology than can be accommodated by clinical studies.

Basic science is critical to the development of future therapies. These efforts fuel new clinical studies.

Initial development of this consortium should include those who interface with the acute resuscitation of these patients. This would include EMS systems personnel and Medical Directors, Emergency Physicians, Traumatologists, Epidemiologists, and the appropriate support staff. It is likely that such a consortium would consist of geographically diverse individuals.

Consequently, regular communication is essential. This could include Internet conferencing, regular investigator meetings as well as NIH sponsorship of follow up conferences to the PULSE Workshop held in June 2000.

Initial consortium setup would involve developing national registries to identify and characterize the problems of acute resuscitation. Such a consortium would involve data accumulation from many sites. This would require the set up and maintenance of secure and reliable communications networks.

Presumably this would involve the Internet. Resources (personnel, communications equipment, computers, etc.) to maintain multiple national registries would be required. This consor-

tium would involve more than a single registry. Both cardiac arrest and trauma are diversely heterogeneous diseases, which can be subdivided into many etiologic subgroups. With sufficient numbers of patients, as a national consortium effort would facilitate, multiple registries directed at the various etiologies of cardiopulmonary arrest can be set up. These registries would form the basis for future study protocols geared towards specific cardiopulmonary arrest etiologies. Institutions and individuals contributing to the registries would most likely be the best study sites for prospective studies.

Other Thoughts Including Cost It is difficult to estimate associated costs. Costs of such a program must include training programs as well as costs to physically set up and maintain the Consortium. A grants mechanism geared towards generating data and collaborating with the consortium would be needed. This would allow institutions to apply on a competitive basis for funding as a benefit of working within the consortium and funding the institutions’ efforts. Additional costs would be incurred in funding of regular investigator meetings and follow up conferences such as the PULSE Workshop.

The Top 5 Most-Frequently-Read Contents of AEM During the Month of October 2001 Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articles archived on AEMJ.org.

1

Electrocardiographic ST-segment Elevation: The Diagnosis of Acute Myocardial Infarction by Morphologic Analysis of the ST Segment William J. Brady, Scott A. Syverud, Charlotte Beagle, et al Acad Emerg Med Oct 01, 2001 8: 961-967. (In "CLINICAL INVESTIGATIONS")

2 3 4 5

A Comprehensive Set of Coded Chief Complaints for the Emergency Department Dominik Aronsky, Diane Kendall, Kathleen Merkley, Brent C. James, Peter J. Haug Acad Emerg Med Oct 01, 2001 8: 980-989. (In "CLINICAL PRACTICE") Post-resuscitative Hypothermic Bypass Reduces Ischemic Brain Injury in Swine Kazuhisa Mori, Yasushi Itoh, Jota Saito, et al Acad Emerg Med Oct 01, 2001 8: 937-945. (In "BASIC INVESTIGATIONS") Dispatcher Assistance and Automated External Defibrillator Performance among Elders Rob Ecker, Thomas D. Rea, Hendrika Meischke, Sheri M. Schaeffer, Peter Kudenchuk, Mickey S. Eisenberg Acad Emerg Med Oct 01, 2001 8: 968-973. (In "CLINICAL INVESTIGATIONS") Faculty Triage Shortens Emergency Department Length of Stay Sirous N. Partovi, Brian K. Nelson, Earl D. Bryan, Matthew J. Walsh Acad Emerg Med Oct 01, 2001 8: 990-995. (In "CLINICAL PRACTICE") 15

Research Funding in Pediatric Emergency Medicine Charles J. Havel, Jr., MD SAEM Research Committee Children’s Hospital of Wisconsin As for Emergency Medicine in general, research in the field of Pediatric Emergency Medicine (PEM) is coming of age. Particularly with respect to clinical projects, the need now exists for larger studies with greater statistical power to support the conclusions and recommendations for the emergency care of children.

This means researchers are needed to carry out more multi-center trials with greater numbers of patients enrolled, a greater number of collaborative efforts, and greater complexity of research questions asked. Thus there is a greater need for larger and larger amounts of funding support. The focus of this article is to identify possible sources for this funding and/or directions in which the inquiring researcher might initially move to acquire such financial underpinning.

Financial support for Pediatric Emergency Medicine can be divided into three general categories of sources.

The first consists of interdisciplinary agencies, such as the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and other local, state, and federal governmental agencies. The second is comprised of organizations sponsoring general Emergency Medicine research, such as the Emergency Medicine Foundation (EMF), Society for Academic Emergency Medicine (SAEM) grants, and the National Emergency Medicine Association Grant Program. Lastly, there are the sources that concern themselves strictly with research in Pediatric medicine or Pediatric Emergency Medicine. This article will concentrate on identifying sources in this third category. More detailed descriptions of the first two categories of funding sources have been or will be covered in other articles in this series prepared by the SAEM Research Committee. However, it is important to emphasize that an application for funding a PEM project in the case of some of these sources may be more favorably received than a more general EM project. Because PEM is a "younger" subspecialty, work in this area may be viewed as more novel and therefore very competitive for some of the larger grants.

The Maternal and Child Health Bureau (MCHB, www.mchb.hrsa.gov)

was initially founded as a federal agency in 1935 by Title V of the Social Security Act. It has grown in scope and mission since that time and currently serves as a federal effort to provide the means to assure the overall health of all mothers and children. Among its many programs are two that may provide options to those seeking financial support for research in Pediatric Emergency Medicine. The first is the MCHB Block Grant that in fiscal year 1999 provided 700 million dollars for research.

Although the Block Grant focuses on projects that primarily deal with primary care issues, injury and violence prevention also is designated specifically as an area of interest and is directly applicable to Pediatric Emergency Medicine research. The second MCHB program of interest to Pediatric Emergency Medicine researchers is Emergency Medical Services for Children (EMS-C, www.ems-c.org). This is a national effort dedicated to improving emergency care to pediatric patients including adolescents. EMS-C goals are to ensure the delivery of state of the art emergency care to pediatric patients, full integration of pediatric services into the EMS system, and provision of the full spectrum of primary, secondary, and tertiary prevention to children and adolescents. EMS-C will provide federal monies not only to fund research, but also sponsors grant-writing workshops for investigators seeking to develop skill in this area and a grants alert web publication to notify investigators of other funding sources of interest (www.emsc.org/funding/framefunding.htm).

The Ambulatory Pediatric Association (APA, www.ambpeds.org) is an organization of academic pediatric health professionals focused on primary care. The stated goal of the APA is to support excellence and innovation in education, research, and health care delivery to pediatric patients. Among the programs that support research is the Young Investigator Grant. Up to $10,000 per project may be awarded to new investigators for research in a number of areas, including Pediatric Emergency Medicine. This grant would be particularly applicable to those in training or junior faculty in the early stages of their research career.

Another academic pediatric organization, the paired American Pediatric Society and the Society for Pediatric Research (APS/SPR, www.aps-spr.org) 16

focuses on facilitating research in a number of areas of Pediatrics. The APS serves to bring together those who are active in advancing the study of children and their diseases. SPR for its part provides encouragement to young investigators involved in research of benefit to children and provides a forum for the exchange of ideas and presentation of work. Together, APS/SPR sponsors the Multi-center Clinical Studies Program that, as its name suggests, funds multicenter clinical trials through seed monies to support these investigations.

In similar fashion, the Pediatric Emergency Medicine Collaborative Research Committee (CRC, www.aap.org/sections/PEM/pemcrc/pe mcrc.htm) functions under the auspices of the American Academy of Pediatrics (www.aap.org). The CRC provides a range of services to individuals engaged primarily in clinical investigations applicable to Pediatric Emergency Medicine (www.aap.org/sections/PEM/ default.HTM). Collaborative proposals are reviewed and recruitment of other centers is facilitated for approved projects. Junior investigators may receive assistance not only developing proposals for collaborative work, but also limited guidance with respect to study design and statistical analysis.

Although not a funding source per se, the CRC will investigate sources of funding for approved studies. Lastly, the CRC reviews nominations and makes the final selection for the Ken Graff Junior Investigators Award (www.aap. org/sections/pem/pemcrc/dlgraff.htm) named to honor a pediatric emergency physician.

A final option not to be overlooked, particularly for junior investigators who may have smaller projects in mind, are sources situated within their local tertiary pediatric referral center. As an example, The Children’s Hospital Foundation of Children’s Hospital of Wisconsin (www.chw.org) carries out a very active research grant program that supports investigations within the Children’s Health System, encompassing a number of different institutions.

Similar opportunities likely exist in other locations and funding may be available particularly if there is an established referral system or some other pre-existing relationship between institutions.

Tales…Opportunity Marcus L. Martin, MD SAEM President University of Virginia

large leaking pulp line. The repair work took place about 30 feet in the air on scaffolds. Around 3:00 am, due to exhaustion, I was relieved of my duties by my boss who had his doctorate degree and was the assistant mill manager. Unfortunately, later at home I heard the sirens of the local rescue squads.

One of the machine operators had accidentally pushed a button that started the pumps delivering hot caustic/pulp material through the large pipeline where the men were working. They were burned and fell 30 feet to the ground, sustaining second and third degree burns and multiple fractures. It was a near miss for me having been in the work area earlier. Fortunately, no one died, but there was extensive morbidity associated with the incident. I later visited my boss in the hospital and developed my first real interest in medicine and later applied to medical school. I was fortunate to become a charter member of Eastern Virginia Medical School entering with 23 other students in 1973.

Being modestly productive academically in college with two majors, carrying 21 hours some semesters, chartering a fraternity and playing football, I am glad I am not competing with today’s medical school applicants. You might say I was a product of affirmative action during the early 1970’s. Yes, an opportunity! My research and production engineering career in the pulp and paper industry ceased. I went on to complete medical school in three years and to obtain training and mentoring in the United States Public Health Service (USPHS) as a commissioned officer and also as a general medical officer in the Indian Health Service in Gallup, New Mexico. I missed an opportunity to obtain a public health masters degree while a member of the USPHS. However, I obtained an outstanding education during my two years of Public Health/Indian Health Service. I also learned tremendously about another culture as I was immersed among members of the Navajo Nation.

I had an opportunity to work in a locum tenens fashion about nine months before entering my residency in Emergency Medicine at Cincinnati. My first opportunity to participate in a national meeting was at the 1981 UAEM meeting in San Antonio where I presented research on phenytoin solubility.

What I missed though was the opportunity for fellowship training. There were not many fellowships during those days. Only a few Emergency Medicine physicians were entering toxicology, EMS, or research fellowships. It has been a joy to see the many more fellowship opportunities in Emergency Medicine develop over the recent years.

Upon completing residency in Emergency Medicine at Cincinnati I went to Allegheny General Hospital in Pittsburgh where I spent 15 years in academic Emergency Medicine. I left Pittsburgh to go to the University of Virginia where I am currently Professor & Chair of Emergency Medicine, another opportunity I am privileged and fortunate to experience. I have appreciated my educational opportunities and work experiences and I encourage physicians considering an academic career in Emergency Medicine to take advantage of the wonderful opportunities available to you to enhance your productivity in research, education, and clinical care. I hope you seize those "times or circumstances favorable to your purpose." It is my pleasure and certainly a distinct opportunity to serve as SAEM President.

A definition of opportunity is a "time or circumstance which is favorable to some purpose." In this tales from the crib (home) I discuss the opportunities provided to me to become an emergency physician. Propitious moments came along for me to enter medical school. I was given the opportunity to enter the field of medicine and embark upon a career which has been quite rewarding. A key link to any successful venture (career, personal relations, business, etc.) is to be given the opportunity to participate.

I grew up in a small mountainous paper mill town with mostly an uneventful childhood. I was drawn to academics and scientific inquiry at an early age. I attended a small all black high school with 40 students in my graduating class. One of my research projects in high school science class was a fermentation experiment using the GAP technique. GAP stood for Grapes, Apples and Potatoes. These were readily available resources in the rural setting. This project was unassigned, unmentored and unsupervised since our science teacher was usually absent from class. Our science teacher was often pulled to go to other schools to teach. There were no controls and my co-investigators and I were probably out of control.

Our experiment took place at one site in the classroom setting.

It was simplified the way NIH likes it. The method included putting GAP in water and sugar, and yeast and an old sock or two into bottles. We were anxious for analysis of results and peer review. Since occasionally caps blew off the bottles (a good sign), we knew we would all be "blinded" if we tried it. The research was evidence-based, adventurous but not the most original. The day before the big homecoming game, after football practice, we tried to transport the results of the research out of a school passageway. I won’t tell you all of the story but I had to rely on blazing speed and quickness that I inherited from my legendary great-grandfather "Roscoe Gone With the Wind" and grandfather "Quick John Willie Show Me the Money Martin." Although considered good quality research by the investigators the results never reached peers for review. Thank goodness! I was really fortunate this adventurous escapade did not end in some other outcome. Prodigiously, I became more involved in traditional high school scientific endeavors, which led to state awards and a scholarship to North Carolina State University. Sadly, however, due to lack of science enrichment and mentoring, many of my classmates did not go to college, an opportunity they missed.

I was fortunate to receive a scholarship through the Department of Forestry at NC State University having a double major in Pulp and Paper Technology and Chemical Engineering, a five year degree program. During my summers, I conducted various studies on the brightness and tensile strength of paper, recycling of waste pulp fibers, development of more efficient bleaching steps and recycling newsprint, the gray colored paper that you see in cereal box liners. After graduation from college, I worked two years as a production engineer in the paper industry before embarking on a medical career.

My decision to pursue a medical career was influenced by a tragic event at work. One weekend late night as the pulp mill production engineer in charge, I supervised the repairs of a

17

ACADEMIC RESIDENT News and Information for Residents Interested in Academic Emergency Medicine Edited by the SAEM GME Committee

An Argument for Professionalism James Adams, MD SAEM Board of Directors Northwestern University Medical School Social values of our current market-driven, financially competitive economy make it difficult for physicians to act without self-interest and remain focused only on patient need.

Because of these circumstances, it is particularly dangerous to take professionalism for granted. At stake is our integrity and, with it, our power. In each preceding modern era, insightful and caring physicians have persevered through their own challenges to professionalism. Now it is our turn.

We must promote honor in order to maintain the trust of the public. It is worthwhile to reflect on our current professional environment and ensure we are proceeding on a successful course. This brief essay is meant to be provocative. It will describe the need for professionalism and question some current assumptions. A case will be made for heightened vigilance.

Professionalism is more than competence.

Professionalism is defined simply as behaviors that place the interests of the patient ahead of one's personal interests.

In practice, this is not so simple. All behaviors and actions related to our physician role are involved, including direct patient care decisions, relationships with the biomedical industry, and relationships with colleagues.

Maintaining professionalism requires more than delivering technically competent care. Physicians are also responsible for maintaining high standards of practice, educating future generations of physicians, providing unbiased scientific and ethical leadership, while ensuring that the interests of patients are promoted.

Why the need for professionalism?

Without professionalism, we are no more than technicians exercising a trade. The difference between a job and a profession is the deference accorded by society, reflected in trust and respect. Because of such deference, professions autonomously set standards of education and performance.

Professions regulate themselves and are accorded special privileges, such as the ability to establish rules of conduct.

Successful professions ensure that members behave according to self-imposed principles. As part of the governing freedoms accorded, the members themselves determine competence, discipline the members, and even select who is allowed to enter.

Some other important skills are not socially constructed as a profession, such as art, music, and writing. Other jobs have prestige because of high standards for education, such as teaching, engineering and architecture, but are limited in professional standing because of high variability surrounding entry, oversight, and performance standards. Notably, as the standards are made consistent and high levels of performance demanded, prestige and influence increase. Medicine 18

has historically been viewed as noble and, therefore, has been granted the most deference. This is true because of the maintenance of rigorous, high expectations of those who practice medicine, along with the practitioners’ devotion to the patient.

It is useful to think about this in comparison to business, manufacturing, and finance. Any person can claim business skills, with or without training. This is the hallmark of our society. Business schools have long struggled to define themselves as a profession, with only partial success. The business schools began to gain professional stature as they elevated entrance and performance standards for their MBA candidates. Even so, the schools maintain that one of the key advantages is the networking opportunities afforded through alumni connections. Business schools struggle with professional identity even as they and their graduates are financially successful.

In medicine, however, there is a clear expectation for professional standards and accountability. Physicians define the practice, set the standards, and control who enters.

Physicians are allowed to do so because of both the technical nature of the field and also because of the unequivocal focus on the good of those served. In business there are no such expectations since the marketplace, capitalistic forces, and the law control behaviors. The goal of business is to generate shareholder return. Maybe medicine is headed this way, moving out of the realm of profession, becoming a business.

We can see some of the problems with the loss of professionalism by the lessons of the legal profession.

Traditionally, doctors, lawyers, and the clergy were the 3 recognized professions. In the law, society has lost some of the benefit associated with high levels of professionalism. The law has unsuccessfully maintained its stature because of the inability or unwillingness to address the nature of the profession and govern behavior. The law believes that justice is best served through rigorous argument, so this limits professional consensus. As an inherently adversarial profession, behaviors are competitive. As competitive behaviors increasingly center on money rather than justice and client-centered principles, the law becomes increasingly disrespected. The law cannot succeed as a business, governed by the marketplace.

The loss of professional integrity means the loss of society’s respect. If attorneys advocate for their own interests, over the interests of individuals or society, honor is lost. To the degree that this has happened, there has been diminished respect and reverence, along with weakening of the profession. Now the law is sometimes disparaged even as lawyers continue to be needed. If medicine allows weakening of professional underpinnings, we will suffer the same fate.

How is professionalism manifested?

Professionalism demands a standard of behavior higher than the marketplace demands, higher than capitalism demands, and higher than law demands. Professionalism requires ethics, honor, integrity, and a service orientation.

Emergency medicine in particular continues to reaffirm such

ideals and promote high standards. Nobody expects this of businesses, but businesses are not accorded the same social status or control that is afforded to the medical profession. If medicine is to preserve and enhance professionalism in order to preserve the trust of society, what does this mean to the individual in practice? How is professionalism manifested in our daily lives? A few examples may begin to help illustrate: Case 1: The Journal of the American Medical Association reviewed a manuscript that reported on a large, multi-center, prospective, randomized trial. The research was apparently well conducted and showed therapeutic benefit of a new drug. The authors were asked to report the contribution that each individual made to the project. The study was funded by the biomedical industry and conducted with the support of the company. The editors of JAMA asked the authors whether there was one person who had unrestricted access to the data and who could vouch for the integrity of the analysis and the results, but who had no conflict of interest. In order to assure absolute integrity of the study, the editor asked if there was any author who had not received compensation from the company that could guarantee the results. There was no such author and the study was not published.

Why did JAMA act this way? The study was good. Yet the editors realized that the journal’s main currency is integrity.

Unless the trust of the public and the practicing physicians is preserved, the journal has little more to offer than an industry publication reporting on science. As a profession, as a holder of public trust, JAMA must hold honesty and the public good in highest regard. It is easy to believe that this is not a big deal. But integrity is fragile. Trust is easily lost. It is essential to remain above suspicion. The highest standards are essential. The editors know all of this and the journal will remain successful because of it.

Case 2: Physicians attended a golf tournament and subsequent dinner that was funded by the biomedical industry.

The representatives of industry were present, but there was no formal discussion of products or prescribing. No requests were made of the physicians.

The physicians received a benefit yet believe that they were not influenced. This is the delusion that allows marketing to be successful. People rarely can be influenced if they are aware of it. Still, the impact of such efforts is easy to project and easy to quantify, even as the involved physicians continue to deny the impact.

Commercials lure with entertainment, comedy, sexuality, and sensuality. The key to success is to disarm and briefly capture the mind. Behavior changes follow, without awareness. Few will admit that television commercials or print ads influence their individual behavior. Yet these create an image, a feeling, an attitude in the subject. These attitudes drive behaviors that positively impact the businesses’ shareholder return.

This is not an argument against industry, by the way.

Businesses only do what contributes to their success.

Further, the biomedical industry is a great strength of our health care system. More money is spent on research by industry than by the National Institutes of Health. Industry has provided some of the most important modern medical breakthroughs. The pressing current concern is not business practices, it is maintenance of physician objectivity. Objectivity will serve the patient best. If we wish to maximize professionalism, we will ensure that our interactions and decisions have little potential bias.

Case 3: The New York Times recently published an article condemning the New York City EMS system for not carrying amiodarone. After all, the article stated, a recent study demonstrated that it improved survival rates of patients in cardiac arrest. This struck fear into some emergency physicians because a standard of care was being promoted. The decision to use amiodarone should not be forced by newspaper articles or industry promotion. The research never demonstrated a survival benefit, but only described a return of spontaneous circulation with out-of-hospital use. High dose epinephrine will also increase rates of return of circulation, but will not increase neurologically intact survivors. High dose epinephrine is not the standard of care for this reason.

Perhaps if the high dose epinephrine data only revealed the rates of spontaneous circulation and if it was also highly profitable, it would be in algorithms. There is no data that support a 1mg dose of epinephrine, after all.

Yet amiodarone is more profitable, so is being promulgated as a standard even though the data do not demonstrate increased rates of neurologically intact survival after out of hospital use. If the drug becomes the standard, no further research demonstrating neurologic recovery will be needed.

One way to promote use is to get lots of attention and influence physicians through publications, symposia, media, "expert" physicians, and aggressive marketing. It will probably work, which means that a little science and a lot of promotion drive changes in care standards rather than a lot of science and objective physician decisions.

This is not the fault of industry, by the way. The manufacturer is doing their job well, which is to provide a return for shareholders. The physicians are the ones with the professional responsibility for medical decision-making. We are the ones challenged to objectively set the standard for the United States public and for our individual patients. The relationship with industry becomes complicated since the fundamental goals are different. If physicians accept financial compensation from industry, we have to worry about subsequent threats to autonomy and professionalism.

Physicians must remain vigilant, independent, and worthy of the public's trust. We must remain independent of undue influence and clearly, even aggressively, establish the proper standards of care. Honest differences of opinion are expected, even encouraged, as the science emerges. If amiodarone proves beneficial, and I hope that it does, physicians should quickly adopt it. Industry should be positively regarded for the support of the science, should be allowed to properly disseminate information about the drug, and be respected for its important role in our health care system. Industry should not, however, be the ones to drive standard of care decisions. This is up to objective medical professionals.

Case 4: A patient presented to a community hospital 1 1/2 hours after the onset of acute left sided weakness. A head CT scan was rapidly ordered, blood tests were ordered, and the patient was rapidly stabilized. The 3 hour window for thrombolytics passed and the drug was not administered. The patient had a dense hemiplegia, was disabled, and sued because thrombolytics were not administered.

There is a lack of evidence that thrombolytics can be safely used in the typical emergency department, under usual conditions, for the treatment of acute stroke. Evidence suggests that it is more dangerous than beneficial unless a rigorous, but resource-intensive system is developed to support its use. This is not currently available in most hospitals.

Despite good evidence that the systems of care in many hos(continued on next page) 19

An Argument for Professionalism

(continued from page 13)

pitals do not support the safe use of thrombolytics, they are still promoted as a standard of care, not always heralded by reason, science, and physician judgment, but by public relations, media, and experts funded by industry. I am unaware of any research paper that has demonstrated the safe use of this agent in usual emergency department conditions. All research has demonstrated dangerous protocol violations and the potential for increased danger to patients. On the other hand, a physician may be able to confidently administer the drug after assessment of risks and benefits. So who should decide? Who is setting the professional standards? Is it industry, the law, or autonomous physicians guided by reason, integrity, balanced assessment of the science and the practical implications? Every physician operates under the illusion that he or she is such a reasoned professional. The equally important question, however, is who is establishing the premise behind the reasoning?

It is not possible to claim that we are not influenced by industry. After all, more stroke patients are harmed from aspiration than could benefit from thrombolytics. We have no aggressive campaigns to increase attention to head positioning and suctioning, though. Technology and industry get more attention than low-tech, but highly beneficial treatments.

Aspiration precautions will not capture the attention of wellmeaning physicians. We all know why. We must then ask who is driving the medical profession, physicians or the biomedical industry? Is industry taking over control of the standards of care, of innovation, of demands for excellence? Are we just along for the ride?

Where will the future lead?

As marketplace incentives continue to hold sway, will physicians subordinate personal financial interests for the sake of objectivity? Will physicians remain outside the realm of marketing in order to remain critically observant? Because of uncertainty, there are many external agencies which would like to regulate physicians because of faltering trust. They will be successful unless physicians maintain, monitor, and model the highest of professional ideals.

A few professional challenges are described in this essay, but only very few.

Some other issues of increasing professional importance include: 1. Behaviors toward colleagues 2. Interactions with patients 3. Honesty, deceptiveness, and shading the truth.

4. Interactions with insurers 5. Documentation and compliance 6. Elimination of bias and prejudice Each of these is complex and worthy of similar provocative discussion. This essay illustrates just a few examples in order to challenge the reader. The trust of the public, preserved through our autonomy, our suspension of self-interest, and our integrity, strengthens us. It is our primary source of influence. Without this, we become a mere trade, a remnant of a profession, and will see our stature fall. As we confront marketplace forces we must reinforce our integrity. We must buttress ourselves. Integrity is easily compromised and hard to restore once lost. Each of us has the duty to protect and preserve the profession. It is an honor to work with colleagues who are models of professionalism. I congratulate you in advance for your ongoing commitment to these principles.

Resident Research: The Basics & Beyond Brian Zink, MD SAEM Board of Directors University of Michigan Scientific investigation is the basis for and foundation of medical practice, including emergency medicine. Although not everything we do is derived from careful scientific inquiry, research has advanced our knowledge and allowed us to help patients in every aspect of care. Consider a typical patient who presents to the ED with a severe headache.

Emergency physicians have studied and given us objective information on everything from the effectiveness of triage by ED nurses for this class of patient,1 the sensitivity and specificity of head CT and lumbar puncture (LP) for diagnosing subarachnoid hemorrhage 2, and the incidence of spinal headache if a LP is performed 3. If the patient turns out to have viral meningitis, emergency medicine investigators have conducted clinical trials on the usefulness of a new antiviral agent, pleconaril, for treatment 4, and basic science EM investigators have just published a study in rats suggesting that Anti-Interleukin-6 antibodies can attenuate inflammation in a model of meningitis.5 The Basics The logical extension of the fact that emergency medicine clinical practice is based on research, is that EM residents should have formal training in the fundamentals of research and how to review and evaluate the scientific literature. The

breadth and depth of EM research training is variable and opinions vary widely amongst EM educators on how research should be taught to resident physicians. In most residency programs research training is accomplished through a combination of didactic presentations on the basics of scientific investigation, participation in journal clubs that evaluate the scientific literature, and involvement in ED clinical projects while working ED shifts. Some residency programs require residents to complete a research project to fulfill the RRC graduation requirement for a scholarly project. The value of mandated resident research has been previously debated, with some questioning the value of forcing a resident who has little enthusiasm for conducting research to do a formal research project. 6,7 The importance of research training for EM residents can be eclipsed by other elements of the curriculum and clinical service commitments. But just as a resident who feels deficient in interpreting ECG’s will correct this deficiency through extracurricular study, or review of ECG’s with a mentor or tutor, so should a resident who is deficient in the basics of research pursue extra training.

A moral and ethical imperative exists for the study of research methodology by emergency medicine residents.

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Our patients obviously count on us to be able to improve care and introduce new treatments or preventive measures. We cannot do this if we are not able to intelligently immerse ourselves in the world of scientific investigation. While this does not mean that we all need to do research, the best EM clinicians understand basic research concepts and how these translate into care at the bedside. Another good reason to study research methodology is to develop the tools to separate marketing propaganda from sound science. The medical marketplace, like other areas of commerce, is teeming with vendors who present information to physicians that is undoubtedly and appropriately biased toward their products.

The only defense for the bombardment of medical advertising is an objective, scientific mind that results from adequate training in research.

In the past the physician has served as an all-knowing repository of medical facts and techniques. Now, the average computer-literate patient can learn almost as much about his or her disease from the Internet (and sometimes more) than the physician knows. The role of the physician is being transformed from holder of information to interpreter and advisor for information. A strong foundation in research is essential for the physician to fill this role. By understanding fundamental research concepts such as hypothesis testing, study design, data collection and interpretation, and the limitations of research, the emergency physician can help patients make decisions about their care.

A number of resources can be used by EM resident physicians to further their knowledge of basic research concepts.

A full accounting is beyond the scope of this article, but here are some suggestions: SAEM has produced a Fundamentals of Research and Advanced Research Series video sets, which are compilations of lectures and handouts on research that were presented by senior investigators at SAEM Annual Meetings. They should be considered essential viewing for all emergency medicine residents. (See the SAEM website at www.saem.org) for information. Academic Emergency Medicine offers in almost every issue articles on research concepts, methodology, and ethics. 8,9 Annals of Emergency Medicine has produced a valuable series of articles on biostatistics and a basic emergency medicine research guide, and frequently publishes articles on theory, design, interpretation of clinical research.10,11 A popular and quite readable book on clinical research that is often recommended by EM faculty is Hulley and Cummins, "Designing Clinical Research" (Williams and Wilkins).

While methodology and analysis receive a lot of attention from those who are training in research, a major area that must not be neglected is research responsibility and the ethical conduct of research. Recent examples of breaches of patient confidentiality, conflict of interest, and failure to properly obtain informed consent have focused national attention on clinical research. An excellent collection of papers, position statements, and recent developments on matters relating to responsible conduct of research can be found at the American Association of Medical Colleges (AAMC) web site at www.aamc.org/research.

Advanced Research Training for Residents Some residents will go beyond the curricular requirements for research and beyond additional reading or study, and desire a hands-on, mentored research training experience during residency. This can be a rewarding way to gain a deeper understanding of research and to assess whether a career that involves original research is appealing. Note that

the term "research training" is used and not "perform research" – the two are not the same. Although a welldesigned research project can be a good vehicle for a resident to learn about research, a meaningful research training experience will be more broad-based. The motivation for and expectations of the research training experience on the part of the resident must be clearly defined prior to starting. There are good and not so good reasons to do research as a resident.

Good Reasons 1. A compelling interest in an area of medicine, and a passion to learn more about this area.

2. A strong desire to develop research skills and knowledge in a mentored environment.

3. Identification of a specific research question that can be answered by a defined, limited study.

4. To assess whether an academic career that involves research is desirable.

Not So Good Reasons 1. To completely answer a major clinical dilemma through research (see reality and logistics below).

2. To publish papers in order to build a strong C.V. and get a good job.

3. To meet an expectation or requirement that "all residents should do research."

Realities and Logistics of Resident Research The excitement and passion that initially drives an EM resident to pursue additional research training almost immediately runs into predictable roadblocks. How the resident fares in negotiating early obstacles is crucial to whether the research training experience will be a positive or negative journey.

Resident research should not be a solitary pursuit.

Having a research mentor to educate, guide, and sometimes console the resident researcher is absolutely essential. As has been noted before, the mentor need not be an academic emergency physician, but may be an expert in the field of interest. 6,7 The resident should look for someone who has a track record of mentoring junior researchers. Often more than one mentor may be necessary. The resident researcher must develop an understanding with the mentor at the onset of the research as to the amount of time, contact, meetings, and skills that will be taught as part of the mentor relationship. The resident must clearly define his or her expectations for the mentor. For example, a senior resident who wants to perform a pilot project on ED asthma prior to writing a fellowship grant, and who plans to pursue an academic research career, is much different than a resident who plans a career as a community emergency physician, and wants to spend a month learning from the mentor how clinical studies are designed and carried out in the ED so that he will better be able to understand the clinical literature. The mentor will take a different approach with these two residents, but must clearly understand their expectations and needs up front.

Once the resident acquires a mentor, the next step is to plan the research training experience. The novice researcher almost always over-estimates what can be accomplished in a defined research training period, and the mentor usually provides needed reality testing and revision. In order to avoid the disappointment that inevitably occurs when a research project is only 10% complete at the end of the research train(continued on next page) 21

ing period, the resident must work closely with the mentor to develop a defined, feasible research project. The steps involved include a careful review of the literature in the area, revision of the general research question down to a specific narrow question, the development of a hypothesis that can be answered by a simple study, and careful planning of the research protocol. If the resident only has a month to perform the research, all of these preliminary steps should be carried out in advance so that the dedicated time can be spent on research, not paperwork. Common snag points as the research is being planned include Institutional Review Board approval for clinical projects and Animal Care approval for laboratory projects. For clinical protocols, working out the logistics of how patients will be identified, recruited and enrolled in the study requires a great deal of time and planning. For laboratory projects, pilot studies or trial experiments are often needed to perfect the model. Often, the mentor has already done the ground work for projects. But even if a research project is teed up for the resident researcher by the mentor, the resident should still study these aspects of planning the investigation, as they are a key part of learning how to do research.

One challenge for a resident who is doing research, is to avoid measuring success by whether or not the project "worked". In many cases the research project proves too difficult to accomplish in the given time frame. Enrollment may be slow, animals may die unexpectedly during a protocol, a database may not be accessible or may not contain the desired information. These setbacks are part of research, and are more common when an investigator is just getting started. Setbacks are also essential to learning how to do research. Just as in the clinical setting we remember and learn more from our mistakes, in research we learn from the things that went wrong and develop ways to avoid these as we move forward. A good mentor can anticipate some of these setbacks and help the junior investigator avoid them.

An even better mentor will let the junior investigator encounter some adversity, and then teach how to reassess, retool, and move forward. Thus, the resident researcher must evaluate a research training experience based on "what I learned," not "what I accomplished."

The Important Role of Emergency Medicine Physician Scientists A resident research experience is valuable simply as a way of increasing a young physician’s knowledge of the world of scientific investigation. It may be even more valuable in helping that physician determine where he or she fits in that world. Career satisfaction can be distilled down to some essential points – it’s nice to be wanted, better to be needed, and those who feel that they are making a difference are the ones who come to work with smiles on their faces. A career as a physician scientist can wonderfully fulfill these key elements for some emergency medicine residents. Clearly, the demand and need to increase the number of physician investigators is a national emphasis, as is the need to improve research training. Funded opportunities for research training for graduating residents are at an all time high. Sources include the SAEM Research Fund grants, the Emergency Medicine Foundation, and a variety of physician research training programs from the National Institutes of Health, many of which focus on patient-oriented research training.

Can well-trained emergency physician-scientists make a difference in the health of our emergency patients? The answer is emphatically yes – from injury prevention and treat22

ment to emergency cardiac care, to asthma, to domestic violence, to public health (to name just a few) emergency medicine investigators have taken a leading role in driving the research that has improved understanding and helped patients. Without their effort, our ability to provide important advances in medical care for ED patients is doomed to stagnate. If the emergency medicine-clinician cannot objectively incorporate information from EM research into practice, this role will be inappropriately delegated to non-EM specialists, such as corporate entities or the legal system to determine our "standard of care".

Thirty years ago there was a great need for trained emergency physicians, and many people helped fulfill this need while developing satisfying career in the field. Now we have a need for more, and better trained emergency physician-scientists. While this path is not for everyone, it can lead to a stimulating, extremely satisfying career. And if enough people take this path, it will become a highway to better health for our emergency patients.

References 1. Wuerz RC, Milne LW, Eitel DR, et al. Reliability and validity of a new five-level triage instrument. Acad Emerg Med, 2000; 7(3):236-242 2. Edlow JA, Wyer PC. How good is a negative cranial computed tomographic scan result in excluding subarachnoid hemorrhage? Ann Emerg Med. 2000;36:507516.

3. Trott SD. Lumbar puncture in the emergency department complications and their costs. (Abstract) Ann Emerg Med. 1999;34(4):S102.

4. Pollack CV. Pleconaril treatment significantly improves outcomes for enteroviral meningitis patients with the most severe disease.(Abstract) Acad Emerg Med.2000:7(5): 5. Marby D, Lockhart GR, Ramond R, et al. Anti-interleukin-6 antibodies attenuate Inflammation in a rat meningitis model. Acad Emerg Med. 2001; 8(10):946949.

6. Biros MA. Reforming a solitary passion. Acad Emerg Med. 2000;7(5):421-424.

7. Zink BJ. Emergency Medicine Research – no more excuses. Newsletter of the Society for Academic Emergency Medicine. 2000;XII(3); 1 8. Lewis LM, Lewis RJ, Younger JG, et al. Research fundamentals: I. Getting from hypothesis to manuscript: an overview of the skills required for success in research.

Acad Emerg Med. 1998;5(9):924-929.

9. Kwiatkowski T, Silverman R. Research fundamentals: II. Choosing and defining a research question. Acad Emerg Med. 1998;5(11):1114-1117.

10. Gaddis ML, Gaddis GM. Introduction to biostatistics: part 1, basic concepts. Ann Emerg Med. 1990;19(1):8689.

11. Whitley TWQ, Spivey WH, Abramson NS, et al. A basic resource guide for emergency medicine research. Ann Emerg Med. 1990; 19(11):1306-1309.

Nominations for the Resident Member of the SAEM Board of Directors are due on February 1, 2002. See details on page 10 of this Newsletter.

Physician Readiness Conference (Continued) opment and manufacture of needed therapies, vaccines and medical supplies; and enhancing the safety of the nation’s food supply and protecting our agriculture from biological threats and attacks. More information may be obtained by accessing (http://www.senate.gov/~frist/). Both ACEP and SAEM both are in support of this important legislation.

Senator Frist entertained a few questions from the conference members; the Emergency Medicine representative commented to Senator Frist that the EM physician community in particular would be on the "front line" to chemical – biological events. It was pointed out that the ED is the "portal of entry" to hospitals and rapid diagnosis, treatment, and appropriate decontamination would be done in the ED for the benefit of the patient as well as for the protection of clinical staff of the rest of the hospital.

The senator received one or two more questions, then excused himself from the meeting to attend related matters.

The senator’s goal in attending this meeting was to obtain letters of support for his important legislation. It may be to both SAEM and ACEP’s interest to ask their members to write Senators Kennedy and Frist office to show an overwhelming level of support from the

Emergency Medicine community.

The various representatives then were each allotted time to describe the activities of their organizations regarding disaster preparation. Of particular interest were comments by Richard A. Levinson, M.D., DPA, and Associate Executive Director of the American Public Health Association. He clearly outlined an agenda of his organization for developing tools for the education of first responders and Emergency Medicine physicians in bio-chem-nuc disaster medical response. He announced a conference to discuss this matter for December 8. ACEP is in the process of making certain appropriate EM representation is arranged for this meeting. Other remarks of interest were made by the AAMC leadership who stated an intention to create a working taskforce containing leadership of the medical community to make recommendations for the long-term goals of educating future physicians in bio-chem-nuc disaster training. It was felt that a national level taskforce was required since the recommendations would be a significant alteration of the present curriculum present in U.S. medical school training.

In addition, the proposed national taskforce would address short-term needs of immediate education of resident

physicians. Emergency Medicine clearly needs to have a major voice in this important national taskforce.

Comments made specifically by the Emergency Medicine Representative General comments were made to the group of the importance of synergy and cooperation to attain the mutual goals of maximizing the nations medical response to potential bio-chem-nuc disasters. It was pointed out that various entities such as ACEP and SAEM have been organizing taskforces over the past few years aimed at the NBC preparedness of 1st responders and physicians. Language was borrowed from Joseph F. Waeckerle, MD, that Emergency Physicians will essentially be "1st responders" given the massive presentation of patients to the ED in the event of a mass disaster. Finally a description of the Nuclear, Biological, and Chemical multiphase training contract was outlined and the need to have the sources to complete the recommended goals set forth by the Final Report dated April 23, 2001. Overall the response to the comments appeared positive – but it is quite clear that most, if not all of the groups represented have their own agendas they would like to see funded.

AAMC Annual Meeting Report (Continued) prospect of 80 hours. The ACGME has not yet decided whether to mandate 80 hours or less to all the RRCs under it by the AAMC will probably have a strong influence. (Does he mean ACGME?) Patient safety and resident education continue to be discussed. The AHRQ director, John Eisenberg, described the need for more research in this area and encouraged grant applications for the next year. The emergency department has traditionally been identified as a high-risk area. The SAEM mini-conference on medical error, which was published in the November issue of AEM, provides an excellent background to this topic.

Continuing concerns about hospital overcrowding, shortages of nurses, medical specialists, and inadequate care for the uninsured fit well with the SAEM presentation on the safety net vulnerability.

The implementation of the HIPAA regulations and the Medicare reimbursement reductions also were discussed in a variety of settings. The AAMC will attempt to work with Congressional supporters to change the proposed activities.

Overall, the meeting covered important topic areas and attempted to relate to the ongoing national crises. Academic medical centers felt that bio-terrorism might lend itself to the research and education capabilities for which they are known.

Emergency medicine should be a leader in those centers where it has developed a research and education program.

Geriatric Emergency Medicine Resident/Fellow Grants Available SAEM, with sponsorship from the John A. Hartford Foundation and the American Geriatric Society, 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 $2,500 for each project.

Applications for the Geriatric Emergency Medicine Resident/Fellow Grant may be obtained from the SAEM office or the website at saem.org.

The deadline for receipt of a complete application at the SAEM office is March 4, 2002 with notification of selections by May 7 and funding awarded by July 1.

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President’s Message (Continued) undergoing a historical transformation in the way health care is organized, delivered, and financed, and academic medicine is headed, without question, toward a future that will be far different from the past."1 "Academic medicine is an industry . . . people want and need well-educated and highly trained physicians, new medical knowledge and high-quality medical care. That’s what our industry makes!" "But no industry, however successful, can expect to go on doing business the same way indefinitely." 1 As we plan for the future, visions for SAEM are not crystal clear but there are some things we should analyze, project and strive to attain. SAEM’s current 5year plan was initiated in 1999. In 2004, (2 short years from now) the 5-year plan will have run its course and the next 5-6 years will take us to 2010.

In reviewing the current SAEM fiveyear goals, we are on track in accomplishing many goals and objectives but there are others that require further pursuit. In research, SAEM supports the development, career longevity and productivity of researchers in Emergency Medicine. We are working to increase federal funding agency awareness of the scientific value and the healthcare impact of Emergency Medicine research. It is our objective to increase the proportion of EM faculty on tenureeligible investigator tracks and to fund 10 SAEM scholarly awards annually.

Although we are on track with supporting the targeted number of scholarly awards, we will need to secure more funding and we will need more time to see measurable increases in the tenureeligible investigator track participation

by Emergency Medicine faculty. In education, SAEM’s goal is to support the development, career longevity and productivity of educators in Emergency Medicine by developing resources that support excellence, and innovation and increase funding for teachers through scholarly sabbaticals. We have initiated scholarly sabbatical awards and will continue to do so. There is opportunity for continued development of resources to support excellence in innovation for teachers. In undergraduate education our goal is to support excellence in Emergency Medicine education for all medical students and develop initiatives that encourage and support students who may be interested in pursuing a career in Emergency Medicine. It is

good to see the Underrepresented Member Mentoring Task Force specifically developing focus groups to research minority students’ interest in Emergency Medicine and to develop a monograph to encourage underrepresented minority students to consider Emergency Medicine as a specialty.

Through SAEM, there are efforts to incorporate Emergency Medicine into the graduate curricula of the majority of medical schools.

We have increased SAEM’s visibility to medical students through our website. Our goal is to support excellence in Emergency Medicine graduate medical education and recommend standards for Emergency Medicine fellowship training and support the development of excellent fellowship training sites. Objectively, SAEM continues to promote quality resident education and promotes activity which helps to meet projected Emergency Medicine workforce needs in academic and community practice. SAEM has established research fellowships and institutional training grants. Our goal is to support the development of new academic departments of Emergency Medicine and strengthen existing academic departments, divisions and sections. A goal is also to recognize and support academic emergency departments which incorporate education and research with the highest level of emergency care. An objective was to complete initial site visits and categorization of 60 potential Level-1 Emergency Departments by 2004. Currently, only one site has been categorized but there are others applying utilizing an improved application process. SAEM offers a consultation service for developing academic emergency departments. An objective is to increase the number of academic Emergency Departments to 100 by 2004, or 75 percent of all American medical schools.

Our goals include promoting national advocacy for universal access to emergency care, the financing of teaching hospital Emergency Departments, and quality health care for all patients.

Through the efforts of our National Affairs Task Force, Public Health Task Force and Board we have pursued these goals vigorously. A goal is to maintain and improve the quality, influence and circulation of Academic Emergency Medicine, SAEM’s peer reviewed journal established in 1994.

AEM is a high quality journal with an ISI citation impact factor of 1.75 as of 1999, a significant increase from the 1998 factor of 1.04 and a notable achievement for such a young journal. The goal is to maintain the quality of the annual meeting through continued innovation, and to develop other SAEM meetings that advance the society’s mission inclusive of regional meetings. Objectively, SAEM would increase the number of scientific presentations that result in publication in peer-reviewed journals, and increase the number of submissions to the annual meeting from funded studies as well as encourage the participation of all Emergency Medicine programs in SAEM regional meetings.

A goal is to improve SAEM’s leadership development to ensure a diverse group of future leaders. Through efforts of the Underrepresented Member Mentoring Task Force’s we believe some of SAEM’s future leaders will evolve.

Further goals include development and enhancement of SAEM’s communications, procedures and staff, and develop financial resources, to provide ongoing funding support for research and faculty development. A major objective written in our 5-year plan is to develop a $5 million SAEM endowment to fund ten scholarly awards annually. The SAEM Research Fund endowment has not reached $5 million yet. A major goal in projecting SAEM 2010, realistically, would be to achieve a $10 million endowment by that time to support the annual research fellowship, institutional training grants, and sabbaticals. It is very important to consider our communications modalities by 2010. By 2010, the current newsletter potentially will become obsolete. Current and new electronic means of communications will become more prominent.

Membership growth has been leveling and will be very much dependent upon further development of academic departments and residency programs.

SAEM staff growth will likely be necessary considering the need for improved public relations, national advocacy activities, communications with the membership, coordination of meetings, and journal activities. It’s my estimation that the current staff is tremendously over-loaded with tons of work including timely production of newsletters and various other communications with the membership. Real estate acquisition may or may not be a concern by 2010. (continued on next page)

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President’s Message (Continued) However, planning should take place starting with a reevaluation of current headquarters including projections for continued maintenance, renovation and estimation of equity by 2010.

Of note, the Association of Academic Chairs of Emergency Medicine has been tracking the number of NIH principal investigator awardees for Emergency Medicine.

Emergency Medicine has not been routinely tracked

by NIH in the past. SAEM should look futuristically at where our organization should be with the number of funded grants, clinician investigator activity, etc.

SAEM should look at the MD/PHD programs at medical schools and consider the possibility of Emergency Medicine research grants geared towards these students.

Regional meetings have grown in numbers and are doing well. There is no indication that significant further growth over the current number of 5 regional meetings will take place between now and 2010. The Annual Meeting has been doing well. However, because the membership will likely not grow tremendously there will probably not be a large increase in number of attendees or abstracts over the next 10 years. The Annual Meeting and benefits offered by SAEM will need to be continuously enhanced for members at all levels including junior and senior level. It’s extremely important that our senior members and previous and current

leaders put forth the greatest effort possible to advance SAEM through all areas of education, research, meetings and development.

Opportunities for increasing interest in Emergency Medicine research could be made more available to medical students, nurses, paramedics, EMTs and other paraprofessionals. SAEM could promote a membership category to the large contingency of EMT/paramedics who are interested in education and research. The opening of membership to other categories has the potential of fostering SAEM’s mission of improved patient care through advances in research and education as well as enhancing academic relationships with a larger segment of the Emergency Medicine community.

With input from the Board, a survey tool was developed with the goal of querying other Council of Academic Society member organizations. Tony Mazzaschi, Director of CAS Affairs, reviewed the survey tool and offered suggestions for revision before distribution. The survey was distributed to other CAS organizations in late November 2001.

The idea is to learn from the other CAS organizations’ missions, operating budgets, modes of communication, products, meeting formats, foundations, endowment funds, staff structure, headquarters, advocacy activities and important services that the organizations pro-

Faculty Development Conference: Navigating the Academic Waters March 2-4, 2002 – 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, presentations 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!

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vide. Information gleaned from the survey will be summarized and shared with the Board and the SAEM membership around March 2002. The SAEM Board will hold a long range planning meeting March 3, 2002. At that time, we will review strategic planning for the SAEM Research Fund, review environmental studies already done by others, consider areas of research emphasized by NIH etc. For the Board long-range planning meeting in March, we have invited a University Director of Corporate and Foundation Relations to provide us an insight into the utility of a development officer, fundraising and gift opportunities for the SAEM Research Fund.

I expect that as the Board analyzes all information available to us we will create a list of projections for 2010 with the idea of developing a working document in progress. I believe it will be the template to develop the next 5-year plan which will replace the current one which ends 2004. I request that you as an SAEM member share your thoughts and visions for the future with me and the Board. You can e-mail your comments to saem@saem.org. Wishing all SAEM members a wonderful New Year!

Reference 1. Cohen JJ. Learning to care for a Healthier Tomorrow. AAMC president’s address presented at the plenary session of the 106th annual meeting, Washington, DC, Oct 27 – Nov 2, 1998.

Password Required to Receive AEM Online SAEM members must now use a password to access their online subscription to Academic Emergency Medicine. All SAEM members are entitled to 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 517-485-5484.

S A E M

2002-2003 SAEM Committee/Task Force Interest Form Deadline: February 1, 2002

Members interested in serving on an SAEM committee or task force in 2002-2003 should submit this form, along with a current curriculum vitae and a cover letter describing relevant experience or other qualifications, and likely contribution to the committee or task force. Completed forms submitted as e-mail attachments to saem@saem.org are preferred, however mail and fax copies are also acceptable. Members are encouraged to review the following materials, available on the home page at www.saem.org or upon request from the SAEM office: 1.

2.

3.

4.

Committee/task force orientation guidelines that detail the role and structure of SAEM's committees and task forces.

Current 2001-2002 committee/task force objectives.

SAEM mission and vision statement, and SAEM's five-year goals and objectives.

The article in the November/December Newsletter by Dr. Lewis, the current SAEM President-elect, regarding the committee/task force member selection process.

The following guidelines should be noted: 1. The completed interest form, CV, and letter must be received by February 1, 2002.

2. SAEM members, even if currently serving on a committee or task force, must submit a complete application to be considered for appointment or reappointment.

3. Due to the relatively small number of committees and task forces, preference will be given to those whose applications are thoughtful and focused.

4. Committee and task force appointments and reappointments will be made by the President-elect by April 15, 2002. The term of appointment is May 2002 to May 2003.

5. Committee and task force members are expected to attend all meetings and actively participate in the committee/task force activities. All committees and task forces meet at the SAEM Annual Meeting and many meet at the ACEP Scientific Assembly.

6. Individuals must be SAEM members to serve on a committee or task force.

7. In general, one resident will be appointed to each committee and task force.

1. Which description best characterizes you? ❒ EM resident, will complete residency in 20____. ❒ Faculty member without previous SAEM committee or task force experience. ❒ Faculty member with previous SAEM committee or task force experience. ❒ Other (e.g. fellow):_________________ 2. Is there a particular committee or task force in which you are interested? ❒ Yes ❒ No If so, which one(s): ______________________________________________________________________________ 3. Is there a particular objective on which you are interested in working? ❒ Yes ❒ No If so, which one(s): ______________________________________________________________________________ 4. What specific objectives or tasks do you think SAEM should pursue in the coming year? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. Have you previously served on an SAEM committee or task force?

If yes, list name of committee/task force and time period served:

❒ Yes ❒ No

________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Name: ____________________________________________________________________________________________ Institution: ________________________________________________________________________________________ E-mail address: ____________________________________________________________________________________ Fax number: ______________________________________________________________________________________ Return to SAEM at 901 N. Washington Ave., Lansing, MI 48906, fax (517) 485-0801, or e-mail at saem@saem.org

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Choosing Members for 2002-2003 Committees and Task Forces: The Selection Process and How to Apply Roger J. Lewis, MD, PhD SAEM President-elect Harbor-UCLA Medical Center In this issue of the SAEM Newsletter, a Committee Interest Form is included, so that all SAEM members may apply for positions on SAEM committees.

SAEM Committees are the "engine" which drives the organization. It is through the work of these committees that the mission of SAEM is advanced, the quality of our Annual Meeting maintained and improved, and in which many of the new ideas which strengthen our organization are developed and nurtured.

Being appointed to an SAEM committee is both an opportunity and a commitment. It is an opportunity to work to improve the world of academic emergency medicine and to influence the direction of the Society as a whole.

Because there are frequently more members who wish to serve on SAEM committees than available committee positions, it is expected that each member applying for a position is prepared to make a significant commitment towards completing the work of the committee.

One should only apply to become a member of an SAEM committee if you are willing and able to commit substantial time and energy.

It is important that potential committee members be aware that the goals and objectives of each committee are not set by the committees themselves, but are guided by the five-year goals and objectives of the Society and defined by the Board of Directors. Thus, committee members must be prepared

to put their efforts towards the completion of predefined goals and objectives.

As outlined below, however, there is significant opportunity to influence the goals and objectives of the committees through feedback to each committee chair or to the Board of Directors directly. The SAEM Board of Directors sets the Goals and Objectives for each committee and task force to help ensure a coordinated set of activities and to reduce duplicative efforts.

How are new Committee members selected? First, each committee chair is asked to evaluate the performance of each current committee member.

Committee members are evaluated in terms of their productivity, work effort, responsiveness to requests, and overall contribution to the function of the committee. Approximately one-third of each committee’s membership is rotated off each year, based on both the chair’s evaluation of each member’s performance, and based on the number of years each member has served on the committee. This rotation is extremely important to ensure that as many SAEM members as possible have an opportunity to participate in the Society’s efforts.

All prospective committee members, whether currently on an SAEM committee or with no prior experience, are required to submit a Committee Interest Form in order to be considered for new appointment or reappointment. The Committee Interest Form should be accompanied both by a current curriculum vitae, as well as a narrative statement outlining the applicant’s motivations for joining the committee, ideas

Newsletter Submissions Welcomed

regarding areas in which they may contribute to the committee, and any other information the applicant deems relevant. In evaluating these applications, the President-elect looks for evidence of enthusiasm, focus, realism, new ideas, and commitment. Applications are generally much stronger if they demonstrate an understanding of SAEM’s mission, the five-year plan for the organization, and the current year’s goals and objectives for the individual committee (this information can be found at the SAEM website at www.saem.org). Please be aware that one-half or more of the goals and objectives for each committee are repeated each year. For example, one can anticipate that an objective for the Program Committee will always be to coordinate the Annual Meeting, to select abstracts for oral and poster presentation, and to select didactic presentations.

Among some SAEM members there is an unfortunate perception that being appointed to an SAEM committee requires being a member of some inner circle. On the contrary, each year the President-elect makes a concerted effort to appoint members who have not previously had an opportunity to serve, as part of an ongoing effort to develop new leadership talent in the Society.

Because the President-elect cannot know all members equally well, the information provided in the narrative statement and curriculum vitae is weighted heavily in the selection process. This helps to ensure fairness, opportunity, and a well-balanced committee and task force membership.

Residency Vacancy Service

David C. Cone, MD Editor, SAEM Newsletter Yale University SAEM invites submissions to the Newsletter pertaining to academic emergency medicine I the following areas: 1) clinical practice; 2) education of EM residents, off-service residents, medical students, and fellows; 3) faculty development; 4) politics and economics as they pertain to the academic environment; 5) general announcements and notices; and 6) other pertinent topics. Materials should be submitted electronically, preferably by e-mail to saem@saem.org. Be sure to include the names and affiliations of authors and a means of contact. All submissions are subject to review and editing. Queries can be sent to the SAEM office or directly to the Editor at david.cone@yale.edu.

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

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

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

FACULTY POSITIONS

University of Cincinnati Medical Center

ALBANY MEDICAL COLLEGE: Emergency Medical Services Fellowship sponsored by the Department of Emergency Medicine. Hands-on experience in EMS practice and management with both ground and air medical agencies.

Medical student, resident and out-of-hospital provider education is emphasized, as is research. Motivated BC/BE emergency physicians interested should send CV to: Deb Funk, MD, EMS Fellowship Director, Albany Medical College, MC-179, 47 New Scotland Ave, Albany, NY 12208 or call (518) 2628800. Affirmative Action/Equal Opportunity Employer.

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.

INDIANA UNIVERSITY SCHOOL OF MEDICINE: Department of Emergency Medicine is recruiting clinician teachers to provide care at the public hospital emergency department located on the medical center campus. Wishard Hospital is a Level I Trauma Center, base for one of the country’s busiest prehospital emergency transport services, and regional burn center. The ED recorded 105,000 visits in 2000. Wishard complements Methodist in providing clinical experiences for IUSM EM residents. Enthusiasm for medical education, facilitation of clinical research, and excitement for patient care in a busy public hospital ED are expectations. Residency training, certification in EM are required. Rank and tenure status are dependent upon interests and qualifications. Apply to Jamie Jones MD (jhjones@iupui.edu) or Rolly McGrath, MD (rmcgrath@iupui.edu), FAX (317) 656-4216. IU is an EEO/AA Employer, M/F/D. LEHIGH VALLEY HOSPITAL: We’re adding two positions to assure triple coverage – one available now and one this summer. Seeking BC/BE EMtrained physicians to join cohesive faculty of 30 BC physicians evaluating 45,000 patients at the main site of 700-bed Lehigh Valley Hospital (Total of 100,000 visits at all three sites.) LVH is academic, tertiary hospital with EM Residency, Level I trauma, 9-bed Burn Center. Member of the prestigious Council of Teaching Hospitals (COTH). Faculty appointment at Penn State/Hershey. Opportunity for resident teaching and clinical research.

Allentown has great public schools, safe neighborhoods, moderate cost of living, 10 colleges and universities, and is 60 miles North of Philadelphia and 80 miles West of Manhattan. Email CV c/o Michael Weinstock MD, Chair EM, to carol.voorhees@lvh.com Fax (610) 402-7014. Phone (610) 402-7008.

Please send Curriculum Vitae to: W. Brian Gibler, MD Chairman, Department of Emergency Medicine University of Cincinnati Medical Center 231 Bethesda Avenue Cincinnati, OH 45267-0769

OHIO STATE UNIVERSITY: Assistant/Associate or Full Professor. Established residency training program. Level 1 Trauma center. Nationally recognized research program. Clinical opportunities at OSU Medical Center and affiliated hospitals. Send curriculum vitae to: Douglas A. Rund, MD, Professor and Chairman, Department of Emergency Medicine, The Ohio State University, 016 Health Sciences Library, 376 W. 10th Avenue, Columbus OH 43210 or call (614) 293-8176. Affirmative Action/Equal Opportunity Employer.

ACADEMIC EMERGENCY MEDICINE

OREGON: The Oregon Health Sciences University Department of Emergency Medicine is conducting an ongoing recruitment of talented entrylevel clinical faculty members at the assistant professor level. Preference is given to those with fellowship training, experience in collaborative clinical research, and writing skills, Please submit a letter of interest, CV, and the names and phone numbers of three references to: Jerris Hedges, MD, MS, Professor & Chair, OHSU Department of Emergency Medicine, 3181 SW Sam. Jackson Park Road, UHN-52, Portland OR 97201-3098.

The University of Washington seeks a physician to join its faculty in the Emergency Medicine Service in the Department of Medicine at the University of Washington Medical Center. This full-time position requires direct patient care, teaching and supervision of medical students and housestaff, and the expectation for engagement in scholarly activities. The applicant must be board certified in emergency medicine.

The successful candidate will be appointed as full-time faculty member; at the rank of assistant or associate professor in the clinician/teacher (patient care/teaching emphasis) pathway, or physician/scientist (research emphasis) pathway. Applicants should submit a curriculum vitae and a statement of career goals to: Terry Mengert, M.D., Emergency Medicine Service, University of Washington Medical Center, Box 356123, Seattle, WA 98195-6123. The University of Washington is building a culturally diverse faculty and strongly encourages applications from female and minority candidates. The University is an Equal Opportunity/Affirmative Action employer. Deadline for inquiries is January 31, 2002.

UNIVERSITY OF CONNECTICUT/HARTFORD HOSPITAL: One year positions in EMS and Research/Administration; available July 2002. Multihospital program with 100,000 ED visits, 30 EM residents, active air/ground EMS service. MPH opportunity. Inquiries: Robert D. Powers MD MPH, Professor & Chief of EM. email: Rpowers@harthosp.org.

UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL: 2 openings for either full-time academically qualified Emergency Medicine, tenure-track physicians or for full-time clinical track physicians at the Clinical Instructor or Clinical Assistant Professor level. Successful tenure-track candidates will be Board Certified/Board Prepared in Emergency Medicine with an interest in clinical cardiology or neurosciences research. Clinical track faculty are expected to do clinical work only. UNC Hospitals is a 665-bed Level I Trauma Center. The Emergency Department sees upward of 40,000 high acuity patients per year, is active in regional EMS, ACLS/ATLS/BTLS education and has an aeromedical service. Send CV to Edward Jackem, MBA, Department of Emergency Medicine, CB #7594, Chapel Hill, NC 27599-7594. (919) 9669500. FAX (919) 966-3049. UNC is an Equal Opportunity/ADA Employer.

Women and minorities are encouraged to apply.

VANDERBILT UNIVERSITY: Research Director - The Department of Emergency Medicine at Vanderbilt University is seeking a research-oriented faculty member for a tenure track position. This position will be customized to meet a junior or senior level faculty members training and experience. This exciting position is based in the Department of Emergency Medicine in collaboration with The Vanderbilt Center for Health Services Research. The individual to be recruited will have completed training in an Emergency

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Medicine Residency Program. He or she should have a strong interest, or record, in an academic career and a desire to focus on outcomes research.

Funding to complete an MPH (if desired) will be provided. This position will have up to 80% protected time and start-up funding for up to 5 years.

Secretarial, research nurse, and statistical support will be provided, along with a premium discretionary research package. Appointments will be commensurate with the individuals level of achievement. Excellent salary and benefits in a great community. Please reply to Corey M. Slovis, M.D., Chairman, Department of Emergency Medicine, Vanderbilt University, Room 703, Oxford House, Nashville, TN 37232-4700, Email: corey.slovis@ mcmail.vanderbilt.edu.

UNIVERSITY OF FLORIDA The College of Medicine is seeking to hire one physician at the rank of Clinical Assistant Professor/Clinical Associate Professor in the Department of Emergency Medicine. This teaching hospital emphasizes active involvement with Emergency Medicine residents and medical students. The position could advance to tenure accruing depending upon qualifications and level of experience. Qualfied applicants will be Board Certified in Emergency Medicine, mature with an academic track record, significant teaching experience and superb administrative/fiscal acumen a plus.

Faculty will provide clinical guidance and supervison of treatment delivered in the ED. A progressive, democratic, superb, 10-person faculty group of team players with emphasis on quality emergency care with dedicated customer service. Shands at UF is the hub of a multihospital network. Emergency Medicine medically directs county EMS and hospital transport including the ShandsCare helicopter. Great compensation, Great benefits package, Great City! Application deadline: 12/30/01; Anticipated start date: 06/01/02. Please send personal statement, CV to Ahamed Idris, MD, Professor and Search Committee Chairperson, Department of Emergency Medicine, University of Florida, 1600 SW Archer Road, P.O. Box 100186, Gainesville, FL 32610-0392. Women and minorities are encouraged to apply. University of Florida is an Affirmative Action Equal Opportunity Employer.

WASHINGTON HOSPITAL CENTER (WHC) and GEORGETOWN UNIVERSITY HOSPITAL (GUH) in Washington, D.C. are seeking physicians board certified or residency trained in emergency medicine to join their faculty. Our Department of Emergency Medicine is both traditional and cutting edge: traditional in that we believe that the provision of medical care is a sacred trust; cutting edge in that we are committed to using the most advanced information technology to improve clinical care. We are seeking physicians who share our common vision, who are willing to work hard, and who want to be part of a very exciting and cohesive group committed to practicing at the leading edge of our specialty. WHC is the largest hospital in the Washington, D.C. metropolitan area. It trains students and residents, operates three helicopters and a critical care ground transport service, is nationally acclaimed for its MedSTAR trauma program, and has one of the nation’s busiest interventional cardiology programs. The Emergency Department has more than 62,000 annual visits and 16,000 annual hospital admissions. GUH is a renowned academic institution in Washington, DC. It is the site of one of the oldest emergency medicine residency training programs in the country. The Emergency Department treats nearly 30,000 adult and pediatric patients. Contact Mark Smith, MD, FACEP, Chairman of Emergency Medicine, at (202) 877-0808, fax (202) 877-2468 or write to him at Washington Hospital Center, Department of Emergency Medicine, 110 Irving Street, NW, Washington, D.C. 20010-2975.

DEPARTMENT OF EMERGENCY MEDICINE MASSACHUSETTS GENERAL HOSPITAL A Teaching Affiliate of Harvard Medical School Academic Emergency Physician Positions

FACULTY POSITION

• Opportunities exist for established academic emergency physicians with a proven track record in clinical or laboratory research and a commitment to excellent clinical care and teaching.

• Academic appointment is at Harvard Medical School.

• MGH is consistently rated among the top 10 in the annual US News and World Report Survey.

• In the year 2000 we had a volume of over 70,000 ED visits.

• We are a Level I Trauma Center for Adults and Pediatrics as well as Burns.

• We are an equal partner in the four-year BWH/HMG Harvard Affiliated Emergency Medicine Residency Program.

• The successful candidate will join 17 full-time academic emergency physicians in an active academic department with a rapidly developing research program.

REQUIREMENTS: • Completion of a four-year residency-training program in emergency medicine, or three-year program, followed by a fellowship or at least one year’s experience.

• Established track record in or strong commitment to academic emergency medicine.

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 an annual volume of 65,000 patient visits. Competitive salary and benefits. Faculty at all academic levels are invited to apply.

Inquiries should be accompanied by a curriculum vitae and may be addressed to:

Please contact:

David F.M. Brown, MD, FACEP, Assoc. Chief Department of Emergency Medicine Massachusetts General Hospital 55 Fruit Street Boston, Massachusetts 02114 e-mail: dbrown2@partners.org

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

Massachusetts General Hospital is an equal opportunity employer.

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FACULTY POSITIONS

University of Cincinnati Medical Center

Department of Emergency Medicine Tufts University School of Medicine Baystate Medical Center Springfield, MA 01199 www.baystatehealth.com

ANNOUNCING

Emergency Medicine Researcher: Seeking an emergency medicine researcher with experience in clinical research and grant writing. The position includes significant protected time; minimal clinical and administrative responsibilities; competitive salary (AAMC Standards) not based on grant support; departmental research staff including a clinical nurse researcher, a data manager, a team of EM research faculty; office space and secretarial support; an academic appointment with Tufts University School of Medicine consistent with experience and publications.

The University of Cincinnati Department of Emergency Medicine has established a second Endowed Chair in Emergency Medicine. We are seeking an established clinician scientist to hold the Endowed

Pediatric Emergency Medicine: Seeking BC/BE physician in Pediatric Emergency Medicine and Emergency Medicine to join a regional trauma center with a fully accredited Emergency Medicine Residency Training Program and a Children’s Hospital. Opportunities include a full unencumbered medical school academic appointment, participation in a Pediatric Emergency Medicine fellowship being developed, and an active clinical research program. You will serve as an attending physician in the Pediatric and Main ED.

DISTINGUISHED CHAIR FOR CLINICAL RESEARCH IN EMERGENCY MEDICINE The University of Cincinnati Department of Emergency Medicine established the first Residency Training Program in Emergency Medicine in 1970. We have a long history of productive research with special emphasis on Cardiovascular, Neurovascular, Toxicology/HBO, and Outcomes investigation. This Endowed Chair offers a special opportunity for an individual to pursue a leadership position in Emergency Medicine.

Baystate Medical Center is a Level 1 Trauma Center, 500-bed hospital with an annual ED census of 98,000 in Western Massachusetts. Baystate Medical Center has a PGY13 emergency medicine residency with 12 residents per year and was recently named one of the top 15 major teaching hospitals in the United Sates for clinical excellence and efficient delivery of care (HCIA and The Health Network).

Springfield is located in the beautiful Connecticut River valley at the foothills of the Berkshires with convenient access to coastal New England, Vermont and metropolitan Boston and New York. The area also supports a rich network of academic institutions including the University of Massachusetts and Amherst, Smith, Hampshire and Mount Holyoke Colleges.

Individuals interested in this opportunity are encouraged to contact: W. Brian Gibler, MD Richard C. Levy Professor of Emergency Medicine Chairman, Department of Emergency Medicine University of Cincinnati College of Medicine 231 Albert Sabin Way Cincinnati, OH 45267-0769 513/558-8086 FAX: 513/558-4599 e-mail: Diane.Shoemaker@uc.edu

Please send your letter of interest with curriculum vitae to: Phil Henneman, MD, Professor and Chair Department of Emergency Medicine Tufts University School of Medicine c/o Don Rainwater, Baystate Medical Center 759 Chestnut Street, S-1578, Springfield, MA 01199 Tel: (800) 767-6612, Fax: (413) 794-5059 E-mail: Don.Rainwater@bhs.org Baystate Health System is an Equal Opportunity Employer

UIC

The University of Illinois College of Medicine at Peoria

Academic Emergency Medicine Faculty Position Peoria, Illinois

Academic Emergency Medicine

Due to expanding faculty coverage, OSF Saint Francis Medical Center is seeking full time Emergency Medicine Residency Trained or Board Certified Emergency physicians to join its 22 member Emergency Medicine Faculty at the University of Illinois College of Medicine at Peoria. OSF Saint Francis Medical Center is a large community teaching hospital, a major affiliate of the University of Illinois College of Medicine at Peoria with over 82,000 total system visits including 61,000 Emergency Department visits. The institution is a Level I Trauma Center, Base Station and resource hospital for EMS and has the busiest aero-medical program, Life Flight (1400 flights annually) in Illinois. We have a total of 24 residents in a 1-2-3 program. This is an exceptional opportunity to be part of an extremely experienced, progressive academic faculty with a top end competitive employee compensation and benefits package.

Academic appointment available at the University of Illinois College of Medicine at Peoria. Peoria is located in Central Illinois in a wonderful, family oriented community. Come help us carry out our mission in providing compassionate, state of the art patient care in a friendly Midwestern environment with abundant recreational opportunities.

For more information contact George Z. Hevesy, MD, FACEP, Director, Emergency Medical Services, Chairman, Department of Emergency Medicine OSF Saint Francis Medical Center, 530 NE Glen Oak Avenue, Peoria, Illinois 61637 or call 309-655-2553, email gzhevesymd@pol.net

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, MSM Department of Emergency Medicine 3525 Southern Blvd., Kettering, OH 45429 Phone: (937) 296-7839 • Fax: (937) 296-4287 email: glenn.hamilton@wright.edu Consideration of applications begins September 15, 2001 and will continue until the positions are filled. Wright State University is an AAEO Employer.

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UNIVERSITY OF FLORIDA College of Medicine, Department of Emergency Medicine is offering a 2-year fellowship in basic science and clinical research. We are seeking a Board Eligible/Board Certified physician, residency trained in Emergency Medicine. We offer courses in an interdisciplinary program in Biomedical Sciences and M.S. in clinical investigation upon successful completion. Our Department has active, cutting-edge multidisciplinary research programs in asthma, ventilation, cardiopulmonary resuscitation, stroke, biomarkers and treatment for oxidant injury, and traumatic brain injury.

Nationally recognized scientists head our research programs. We collaborate with the University of Florida McKnight Brain Institute, a nationally recognized resource and also have international collaborative clinical projects.

We have a fully equipped laboratory and resources for clinical research. Fellows have the opportunity to work with small and large animal models. We offer 80% protected time for research, competitive compensation and benefits, a great working environment, and a great city! Application deadline: February 20, 2002; Anticipated start date: July 1, 20002. Please send a personal statement, Curriculum Vita to Ahamed Idris, MD, Professor and Director of Emergency Medicine Research, Department of Emergency Medicine, University of Florida, P.O. Box 100186, Gainesville, FL 32610-0186. Women and minorities are strongly encouraged to apply.

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FULL-TIME FACULTY ASSISTANT OR ASSOCIATE PROFESSOR LEVEL The Section of Emergency Medicine at Yale University School of Medicine is recruiting full time faculty members at the Assistant or Associate Professor level. Our environment offers: • Academic growth with generous protected time to pursue research and scholarly activities • All clinical practice at Yale-New Haven Hospital, a Level I Trauma Center with over 80,000 ED visits per year • An accredited Emergency Medicine Residency program with 40 residents (PGY-1-4) • An EMS fellowship • Opportunities for collaboration with other faculty in the School of Medicine, School of Public Health and other professional schools in the University Applicants should be residency trained and board certified/qualified in Emergency Medicine. Salary and academic rank is commensurate with experience and accomplishments.

Send letter of interest and Curriculum Vitae to: John A. Schriver, MD Chief, Section of Emergency Medicine Department of Surgery Section of Emergency Medicine 464 Congress Avenue, Suite #260 New Haven, CT 06519-1315 Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women and members of minority groups are encouraged to apply.

Newsletter Advertising

UNIVERSITY OF OTTAWA

The SAEM Newsletter is mailed every other month to the 5,500 members of SAEM. Advertising is limited to fellowship and academic faculty positions. All ads are posted on the SAEM web site at no additional charge.

Clinical Research Faculty Position

Deadline for receipt: March 1 (March/April issue), May 25 (May/June issue), June 15 (July/Aug issue), August 1 (Sept/Oct issue), and October 15 (Nov/Dec issue). Ads received after the deadline can often be inserted on a space available basis.

The Division of Emergency Medicine and the Ottawa Health Research Institute seek an experienced clinical investigator at the Associate or Full Professor level.

Applicants must possess an MSc in Epidemiology or MPH or equivalent, and must have a well-established record of clinical research in emergency medicine. The successful candidate will participate in a world-class research program in the new Centre of Research in Emergency Medicine.

Advertising Rates: Classified Ad (100 words or less) Contact in ad is SAEM member ................$100 Contact in ad non-SAEM member ............$125 1/4 - Page Ad (camera ready) 3.5" wide x 4.75" 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) 4850801 or mail to 901 N. Washington Avenue, Lansing, MI 48906. For more information or questions, call (517) 485-5484 or jmastrovito@saem.org.

For further information contact: Ian G. Stiell, MD, MSc, FRCPC OHRI Chair of Research in Emergency Medicine Ottawa Health Research Institute 1053 Carling Avenue, Room F650 Ottawa, Ontario. CANADA K1Y 4E9 Telephone: (613) 798-5555, ext. 18688 E-mail: istiell@ohri.ca http://www.ohri.ca/profiles/stiell.asp

All ads posted on the SAEM web site at no additional charge.

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Emergency Medicine Foundation Research Grant Program Overview All funding periods are July 1, 2002-June 30, 2003 unless otherwise noted. Contact EMF at 800-798-1822 or www.acep.org.

EMF Career Development Grant Description: A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who needs seed money or release time to begin a promising research project.

Deadline: January 11, 2002 Notification: March 20, 2002 EMF Creativity and Innovation in Emergency Medicine Grant Description: A maximum of $5,000 to support small pilot projects that are new and innovative. It is intended to provide release time or provide equipment and supplies for new investigators or for experienced investigators who have a novel idea.

Deadline: December 12, 2001 Notification: March 20, 2002 EMF Research Fellowship Grant Description: A maximum of $35,000 to emergency medicine residency graduates who will spend another year acquiring specific basic or clinical research skills and further didactic training in research methodology.

Deadline: January 11, 2002 Notification: March 20, 2002 EMF Resident Research Grant Description: A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level.

Deadline: December 12, 2001 Notification: March 20, 2002 Riggs Family/EMF Health Policy Research Grant Description: Between $25,000 and $50,000 for research projects in health policy or health services research topics.

Applicants may apply for up to $50,000 of the funds, for a one- or two-year period. The grants are awarded to researchers in the health policy or health services area, who have the experience to conduct research on critical health policy issues in emergency medicine.

Deadline: December 5, 2001 Notification: March 20, 2002 EMF/FERNE Neurological Emergencies Grant Description: This grant program is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE). The goal of this directed grant program is to fund research based towards acute disorders of the neurological system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 will be awarded in this program annually.

Deadline: January 16, 2001 Notification: March 20, 2002 EMF/SAEM Medical Student Research Grant Description: This grant program is sponsored by EMF and SAEM. A maximum of $2,400 over 3 months for a medical student to encourage research in emergency medicine.

Deadline: January 18, 2002 Notification: March 20, 2002 EMF/SAEM Innovation in Medical Education Research Description: This grant program is sponsored by EMF and SAEM. A maximum of $5,000 to support projects related to educational techniques pertinent to emergency medicine training.

Deadline: November 14, 2001 Notification: March 20, 2002 EMF Directed Research Cardiac Arrest Survival Award Description: This grant program is sponsored by the EMF and Wyeth-Ayerst. The goal of this directed grant program is to fund research proposals specifically targeting research that is designed to improve the outcome of patients who suffer cardiac arrest.

Potential proposals can include basic science, translational or clinical science investigations. A maximum of $100,000 over 2 years (July 1, 2002-June 30, 2004) will be awarded in this program.

Deadline: November 21, 2001 Notification: March 20, 2002 EMF/ENAF Team Grant Description: 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: January 11, 2002 Notification: March 20, 2002 EMF Established Investigator Award Description: A maximum of $50,000 to established researchers.

Deadline: December 19, 2001 Notification: 33

March 20, 2002

S A E M

Call for Abstracts Southeastern Regional SAEM Meeting April 12-14, 2002 Jacksonville, FL

The program committee is now accepting abstracts for oral and poster presentations. Abstracts may be submitted electronically via the SAEM web site at www.saem@saem.org or by email to se.saem@jax.ufl.edu until January 8, 2002. Please use the SAEM submission form http://www.saem.org/meetings/regabst.htm if submitting by email.

There will be oral and poster research presentations, round table discussions with leaders in Academic Emergency Medicine, keynote presentations, and hands on educational sessions including: - difficult airway management / alternative airway devices - resuscitation using an advanced patient simulator - emergency ultrasonography All in a relaxed atmosphere in sight of the Atlantic Ocean!

Registration: medical students and residents are particularly encouraged to attend, and receive a discounted registration fee of $50 (medical students) and $75 (residents). Registration for attending physicians is $110.

To register, contact: Ms. Everlena Owens • phone: (904) 244-4106 • fax: (904) 244-4508 • email everlena.owens@jax.ufl.edu Hotel: Rooms have been reserved at the host hotel, the Sea Turtle Inn http://www.seaturtle.com/ • phone (800) 874-6000 or (904) 249-7402, for $140 – $180 per night. Mention the SE SAEM conference to receive the discounted rates.

Other Activities: Spouses and children are welcome. The beach is the main attraction. Transportation will be provided for those who would like to take a day trip to historic downtown St. Augustine on Saturday.

S A E M

Call for Abstracts 5th Annual SAEM Mid-Atlantic Regional Meeting

Call for Abstracts SAEM Western Regional Research Forum San Diego, CA April 6-7, 2002

April 11 & 12, 2002 First USA Riverfront Arts Center Wilmington, DE

Keynote Speaker: Peter Rosen, MD Location: The beautiful Holiday Inn on the Bay Conference Center overlooking San Diego Harbor Deadline for abstract submission: January 15, 2002.

On-line submission preferred via abstract submission process for national SAEM Annual Meeting at www.saem.org. However abstracts may also be submitted to: dtanen@yahoo.com. All regions invited to submit abstracts.

Highlights include oral and poster presentations, small group sessions where you can bring your research proposals to the experts, IRB issues, what to do if your manuscript is rejected, a medical version of the Weakest Link, and special EM resident and medical student tracks.

Come and enjoy the sun and surf in San Diego!

Hosted by the University of California, San Diego Emergency Medicine Residency For more information contact Stephen R. Hayden, MD, at: shayden@ucsd.edu

Keynote Speakers: Marcus Martin, MD, and Charles Pollack, Jr, MA, MD Special presentation: Joseph Lex, Jr., MD Other highlights: oral paper and poster scientific presentations, renowned speakers, convenient location.

The deadline for abstract submission is February 1, 2002 via the SAEM online abstract submission form at www.saem.org.

Hotel reservations can be made at the Sheraton Suites Hotel in Wilmington, DE and transportation will be provided to the meeting site.

For information contact: Patty McGraw, RN, MS or Brian Burgess, MD, Department of Emergency Medicine, Christiana Care Health Services, 4755 Ogletown-Stanton Road, Room L877, Newark, DE 19718; phone: 302-7334166; fax: 302-733-1625; e-mail: pmcgraw@christianacare.org. The deadline for conference registration is March 8, 2002.

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Call for Nominations SAEM Elected Positions

S A E M

Deadline: February 1, 2002

Nominations are sought for the SAEM elections which will be held in the spring of 2002 via mail or electronic ballot. The Nominating Committee will select a slate of nominees based on the following criteria: previous service to SAEM, leadership potential, interpersonal skills, and the ability to advance the broad interests of the membership and academic emergency medicine.

Interested members are encouraged to review the appropriate SAEM orientation guidelines (Board, Committee/Task Force or President-elect) to consider the responsibilities and expectations of an SAEM elected position. Orientation guidelines are available at www.saem.org or from the SAEM office.

The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more than one nominee for each position. Nominations may be submitted by the candidate or any SAEM member and should include the candidate's CV and a cover letter describing the candidate's qualifications and previous SAEM activities. Nominations are sought for the following positions: President-elect: The President-elect serves one year as President-elect, one year as President, and one year as Past President.

Candidates are usually members of the Board of Directors.

Secretary/Treasurer: The Secretary/Treasurer serves a three-year term on the Board. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces and are usually members of the Board.

Board of Directors: Two members will be elected to three-year terms on the Board. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces.

Resident Board Member: The resident member is elected to a one-year term and is a full voting member of the Board. Candidates must be a resident during the entire term on the Board (May 2002-May 2003) and should demonstrate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of support from the candidate's residency director.

Nominating Committee: One member will be elected to a two-year term. The Nominating Committee selects the recipients of the SAEM awards (Young Investigator, Academic Excellence, and Leadership) and develops the slate of nominees for the elected positions. Candidates should have considerable experience and leadership on SAEM committees and task forces.

Constitution and Bylaws Committee: One member will be elected to a three-year term, the final year as the chair of the Committee. The Committee reviews the Constitution and Bylaws and makes recommendations to the Board for amendments to be considered by the membership. Candidates should have considerable experience and leadership on SAEM committees and task forces.

S A E M

Call for Abstracts 6th Annual New England Regional SAEM Meeting April 3, 2002 Hoagland-Pincus Conference Center Shrewsbury, Massachusetts

Keynote Speaker: Ian Stiell, MD, MSc, FRCPC The Program Committee is now accepting abstracts for review for both oral and poster presentations at the New England Regional SAEM Meeting. The meeting will take place April 3, 2002, 9:00 am-4:00 pm, at the Hoagland-Pincus Conference Center in Shrewsbury, MA; www.umassmed.edu/conferencecenter/ The deadline for abstract submission is Tuesday, January 8, 2002 at 3:00 pm Eastern Time and will be strictly enforced.

Only electronic submission via the SAEM online abstract submission form will be accepted. Go to www.saem.org for more information. Acceptance notifications will be sent in late February 2002.

Send registration forms to: Kathleen Shea, Department of Emergency Medicine Research, 1BMC Place, Dowling 1S - Room #1332, Boston, MA 02118-2393; www.kashea@bmc.org Registration fees: Faculty - $100; Resident/Nurses - $50; EMTs/Students - $25. Late fee after March 20: add $25. Checks payable to Boston Emergency Physicians Fund.

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NEWSLETTER

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

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

Newsletter of the Society for Academic Emergency Medicine Board of Directors Marcus Martin, MD President Roger Lewis, MD, PhD President-Elect Donald Yealy,MD Secretary-Treasurer Brian Zink, MD Past President James Adams, MD Felix Ankel, MD Carey Chisholm, MD Glenn Hamilton, MD Judd Hollander, MD Debra Houry, MD, MPH Susan Stern, 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

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

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

S A E M

Call for Photographs Deadline for receipt: February 15, 2002

Original photographs are invited for presentation at the SAEM 2002 Annual Meeting in St. Louis. Photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data may be submitted. 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 mounted by SAEM and presented in the "Clinical Pearls" session and/or the "Visual Diagnosis" medical student/resident 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) or a digital copy in 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, send an original and a digital image. 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.

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 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 with at least one blank line between sections. The case history MUST be submitted as an email attachment to saem@saem.org. If accepted for display SAEM reserves the right to edit the submitted case history.

Submissions will be selected based on their educational merit, relevance to emergency medicine, quality of the photograph, the case history, and appropriateness for public display. 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. Patients should be appropriately masked. Written consent is required for all submissions except for isolated diagnostic studies such as EKGs, radiographs, gram stains, etc. Written consent and release of responsibility, where necessary, must accompany submissions.

All submissions will be considered for publication in Academic Emergency Medicine. In addition, SAEM reserves the right to post selected images and case histories on the SAEM website for teaching purposes. Submitters will be acknowledged. SAEM will retain the rights to use submitted photographs 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.