January-February 2005

S A E M

Newsletter of the Society for Academic Emergency Medicine January/February 2005 Volume XVII, Number 1

PRESIDENT’S MESSAGE As we close another calendar year, I’d like to provide the membership with a brief update about some of the activities of the Board of Directors (BOD) over the last months of the year.

In October, the BOD had an additional full day meeting in order to work on the organization’s 5 year strategic goals. The BOD reaffirmed the organization’s current mission and vision stateCarey Chisholm, MD ments: Mission Statement: Our mission is to improve patient care by advancing research and education in emergency medicine.

Vision Statement: Our vision is to promote ready access to quality emergency care for all patients, to advance emergency medicine as an academic and clinical discipline, and to maintain the highest professional standards as clinicians, teachers, and researchers.

The strategic goals were organized under a conceptual framework of 5 major themes: research, education, membership services, advocacy and operations. Each theme has an overarching mission/goal, with 3 to 5 objectives and a plan to accomplish each. At this time (the BOD has not yet finalized these) the overall 5 overarching mission/goals are as follows: Research: Improve available knowledge and resulting patient care outcomes through quality investigation.

Education: Expand the breadth and the depth of education in emergency medicine/acute care medicine in US medical schools by EM educators.

Membership services: Maximize the dollar value of SAEM membership.

Advocacy: Advocate for research and education in emergency care within medical schools, funding agencies (governmental and non-governmental) and specialty organizations.

Operations: Assure that an appropriate infrastructure exists to support the activities of SAEM. I look forward to reporting the specific objectives in the next Newsletter. Future BOD’s will use these in setting each year’s specific committee and task force objectives.

In addition, the organization will shortly conduct its first ever survey of the membership. While SAEM’s mission is focused, and the membership represents the largest organization devoted solely to emergency medicine research and education, our resources are finite. Over the years the BOD has had the hardest time making decisions about which

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

Call for Nominations SAEM Elected Positions Deadline: February 7, 2005 Nominations are sought for the SAEM elections which will be held in the spring of 2005. 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 must be submitted electronically to saem@saem.org and 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.

Board of Directors: Two members will be elected to threeyear 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. Candidates must be a resident during the entire term on the Board (May 2005-May 2006) 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: Two members will be elected to two-year terms. The Nominating Committee 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.

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

John G. Wiegenstein, MD 1930-2004

John G. Wiegenstein, MD Photo courtesy of Michigan College of Emergency Physicians

John G. Wiegenstein, MD, one of the founders of the specialty of emergency medicine was killed in a tragic motor vehicle crash in Naples, Florida on October 28, 2004. Dr. Wiegenstein’s major contribution to emergency medicine was to organize emergency physicians in the late 1960’s and early 1970’s into the American College of Emergency Physicians (ACEP), and then help propel the field to a higher level - that of an approved medical specialty.

Born in 1930 in rural Missouri, and raised during the Depression, Dr. Wiegenstein’s schooling was in the St. Louis Preparatory Seminary, a six-year program for those aspiring to priesthood. He eventually decided that he wanted to do something else, and spent a few years finding his calling. He studied engineering, business and economics and enrolled in the military. He finally focused on a career in medicine and graduated from the University of Michigan Medical School in 1960. One of his formative experiences was as a fourth year medical student when he was hired as the nighttime “emergency physician” at Beyer Hospital in Ypsilanti, Michigan.

He did a rotating internship and two additional years of training at Tripler Army Hospital in Hawaii, and then set up a general practice near Lansing, Michigan.

Dr. Wiegenstein, like many general practitioners of the time, was assigned to staff the emergency department (ED) a couple times a month at St. Lawrence Hospital. He enjoyed this work, and became aware that some physicians, like James Mills, Jr. MD in Alexandria, Virginia, had begun to practice full time in ED’s. With a partner, Dr. Wiegenstein formed an emergency medicine group to provide staffing at St. Lawrence

Hospital.

One of his first realizations in his emergency medical practice was the great need for additional training. He took an EMT-type course in Ohio, where he met some government leaders who asked him why there was no national organization for this new breed of physicians. Dr. Wiegenstein believed that a national organization could fill a huge void by providing educational courses for emergency physicians and could strengthen and support emergency medicine practice.

In August 1968, Dr. Wiegenstein and seven other emergency physicians from Michigan met in Lansing and formed the American College of Emergency Physicians. A few months later in November 1968, this group joined twenty-two other physicians at a national meeting in Arlington, Virginia, and ACEP became the national specialty organization for emergency medicine. At this time, only the rudiments of a “specialty” of emergency medicine existed, and it would take a major effort by Dr. Wiegenstein and his colleagues to have emergency medicine officially accepted as a new medical specialty. The field needed to develop an infrastructure and power in medical politics in its move toward legitimacy, and it was in this regard that the talents of John Wiegenstein became so valuable.

Dr. Wiegenstein became the first Chairman (President) of ACEP, and served in this role for three years. Working out of a small office in the basement of the Michigan State Medical Society, he and a small band of colleagues built the organization member by member, state chapter by state chapter. He enlisted the help of the AMA to sponsor the first organizational meeting of ACEP in 1969. He was instrumental in creating the first ACEP Scientific Assemblies, providing the venue and forum for emergency physicians from around the country to gain knowledge in the field and learn how to deal with common problems.

By the early 1970’s, Dr. Wiegenstein and ACEP had a plan to gain specialty status in American medicine. The steps were complex and challenging – establishment of the content and boundaries of the field, establishment of residency training programs, recognition as a Section in the AMA, and then the approval of a specialty Board by the AMA and American Board of Medical Specialties

(ABMS). Dr. Wiegenstein was the prime mover in many of these efforts. Along with the other early emergency medicine leaders, he put together the required components and developed the diplomatic and political skills to negotiate successfully for a specialty of emergency medicine. All the while, he was working more than fifty clinical hours per week as an emergency physician.

Just nine years after the formation of ACEP, emergency medicine was presented to the ABMS for approval as a specialty. However, the initial vote in 1977 was a resounding defeat, and things almost came apart. Many emergency physicians wanted to form an independent Board and proceed with a certifying exam. Dr. Wiegenstein’s skills as a well-prepared diplomat and clever negotiator were instrumental both in appeasing the unrest in emergency medicine and in creating a plan for a modified conjoint Board in emergency medicine. Two years later, in 1979, emergency medicine was approved as the 23rd U.S. medical specialty. A decade later, it would become a primary Board in the ABMS. Dr. Wiegenstein was a founding member of the Board of Directors of the American Board of Emergency Medicine and helped this young organization get started, just as he had done with ACEP. Dr. Wiegenstein created an emergency medicine residency program at St. Lawrence Hospital in 1974.

Although he was more comfortable in the political world of medicine, he realized the need for the academic development of emergency medicine, and was a strong proponent of research. He often recounted in interviews that his primary motivation in organizing emergency medicine as a field was to promote the education of emergency physicians. He enjoyed his role as a teacher and mentor to future emergency physicians. After establishing the Residency Program at Michigan State University in 1973, he became its Director. For over 20 years he shared the principles of emergency medicine with its future practitioners. Dr. Wiegenstein later was appointed department Chairman, and in 1999, Professor Emeritus. From 1977 on he was a member of University Association of Emergency Medical Services and then SAEM. Throughout the formative years of emergency medicine, John G. Wiegen-

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Silent Auction to be Held During 2005 Annual Meeting Contact SAEM to make donations

A Silent Auction will be held during the SAEM Annual Meeting. The purpose of the Auction is to promote awareness and raise funds for the SAEM Research Fund, which supports the SAEM grants program.

SAEM needs the support of the membership to donate items for the Silent Auction. Donations do not have to be large or expensive, but anything that you think someone attending the Annual Meeting may be interested in bidding on in New York. Contributions such as the donation of a time-share in

Colorado, tickets to events, dinners at a local or national restaurant, gift certificates, sports memorabilia, books, etc. are all wonderful items. Please contact SAEM at saem@saem.org to contribute to the Silent Auction. A donation form is also available on the SAEM web site.

Donations will be accepted until May 1, 2005. Donations are tax deductible. All donated items will be posted on the SAEM web site after January 1. The Silent Auction itself will take place during the Annual Meeting in New York City.

Please support the SAEM Research

Fund by contributing items for the Auction, as well as participating in the Auction during the Annual Meeting. The SAEM Research Fund is dedicated to providing professional development grants such as the Research Training Grant, the Institutional Research Training Grant, the Scholarly Sabbatical Grant, and others. SAEM assumes the administrative costs of the Research Fund, so 100% of every contribution goes directly to support the Society’s grant program.

2005 Annual Meeting in New York Judd E. Hollander, MD University of Pennsylvania Chair, 2005 Program Committee The SAEM Program Committee has been working hard to organize the 2005 Annual Meeting in New York City. The meeting is shaping up well and promises to once again have high quality didactic and scientific sessions, along with ample opportunity for networking with your national and international colleagues. Due to the quality of the meeting and the location, this year we anticipate our largest meeting ever.

The SAEM Didactic subcommittee received 68 didactic proposal submissions. The review process was analogous to that used by scientific journals.

Each proposal underwent primary review by a subcommittee. Proposals that fit within the mission of SAEM and were well developed were provisionally accepted or distributed to the full program committee for evaluation. After committee review proposals fell into one of three categories: accept, discussion by the full committee or unable to accept. After face-to-face discussion at ACEP, more than 50 hours of programming have been accepted for presentation at the May 2005 meeting.

The program committee is thrilled to announce some very novel new sessions. State-of-the-Art Sessions feature some cutting edge topics such as Pain in ED Patients with Serious Illness; Knowledge Translation and EM: Bridging the Gap from Evidence to Clinical Practice; and even Space Medicine. A new trio of luncheon sessions focuses on the faculty at different levels of academic stature, including a “Full Profes-

sor: Now What?” session. The research series includes several new lectures including how to utilize large databases, developing qualitative research; and setting up your own clinical research unit. The educational research series that commenced last year is being continued with two more advanced sessions this year. There is an additional focus on health policy and federal research with several sessions that span this theme. Of course, the program continues to include a variety of research and educational sessions, including the medical student and chief resident forums.

One very new session will be simultaneously lighthearted yet intense: a courtroom trial that will place the topic of registry research into trial-like scrutiny.

You, the jury, will ultimately decide which side wins this debate.

As you are reading this Newsletter article each submitted abstract is currently undergoing peer review by approximately 6 abstract reviewers.

Each expert grades each abstract on 9 individual components that are totaled to give a final abstract score that ranges from 0 to 20. An average abstract score is calculated for each abstract. This system ultimately determines which scientific abstracts will be presenting in New York. Because no scoring system is perfect we have several quality checks within the system. Within each category, we review the mean scores for each reviewer to make sure that one category does not contain exceptionally hard 3

or easy reviewers. We review the range of scores within each category and compare that to the study designs submitted within each category to reduce biases for or against a particular type of research. We review a report of all the scores for each individual abstract to try to make certain that an abstract with a single low score did not end up with an average below the cut-point. We review a report of all comments sent in by abstract reviewers to look for data splitting or duplicate submissions. These are just a sample of the reports that we review to make the abstract submission process as valid as possible.

Finally, we are of course beginning to plan the entertainment events. We fully expect to have a lively opening reception, a banquet featuring a cruise around Manhattan, and quite possibly an opportunity to take in a Broadway show and a baseball game. Hopefully we can watch the Yankees get back at the Red Sox, but despite my requests it is not clear that Major League Baseball will accommodate my request to have this series during our meeting. The Development Committee and the Board are also working on putting together a silent auction to raise money for the Research Fund. This event should also add some activity to the meeting.

So…the bottom line is that the annual meeting planning is coming along.

Please put May 22-25 on your schedule requests and come join us in New York.

2003-2004 Academic Emergency Medicine Outstanding Reviewers From July 1 ,2003 to June 30, 2004, Academic Emergency Medicine received 813 manuscripts. Of these, 728 underwent peer review. 235 (29%) were accepted for publication in AEM. This contribution to the medical literature was assisted by our 22 associate editors, whose expertise is broad and encompasses every corner of our specialty. In order to reach their decisions, our associate editors rely on the help of over 400 peer reviewers and 22 statistical reviewers. Our peer reviewers also possess far reaching expertise, and their assistance has helped us maintain the high quality of our journal. Their names are listed in the December, 2004 issue of AEM, and we thank them sincerely for their voluntary efforts to help maintain the quality of the medical literature.

Among these fine professionals are several who have repeatedly stepped up to the plate to assist in our decision making and have provided reviews of consistently excellent quality, demonstrating extreme thoughtfulness, providing very useful constructive suggestions, and who were exceeding timely in the review process. The following individuals have been selected by our associate editors as outstanding reviewers for 2003-2004. They have returned at least three (and often many more) reviews that our decision editors have ranked as among the best. The editors of AEM thank these individuals for their effort and we look forward to working with them, as well as with all of our reviewers, in the future.

2003-2004 Outstanding Peer Reviewers Annette Adams, MPH Amado A. Baez, MD Adrienne Birnbaum, MD Jonathan Burstein, MD Mark Courtney, MD Douglas Flocarre, MD, MPH Michelle Gill, MD Lewis Goldfrank, MD

Jim Niemann, MD Alfred Sacchetti, MD Manish Shah, MD Latha Stead, MD Michael Turturro, MD Henry Wang,MD Scott Wilbur, MD

Gregory Guldner, MD Davis Guss, MD Brian Holroy, MD Gregg Husk, MD Jeff S. Jones, MD Gloria Kuhn, DO, PhD Brooke Lerner, PhD Keith Marill, MD

And from our Editorial Board Jonathan Handler, MD Mark Hauswald, MD Jim Holmes, MD Amy Kaji, MD Jim Miner, MD Terri Schmidt, MD

Call for Submissions Innovations in Emergency Medicine Education Exhibits Deadline: February 22, 2005 The Program Committee is accepting Innovations in Emergency Medicine Education (IEME) Exhibits for consideration of presentation at the 2005 SAEM Annual Meeting, May 22-25, 2005 in New York City.

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 be published in a summer 2005 issue of Academic Emergency Medicine, as well as in the Annual Meeting 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 6 deadline.

The deadline for submission of IEME Exhibit applications is Tuesday, February 22, 2005 at 5:00 pm Eastern Daylight Time. Only online submissions using the form on the SAEM website at www.saem.org will be accepted. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Doug McGee, DO, the National CPC Coordinator is pictured with the 2004 Final CPC Competition winners and runners-up.

Pictured (L-R) Best Discussant Runner-up: Esther Chen, MD, University of Pennsylvania; Best Presenter: Lyn Aborn, MD, Carolinas Medical Center; Dr. McGee; Best Discussant: John Southall, MD, Maine Medical Center; and Best Presenter Runner-up: Jeremiah Schuur, MD, Brown Medical School

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AEM Consensus Conference on Conducting Ethical Resuscitation Research Terri Schmidt, MD Oregon Health & Science University AEM Consensus Conference Planning Committee Academic Emergency Medicine is sponsoring a Consensus Conference to be held in association with the SAEM Annual Meeting in New York City. The Consensus Conference, entitled "Conducting Ethical Resuscitation Research", will be held on Saturday, May 21, 2005. It will focus on questions surrounding the performance of research using the 1996 federal guidelines for performing resuscitation research.

In 1996 the Department of Heath and Human Services (DHHS) and the Food and Drug Administration (FDA) jointly published regulations, known as the Final Rule, for performing studies when obtaining prospective informed consent is impossible because of the patient’s acute medical condition.

(21CFR50.24). These regulations create two new safeguards to protect human subjects: community consultation and community notification. Limited information is known about the effectiveness of the community consultation and notification process. Researchers have raised concerns that the rules hinder their ability to perform resuscitation research. At the same time, questions have been raised about whether the rights of subjects are adequately being protected.

The goal of the conference is to bring together experts and interested parties including representatives from emergency medicine and other organizations, resuscitation researchers, ethicists, representatives from regulatory agencies, industry and public interest groups. This group, with a wide range of interests, will work to develop a consensus on questions related to this topic, including: ● What is empirically known about whether or not the current rules provide adequate protection of subjects

Call for Papers –

in resuscitation research?

What is empirically known about whether or not the current rules create undue barriers to performing important resuscitation research under the current rules? ● What is known about the best methods of community consultation and notification? ● Does the current processes achieve what the rules were meant to achieve? ● Are the current rules too vague? ● Under what specific conditions do the regulations apply? ● What is the definition of life-threatening condition ● How is equipoise determined? ● What level of evidence is required before an intervention can be tested? ● What constitutes effective community consultation and notification? ● Is enough currently known to recommend changes in the current rules? If so, what changes should be recommended? ● What are the future research directions that should be taken to further study the regulations?

The final product of the conference will be a proceedings issue of Academic Emergency Medicine published in November 2005. AEM is currently accepting manuscripts for possible publication in the issue (see below). All members of SAEM and anyone interested in resuscitation research are encouraged to attend. ●

"Research Ethics: Informed Consent and Research without Consent"

Clinical research hinges on the ability of investigators to identify, recruit and enroll human subjects into clinical trials.

The process of informed consent for research participation is designed to protect potential research subjects by educating them about the trial and their rights as participants, allowing them to ask questions regarding the study and their role, and assisting them in making an informed decision about research participation.

There is evidence that even when done under the most controlled clinical circumstances, potential study subjects do not always fully comprehend or even recall the issues presented to them. In the ED, this possibility is even greater because of time pressures to enroll patients when study interventions have narrow therapeutic windows, when patients have language and reading skills discordant with the investigators, and where investigators are often clinicians with competing attention demands.

An additional circumstance, faced by emergency and resuscitation researchers, involves patients who are eligible for enrollment into studies but who cannot provide consent because of their critical clinical condition. Current regulations for waiver of and exception from prospective informed consent are cumbersome and have not often been successfully applied. The methods for fulfilling the requirements of the regulations have not been well defined, and individual IRBs have different levels of comfort in allowing these studies to proceed.

It is also not certain if the patient safeguards built into these regulations, actually provide the protections they were intended to.

The AEM Consensus Conference will be held on May 21, 2005 the day before the SAEM Annual Meeting. It will address issues of informed consent for research participation as it is provided and obtained in the ED, problems arising when informed consent is waived, and challenges when attempting studies with exception from informed consent. It is our hope that the conference will result in recommendations, a research agenda, and a call for action from the emergency research community on how to ensure patient safety as research subjects while providing reasonable and practical guidelines for refining current regulations on waiver of and exception from prospective informed consent.

Original contributions describing relevant research or concepts in this topic area will be considered for publication in the Special Topics issue of AEM, November 2005, if received by March 1, 2005. Proceedings of the conference will also appear in the November Special Topics issue. All submissions will undergo peer review by guest editors with expertise in this area. If you have any questions, please contact Michelle Biros at biros001@umn.edu. Watch the SAEM Newsletter and the AEM and SAEM websites for more information about the Consensus Conference.

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NOTE: SAEM members who wish to be considered for appointment to an SAEM committee in 2005-06 (May 2005-May 2006) must complete the online Committee Interest Form, which can be found on the SAEM web site at www.saem.org. All interested members, whether currently serving on a committee or task force or not currently serving, must complete the Interest Form in order to be considered. The deadline to submit the Interest Form is February 4, 2005.

Individuals must be current members of SAEM in order to serve on a committee or task force.

Contact SAEM at saem@saem.org if you have any questions.

Committee and Task Force Selection Process Begins Glenn C. Hamilton, MD Wright State University SAEM President-elect Most of our annual planning for the 2005-2006 SAEM year, which begins each May, occurs during the winter months. An important component of this is the development of realistic objectives for our committees and assignment of special needs projects to task forces.

The committees have an essential role in determining how well SAEM progresses in our mission each year. The work each year focuses on a number of specific objectives.

Although ultimately assigned by the President-elect, these objectives are developed by soliciting ideas from the entire membership, as well as current and prior committee chairs and members. The Board of Directors reviews these assignments, to assure coordination and resource allocation appropriate to each task.

Task Forces (TF) are unique entities developed by the President-elect in cooperation with the Board of Directors to address a specific focused issue in a timely manner. SAEM relies on task forces to deliver recommendations to the Board or produce a time sensitive product for the organization. A task force usually accomplishes its objectives within one to two years from inception.

Why Should You Become a Committee or Task Force Member? ● You believe in SAEM’s mission statement: “to improve patient care by advancing research and education in emergency medicine”. ● You wish to assist in defining the future practice of your specialty. The academic mission is a special and unique pursuit, critical to the future of our specialty and the patients we serve. We are responsible for training the next generation of EM clinicians and academicians.

We define the future practice of our specialty through the work of our members, both with SAEM activities and at our academic institutions. You have special knowledge/skills or interests in a committee/TF work area.

Sometimes more junior members in the Society are afraid to volunteer because they “lack expertise” in an area. However, if you have the time, are willing to do

the work, and have a passion for that area, you represent exactly what a committee/TF really needs.

How Do I Get Assigned to a Committee/TF? ● First, assess your ability to offer a realistic time commitment. ● Second, review the current committee and task force objectives. Where do your interests and experiences lie? What abilities or perspectives might you contribute? ● Third, everyone who desires appointment MUST complete the Committee/TF Interest Form available online at www.saem.org. This includes currently assigned members as well! Remember committee composition rotates regularly, with approximately one-third of the members turning over each year. This assures that all SAEM members who desire to participate can do so.

While invariably disappointing to some members who are not reassigned, this practice has served SAEM very well over the years and is a critical component of individual member development. Reassignment also is influenced by the chair’s evaluation of an individual’s productivity, timeliness, responsivity and overall contributions. ● Finally, when submitting your interest form, please make a brief statement supporting your committee choice.

SAEM is a large organization, and I unfortunately do not know every member’s skills and talents. While performance record goes a long way for those currently serving, the interest form will be a major factor in appointment decisions for all members.

SAEM’s mission has never been more critical for the lives of our patient population. We are charged with defining the future practice of EM, both clinical practice and academics.

The Committees and Task Forces are central to the mission and goals of the Society. We look forward to your volunteering this year. Please address specific questions about this process to the central office at saem@saem.org.

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SAEM Evidence Based Medicine Online Course February 1-June 1, 2005

The SAEM Evidence Based Interest Group is pleased to offer an on-line, web based, evidence based medicine course. This course is a modification of a previous pilot course. The platform for the course is an interactive state of the art teaching tool that incorporates all the necessary links to pertinent web addresses and teaching aids. Many of the instructors for the New York Academy Evidence Based Medicine course contributed to this course content, and it

is offered in collaboration with the Centre for Health Evidence. The course is designed for junior faculty, but is open to all SAEM members.

Participants will need to have access to a personal computer with internet hookup in order to participate. Exact specifications are listed below. The text book for the course is Users Guide to the Medical Literature and is included in the cost for the course. The cost for this course will be $200 (U.S. funds), and

those interested can register by downloading the form located at www.saem.org/ebm/regform.htm. As space is limited, interested participants are encouraged to sign up early. Paid participants will be added to the course list on a first come first serve basis.

Specific questions regarding this course can be addressed to Dr. Charlene Irvin, the course director at cbi@123.net.

Toxicology in the Great Northwest Shaun D. Carstairs, MD Naval Medical Center This past September brought many toxicologists, pharmacologists, and poison center specialists from North America and the rest of the world to Seattle for the 2004 North American Congress of Clinical Toxicology. As one of two recipients of the 2004 SAEM/ACMT Michael P. Spadafora medical toxicology scholarship, I was fortunate enough to be able to attend as well.

The conference began with the NACCT keynote breakfast, which featured Dr. Bruce Ames. Dr. Ames, a senior scientist at Children’s Hospital Oakland Research Institute, gave an entertaining and informative talk on mitochondrial physiology and its relationship to the process of aging. Dr. Ames lectured the next day on public perception versus actual risk in environmental chemical exposures and cancer (think Erin Brockovich).

Mitochondrial toxicology was also the subject of this year’s ACMT scientific symposium. Dr. Steven Curry gave a concise review of oxidative phosphorylation and metabolic acidosis (which is not an easy thing to do!). This was followed by Dr. Serge Przedborski’s lecture on toxin-induced mitochondrial dysfunction, which included a discussion of MPTP-induced neurodegeneration.

The ABAT symposium tackled the still-simmering topic of ipecac. After an overview by Dr. Anthony Manoguerra of various position statements on the use of ipecac, a spirited case-based discussion began between Dr. Daniel Cobaugh and Dr. Edward Krenzelok on opposite sides of the argument. After an often humorous debate, both sides agreed to disagree upon when and if ipecac should still be used.

A perennial favorite was the meeting

of the Toxicology History Society, which discussed a wide range of topics, including the mass poisoning that occurred at Lake Nyos, Cameroon in 1986 and the history of oleander poisonings. One of the more interesting talks reviewed the history of poisons throughout children’s literature, including the toxic mushrooms of Babar and Alice in Wonderland, as well as poisons in such stories as Snow White and Uncle Shelby’s ABZ Book.

A total of 251 abstracts were selected for oral or poster presentation at this year’s conference. They included a mix of original research and interesting case reports, some of which are summarized below.

Fomepizole for DEG poisoning: Diethylene glycol (DEG) has been implicated in multiple mass poisonings, typically from contaminated pharmaceutical elixirs. Kostic et al. used fomepizole (4MP) for treatment of DEG poisoning in a rat model. They found that while 4-MP mitigated the metabolic acidosis and renal injury associated with DEG poisoning, it actually worsened mortality, suggesting that high-dose 4-MP may itself have inherent toxicity.

Coral snake antivenin for exotic elapid envenomation: Although the coral snake is the only elapid native to North America, envenomations from exotic elapids are becoming more common, and their antivenins may not be readily available. Richardson et al. evaluated coral snake antivenin for the treatment of Naja naja (Indian cobra) and Dendroaspis polylepsis (black mamba) envenomation in a murine model. Animals receiving the antivenin survived significantly longer than those receiving the placebo, but mortality was 7

unchanged.

Poison hunting on eBay®: Many substances that are deemed too dangerous for commercial use are still available to the public. F. Cantrell did a daily search on eBay® for the terms “poison” and “contents”; what he found was concerning. There were 121 products identified, 24 of which contained ingredients rated as “supertoxic,” including strychnine (10), arsenic trioxide (8), cyanide (2), as well as nicotine, pilocarpine, phosphorus, and powdered conium maculatum. Although the actual contents of these items could not be individually verified, the mere possibility that these items can be so easily obtained over the internet is somewhat alarming.

Deadly NAC: Although N-acetylcysteine is generally believed to be a somewhat innocuous antidote for treatment of acetaminophen toxicity, the fact is that it can be deadly in high doses. Bailey et al. describe the case of a 30-month-old girl who was inadvertently given more than 10 times the normal dose of NAC for treatment of acetaminophen overdose.

She developed intractable myoclonus, followed by intracranial hypertension and death. This particular case highlights the pitfalls of medication errors, as well as the fact that, in the words of Paracelsus, “the right dose differentiates a poison and a remedy.”

This represents only a fraction of the interesting items presented and discussed at this year’s NAACT. I am glad to have been given the chance to attend, and would like to thank the American College of Medical Toxicology, SAEM, and Dr. Leslie Dye for awarding me the opportunity to do so.

Call for Medical Student Volunteers The Program Committee for SAEM is soliciting a request for medical students who are interested in working at the 2005 Annual Meeting in New York City on May 22-25. The Program Committee will waive the registration fee for a limited number of medical students willing to assist with some administrative duties. Each medical student will be responsible for coordinating evaluations at assigned didactic sessions during two half days and one luncheon session. The Annual Meeting provides

a unique opportunity for medical students to familiarize themselves with the research and educational interests of emergency medicine. In return the students will receive a complimentary registration fee. Interested medical students should contact the SAEM office at saem@saem.org and include “Medical Student Volunteer for Annual Meeting” in the subject line.

How to Get the Most Out of the SAEM Annual Meeting: Advice and a Guide for Medical Students Kimberly Schertzer Penn State University Susan Farrell, MD Brigham and Women's Hospital David Manthey, MD Wake Forest University SAEM Undergraduate Committee Attending the SAEM Annual Meeting presents a unique opportunity for medical students to experience the broad national aspects of emergency medicine. The meeting lasts for several days in May, and consists of presentations, posters, interactive sessions, business meetings and a medical student symposium.

Consider attending the full day Medical Student Symposium that is held during the SAEM Annual Meeting. The Symposium includes a lunch session that affords the opportunity to talk to Residency Program Directors. In addition, at the conclusion of the day's activities a Residency Fair is held. Last year 69 residency programs attended this fair.

This is a brief discussion of the opportunities, which a student may take advantage of at the SAEM Annual Meeting.

Education – The oral paper presentations and posters represent the most current and nationally recognized emergency medicine research. Attending these sessions is a great opportunity to learn what is new in the field and to get to know the research that is being performed at various academic institutions.

If one is interested in research, the presentations as well as the question and answer sessions which follow, provide unique insight into study design, implementation, and complications, which may be useful in one’s own future research plans.

Networking – The majority of physicians attending SAEM are excited to talk to students. This is an ideal place to strike up informal conversations about

residencies, and clinical practice around the country. If a student has an advisor through the SAEM virtual advisor program, this meeting affords a chance to meet that mentor and have a tangible contact for future questions.

Insight – The business meetings and interest group sessions provide a chance to learn more about the issues pertaining to, and affected by emergency medicine. For example, topics such as overcrowding or physician staffing will be issues of importance to future physicians. These sessions may highlight departments in the nation that are designing or implementing innovative means to solve relevant problems.

Being informed about such national issues may allow one to ask insightful and knowledgeable questions during upcoming interviews. These are the topics that will also be relevant as emergency medicine residents, working daily in the specialty.

Leadership – Attending SAEM offers the opportunity to meet some of the leaders in emergency medicine, and to become involved in activities that may refine one’s own leadership skills.

Medical students may join national committees and contribute to projects in academic emergency medicine.

Morale – SAEM is a forum for meeting people who practice and teach emergency medicine for a living, and who love it. Their enthusiasm is contagious.

Advance preparation can help medical students maximize their meeting experience. This is a brief list of suggestions of preparation activities, which can enhance one’s attendance at the 8

SAEM Annual Meeting.

Identify Residencies – Before attending, one might make a list of residency programs under consideration, and then review the program calendar for presentations, posters, and exhibits by people from those programs. Meeting faculty and residents at poster sessions may be less formal and intimidating than at the applicant interview, and will provide greater insight into the work and interest of a program.

Explore Research – If one has a research or educational interest, reviewing the posters and oral presentations related to that interest may broaden one’s view, and potentially spark ideas for future residency projects.

Review Committees – Committees, task force, interest group, and even Board meetings are open to members.

Medical students might sit in on a meeting to learn about current ideas and topics. Committee, task force and interest group members are happy to share their insights.

Participate in Learning – The photography/visual diagnosis presentation provides a fun opportunity for education.

One can see photos of real patients and test one’s knowledge in this informal, non-pressured display.

Consider Staying Local – If not ready or able to attend the SAEM Annual Meeting, one could consider attending a nearby regional SAEM meeting.

These meetings afford many of the same opportunities on a smaller scale, and almost always include sessions specifically designed for medical students.

SAEM Medical Student Symposium May 21, 2005

The Medical Student Symposium is intended to help medical students understand the residency and career options that exist in emergency medicine, evaluate residency programs, explore research opportunities, and select the right residency. At the completion of the session, participants will: 1) know the characteristics of good emergency physicians and the "right" reasons to seek a career in this specialty, 2) have a better understanding of the application process with regard to letters of recommendation, personal statement, planning the 4th year, etc., 3) consider factors important in determining the appropriate residency, including geographic locations, patient demographics, length of training, etc., 4) understand the composition of an emergency medicine rotation and what to expect while they are rotating in the ED, 5) discuss the skills needed to get the most out of your educational experience in the ED rotation, 6) Identify the standard sources of information in the field of emergency medicine, 7) have an appreciation of various career paths available in Emergency Medicine, including academics, private practice, and fellowship training, and 8) discover current areas of research in Emergency Medicine. To register for the Symposium, use the online Annual Meeting registration form at www.saem.org.

9:00-9:15 9:15-10:00

10:00-10:30

10:45-11:45

11:45-12:15

12:30-2:00 2:00-2:45

2:45-3:30

3:45-4:45

5:00-6:30

Welcome and Introduction, Kevin Rodgers, MD, Indiana University How to Select the Right Residency for You, Cherri Hobgood, MD, University of North Carolina An overview of EM residency programs will be discussed. Important factors to consider in the selection process including length of training, geographical location, patient demographics, and academic vs. clinical setting will be reviewed. The speaker will also discuss the difference between allopathic and osteopathic programs.

Getting Good Advice, Wendy Coates, MD, Harbor One of the keys to any successful career is getting and following good advice. How do you choose the right advisor(s) and use their wisdom to help your succeed? What do you do when your medical school doesn't have an EM Residency Program? What resources are available to you about the various programs?

Navigating the Residency Application Process, Peter DeBlieux, MD, Charity Hospital - Louisiana State University This presentation will provide students with tips on how to prepare their ERAS application, how and when to successfully interview and how to follow-up with top programs.

The Dean's Letter, Brian Zink, MD, University of Michigan The speaker, an emergency physician and Dean, will review with the students the components of the Dean's letter. The importance of your input into the contents of the Dean's letter will be discussed.

Lunch with Program Directors Getting the Most out of Your EM Clerkship,Gus Garmel, MD, Stanford University This session will provide the student with valuable tips for getting the most from your Emergency Department Clerkship. Specific topics to be discussed will include: 1) appropriate educational goals for an emergency medicine rotation; 2) how to best prepare for your rotation in order to make the most of your ED experience; 3) recommended textbooks and references; and 4) important considerations when deciding when and where to do your emergency medicine rotation.

Career Paths and Prospects in Emergency Medicine, Carey Chisholm, MD, Indiana University This session will expose students to a variety of career paths including private practice, academics, and dual training (EM-IM / EM-PEDS) as well as fellowship training.

Breakout Groups Balancing Act - Susan Promes, MD, Duke University and Elizabeth Datner, MD, University of Pennsylvania This session will discuss how to optimize your career and person life.

Financial Planning - David Overton, MD, Michigan State University This session will review practical tips on financial issues. The speaker will address such issues as how to put together a budget and what to so with medical student loan debt.

Optimizing Your Fourth Year - Doug Ander, MD, Emory University This session will provide students with recommendations for making the most of their senior year including information about EM and other electives, research experience, and when to take their Boards exams.

Medical Schools without EM Residencies – Kevin Rodgers, MD, Indiana University This Q&A session will help guide medical students from medical schools without EM residencies through the complicated maze that leads to a residency and career in EM. It will specifically address how this process differs from those students with a EM residency at their medical school.

Residency Fair and Reception All osteopathic EM residency programs are invited to exhibit and should contact Jennifer@saem.org to register.

Last year residency programs participated in the Residency Fair.

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Medical Student Interest Groups Grant Recipients Selected Clif Callaway, MD, PhD University of Pittsburgh Chair, SAEM Grants Committee SAEM has selected eight recipients for the Medical Student Interest Group Grant. The grants provide $500 to each institution for activities to assist in the development and activities of interest groups for medical students who are interests in a career in emergency medicine. The Grants Committee received 19 applications for this award. All applications were reviewed for their educational focus, likely impact, and feasibility. All applicants are medical students who have solicited the guidance of a faculty sponsor. Congratulations to this year's recipients:

Yoheved Rose plans to train members of their interest group to act as standardized emergency patients. These standardized patients will participate in the training of emergency medicine residents, thereby improving education on several levels.

Jefferson Medical College students Michelle Price and Kristopher Lyon proposed an Ultrasound Training Clinic for Medical Students. This experience will be offered to first and second year medical students.

For the second year, SAEM will help to support a team of students at the University of California, Irvine who are organizing the Southern California Emergency Medicine Student Workshop Symposium. The second meeting is planned for Spring 2005, and has several sponsors. It provides a forum for medical students to attend simulations, workshops and present research.

The Medical College of Georgia proposed a series of emergency care lectures, skills labs, and orientations for preclinical students. The students Elizabeth Mendell and Elga Tinger developed a detailed series of lunch-time lectures and tours for first and second year students.

New York University-Bellevue student

A team of students at the University of Buffalo will create an interactive DVD that teaches advanced airway skills.

This project will address the need for specific training for the large numbers of students passing from second to third year.

University of California, San Francisco students Jon Rosenson and Carina Baird have developed a structured cadaver workshop that will allow third and fourth year students to perform ultrasound and advanced procedures.

Benjamin Bassin at the University of Michigan proposed a series of Wilderness Medicine training activities. Students in all four years of training have a role in organizing didactic and expedition experiences focusing on environmental problems.

University of South Alabama students Brett Miller and Saba Rizvi developed a five day program for second year students. This program, “Total Immersion in Emergency Medicine,” presents a series of two to three hour evenings, highlighting the procedures and practice of emergency medicine. The program is likely to provide broader exposure to the specialty than normally encountered in the medical school curriculum.

SAEM receives a consistently high number of applications from medical student interest groups, and the selection of awardees remains challenging.

Over the past few years, SAEM has been able to provide support for more programs thanks to the contributions to the Research Fund. We are certain that these programs will help foster the continued growth of our specialty.

Dr. Wiegenstein…(continued from page 2) stein was a fixture as a calm, collected leader. He was a master at analyzing the processes, reacting to roadblocks, and making the right decisions. Tall and white-haired, he was a humble, nonassuming man but projected the air of a statesman. He knew how to temper and cajole those in emergency medicine who were a bit too radical, and how to inspire those who needed someone to follow. Dr. Wiegenstein remained active in ACEP, and current leaders frequently sought his sage advice. He encouraged emergency physicians to excel in patient care, teaching and in advancing the specialty. He was a vigorous man who did not easily slide in to retirement.

At the time of his death, he was planning to become licensed in Florida to resume practice.

John G. Wiegenstein was one of the heroes of emergency medicine. He

became a leader out of his desire to improve emergency medical practice and education. He worked incredibly hard and sacrificed some of his own career interests and development in order to move emergency medicine to a legitimate place in American medicine.

ACEP’s John G. Wiegenstein Leadership Award was created in his honor in 1975. Dr. Wiegenstein received the AMA’s Distinguished Service Award, the association’s highest honor, in 2001. He has been recognized by his medical school, and other medical organizations with achievement awards. Along his journey, Dr. Wiegenstein inspired legions of young emergency physicians, and acquired a group of close friends and acquaintances who now feel a great sense of shock and loss with his sudden death. But the legacy of John G. Wiegenstein can be seen in the thou10

sands of emergency physicians who attend the ACEP Scientific Assembly each year to learn about the new developments in their field, the thousand or more graduating emergency medicine residents each year who will sit for their Boards in emergency medicine, and the millions of emergency department patients whose care has been improved. The best thing that academic emergency physicians can do to honor and pay tribute to Dr. Wiegenstein is to work as hard as he did to promote excellence in the education of emergency physicians.

Robert W. Schafermeyer, MD Carolinas Medical Center Brian J. Zink, MD University of Michigan

Chief Resident Forum May 24, 2005 Chief residency is a demanding and highly responsible position, however little formal and structure preparation is available prior to becoming a chief resident. New chief residents typically have not had the benefit of training in essential administrative, academic, and leadership skills. This one-day course will include a variety of sessions covering administrative and academic topics relevant to new chief residents. Talks and small group discussions will be led by experienced program directors and past chief residents. All sessions will include ample time for questions. In addition, a lunch session and coffee breaks will provide opportunities for chiefs from different programs to meet and exchange ideas. The small group discussion sessions will also allow for interaction with workshop faculty and former chief residents.

At the completion of this course, participants will be able to understand basic characteristics of good leadership, management techniques, administration and problem solving concepts; have learned successful scheduling and back-up techniques; become aware of common pitfalls faced by chief residents; learned effective communication techniques; had the opportunity to discuss potential ethical dilemmas that may arise during the chief resident year; and learned time management techniques.

All chief residents registered to attend the Annual Meeting are invited to register for the special Chief Resident Forum. Enrollment is limited and the fee is $100, in addition to the basic Annual Meeting registration fee. Use the online Annual Meeting registration form to register for the Annual Meeting and the Chief Resident Forum.

7:30-8:00 am

Registration and Continental Breakfast

8:00-8:45 am

So You’re Chief Resident. What Does that Mean?, Stephen Playe, MD, Baystate Medical Center This session will explain the various roles and requirements of chief residents.

8:45-9:45 am

Leadership and the Management Role, Robert Hockberger, MD, Harbor UCLA Medical Center This session will describe the scope of authority and responsibility in your role and explain leadership theories focusing particularly on action-centered leadership.

9:45-10:00 am

Break

10:00-11:00 am

Effective Communication, Marc Borenstein, MD, Newark Beth Israel Medical Center Communication is a key element to the success of any leader. At the end of this discussion, participants will understand how to build effective communication networks, identify the key communication skills required to manage staff, explain formal and informal communication networks, facilitative questioning, active listening, and describe the principles of giving and receiving feedback.

11:00-12:00 noon

Developing a Schedule, Kevin Rogers, MD, University of Indiana (moderator) The emergency department schedule is a central element of any chief resident’s responsibility. This discussion will outline the RRC requirements for scheduling in EM, suggest tips for managing the complexities of an ED work schedule and explain mechanisms for dealing with sudden changes.

12:00-1:30 pm

Lunch - Question and answer session

1:30-2:15 pm

Professional Growth, Sandra Schneider, MD, University of Rochester This session will illustrate strategies for successful career development, describe various routes to advancement and describe the challenges and barriers to promotion.

2:15-3:00 pm

Ethics and Professionalism, James Adams, MD, Northwestern University As chief resident, you may confront a new series of ethical dilemmas. This session will highlight ethical and confidential issues that involve other residents and describe how to set professional examples for others.

3:00-3:45 pm

Time Management, Susan Promes, MD, Duke University At the end of this session, participants will understand what you can realistically achieve with your time, recognize the importance of prioritizing To-Do lists and describe time management principles that can help you in your role as chief resident.

3:45-5:00 pm

Lessons Learned - Panel discussion of former chief residents

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Call for Photographs Deadline: February 18, 2005 Original photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data are invited for presentation at the 2005 SAEM Annual Meeting in New York City. 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) and a digital copy in JPEG or TIFF format on a disk or by email attachment (resolution of at least 640 x 48).

Radiographs and EKGs should also be submitted in hard copy and digital format. Do not send X-rays. 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 brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding, 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.”

The case history must be submitted on the template posted on the SAEM website at www.saem.org and must be submitted electronically. The case history is limited to no more than 250 words. 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 Annual Meeting. Academic Emergency Medicine (AEM), the official SAEM journal, may invite a limited number of displayed photos to be submitted to AEM for consideration of publication. SAEM will retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

Photographs must not appear in a refereed journal prior to the Annual Meeting. Patients should be appropriately masked.

Submitters must attest that written consent and release of responsibility have been obtained for all photos EXCEPT for isolated diagnostic studies such as EKGs, radiographs, gram stains, etc.

Board of Directors Update The SAEM Board of Directors meets monthly usually by conference call.

This report includes the highlights from the October 17 and October 18 Board meetings during the ACEP Scientific Assembly in San Francisco, as well as the November 18 Board conference call.

The face-to-face meetings of the Board provided an opportunity for reports from some of the leaders in the Society. Dr. Michelle Biros provided an update on the activities of the AEM Editorial Board and the AEM Consensus Conference. She reviewed the publisher’s report, as well as the marketing reports. Dr. Brian Zink reported on the activities of the Development Committee, including a multi-year membership campaign and a Silent Auction. Additional information on the Silent Auction is included in this issue of the Newsletter. Dr. Judd Hollander reviewed the progress of the Program Committee in developing the 2005 Annual Meeting.

The Board reviewed and approved a slate of six nominees to submit for the open seat on the American Board of Emergency Medicine.

The Board

selected Dr. Jeff Kline and Dr. Robert Neumar to serve as the Society’s representatives on the ACEP Emergency Medicine Foundation.

The Board endorsed a manuscript on critical care medicine, which was submitted by the Critical Care Fellowship Task Force. Further information on the manuscript will be published in the next (March/April) issue of the Newsletter.

The Board approved the proposal of the Evidence Based Medicine Interest Group to offer the online evidence based medicine course in 2005. Further information on the course is published in this issue of the Newsletter. In addition, the Board approved a proposal to provide the online evidence based medicine course to the second year residents at Emory University. Funding for the course was provided by a grant, and there will be no cost to SAEM. The Board approved a proposal developed by Dr. Jeff Kline to complete the work required to protect the Society’s name, logo, and the SAEM acronym. The Board approved funding for this project of up to $5,000.

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The Board approved funding eight Medical Student Interest Group grants, as recommended by the Grants Committee. Information on these grants is published in this issue of the Newsletter.

The Board approved the new Web Policy, submitted by the Web Development Task Force. The Board also approved a new policy regarding requests for letters of support for grants.

The Board continued its review of all SAEM policies and position statements.

The Board approved revisions of the Organizational Liaison Policy and the Ultrasound Position Statement and approved other editorial changes in other documents. Updated information on the policies and position statements can be found on the SAEM web site at: http://www.saem.org/publicat/postlist. htm and http://www.saem.org/publicat/ adpolist.htm.

The Board approved the 2005 SAEM Western Regional Meeting and the 2005 Southeastern Regional Meeting.

The call for abstracts for the four spring regional meetings, is published in this issue of the Newsletter.

Advancement to the Position of Academic Chair: Strategies for Preparation, Negotiation, and Survival David Karras, MD Temple University SAEM Faculty Development Committee At the 2004 Annual SAEM meeting, Dr. John Gallagher of Albert Einstein Medical College moderated a discussion on strategies for advancing to the position of academic chair. The panelists included Dr. James Hoekstra of Wake Forest University, Dr. Stephen Hargarten of the Medical College of Wisconsin, and Dr. Glenn Hamilton of Wright State University. The session was well-attended and provided valuable insights for those interested in working their way to the top of the academic ladder. The following is a synopsis of the presentations.

A number of prerequisites are necessary for an individual to be successful in a quest for an academic chair position.

It is essential that a candidate be recognized as a national leader in emergency medicine or related medical organizations, and it is usually important that the applicant have a strong academic track record. Potential chairs should be familiar with the functioning of undergraduate medical education systems, residency leadership, and the basics of clinical ED management. Building and maintaining strong contacts throughout the emergency medicine community fosters mutually supportive relationships that will prove invaluable in learning about opportunities, assessing specific institutions, and providing references for the candidate.

A potential chair may consider applying for a position 2-3 years prior to what he or she believes would be the ideal time for advancement. Going through the process allows the candidate to gain interviewing experience, gather detailed information about specific institutions, learn different management strategies, and see what characteristics institutional leaders are seeking in a chair. Initiating the process early gets the applicant “on the radar screen” within the specialty as someone who might be considered for future chair opportunities. For similar reasons, chair candidates should consider investigating open positions even if the opportunity does not appear to be highly desirable. The experience will be valuable when a more suitable opportunity becomes available.

The chair candidate must carefully assess how closely a potential position

matches his or her professional and personal strengths. While a candidate with an exceptional funding record might be an excellent match at a research-oriented institution, the same candidate may not be a good fit at an institution that does not highly value research or where the priorities are service-oriented. The candidate should determine the institution’s development plans and carefully assess whether he or she has the leadership skills to help the institutional leaders meet their goals. The applicant must strive to find common ground with the institutional leaders and clearly understand their priorities. If the candidate finds that his or her professional interests and skills do not match the priorities of the institutional leaders, it is likely that he or she will not fit well at that institution.

A well-positioned chair candidate will recognize that egocentricity – doing what’s best for the department and the institution – is valued more highly than egocentricity – doing what’s best for one’s self or one’s own career. Throughout the interview process, it is usually advisable for prospective chairs to view their mission as helping the department, its faculty, and the institution achieve their goals. Candidates should generally not see themselves – or portray themselves – as individuals who plan to “clean house” by reorganizing the department infrastructure and purging faculty and staff. While novel approaches to problems are welcome, proposing radical changes during the interview process will usually be met with resistance from existing faculty and institutional leaders. A better approach is to carefully assess the department’s existing strengths and propose ways to leverage these assets to create a better teaching environment, provide better clinical care, enhance research activity, and help the institution grow.

The initial interview day is an intensive information-gathering experience for the candidate and for the institutional leaders. Presenting grand rounds is an excellent way for the applicant to be introduced to prospective faculty, residents, and staff, and allows the candidate the opportunity to demonstrate leadership by discussing an area of 13

expertise. Applicants should meet with as many faculty as possible, both during formal interviews and informally throughout the day. The candidate should seek to learn the strengths and weaknesses of the department, the hospital, the medical school, and the institutional leadership. EM and non-EM faculty can often provide vital information about the supportiveness of the dean and the hospital leadership, and the regard with which the department is held within the hospital and medical school. It is important that the candidate get a sense of the institution’s reporting structure and the individuals to whom the candidate will be directly accountable. The first interview is not, however, an ideal time to negotiate salary, benefits, and other concessions from the institution.

The second visit is an opportunity for the applicant to round out his or her knowledge of the institution, outline a strategy for helping to achieve the institution’s goals, and consider how well the institution’s agenda fits with the applicant’s own professional and personal goals. Institutional chains of command and the financial structure can be further explored. This is the opportunity for the candidate to initiate discussions of specific assurances necessary from the institution and the criteria that will be used to assess the chair’s performance.

Assuming both parties remain interested in pursuing the position after the second interview, many of these issues will be carried over for discussion in subsequent meetings and calls. Salary and benefits are usually the last items negotiated in putting together the chair package.

The workshop touched on key elements in securing the chair’s survival and longevity. Deans and CEOs often come and go in relatively short order, but a well-prepared department chair can weather these tides and have a career spanning multiple changes in institutional leadership. It is vital to maintain strong lines of communication with associate deans and chairs of other departments. The chair needs to be highly selective in seeking sources of reliable information, and recognize that there is no unbiased source of informa(continued on page 15)

Academic Announcements SAEM members are encouraged to submit Academic Announcements on promotions, rsearach funding, and other items of interst to the SAEM membership. Submissions must be sent to saem@saem.org by February 1 to be included in the March/April issue.

Three emergency physicians have been appointed to the Institute of Medicine: Georges C. Benjamin, MD, the Executive Director of the American Public Health Association; John R. Lumpkin, MD, Senior Vice President and Director, Health Care Group, Robert Wood Johnson Foundation, and Ricardo Martinez, MD, Chief Executive Officer and President, Safety Intelligence Systems.

Frederick C. Blum, MD, was elected president-elect of the American College of Emergency Physicians during the ACEP Scientific Assembly in San Francisco in October. Dr. Blum is Associate Professor of Emergency Medicine and Pediatrics at the West Virginia University.

Michael D. Burg, MD, Assistant Clinical Professor at the University of California, San Francisco is the founder and chair of the ACEP Section of Medical Humanities. The Section will further the artistic and literary interests of emergency physicians.

E. Martin Caravati, MD, MPH, Professor of Surgery (Emergency Medicine) at the University of Utah has been elected to a three-year term on the Board of Trustees of the American Academy of Clinical Toxicology.

Ten residency directors have been honored with the ACGMEs 2005 Parker J. Palmer Courage to Teach award. The annual award honors residency program directors for their dedication to teaching physicians in training. Francis Counselman, MD, Department of Emergency Medicine at Eastern Virginia Medical School, was one of the ten recipients, and the only recipient from emergency medicine.

Lowell W. Gerson, PhD, has been awarded the honor of Professor Emeritus of Epidemiology by the Board of Trustees of the Northeastern Ohio Universities College of Medicine, effective January 1, 2005.

University of the Health Sciences (USUHS). In addition, Dr. Lawrence, a Lt. Col. In the US Air Force, is an associate professor in the Department of Military and Emergency Medicine at the USUHS.

Cherri D. Hobgood, MD, was elected to the Board of Directors of the American College of Emergency Physicians in October. Dr. Hobgood is assistant professor of emergency medicine and Associate Dean for curriculum and Educational Development at the University of North Carolina School of Medicine.

Ronald Maio, DO, Professosr of Emergency Medicine, has been named the Assistant Dean for Researach and Regulatory Affairs at the University of Michigan.

Ramon W. Johnson, MD, was elected to the Board of Directors of the American College of Emergency Physicians in October. Dr. Johnson is director of pediatric emergency medicine at Mission Hospital Regional Medical Center in Mission Viejo, California.

Catherine A. Marco, MD, has been promoted to Professor, Department of Surgery, Division of Emergency Medicine at the Medical College of Ohio in Toledo.

Christina Schenarts, MD, has been named the director of the Emergency Medicine Residency Program at East Carolina University/Pitt County Memorial Hospital.

Brian F. Keaton, MD, was elected vice president of the American College of Emergency Physicians in October. Dr. Keaton is a Professor of Clinical Emergency Medicine at Northeastern Ohio University's College of Medicine.

Sandra M. Schneider, MD, professor and chair of emergency medicine at the University of Rochester, has been elected to the Board of Directors of the American College of Emergency Physicians. Dr. Schneider is a past president of SAEM.

Kristi L. Koenig, MD, has been named Director of Public Health Preparedness and Professor of Clinical Emergency Medicine in the Department of Emergency Medicine at the University of California, Irvine. She previously served as National Director of the Emergency Management Office at the Department of Veterans Affairs.

Robert E. Suter, DO, assumed the presidency of the American College of Emergency Physicians in October during the ACEP Scientific Assembly. Dr. Suter is an associate professor of emergency medicine at the University of Texas-Southwestern, the Medical College of Georgia, and the Uniformed Services University of Health Sciences.

Linda L. Lawrence, MD, was elected secretary-treasurer of the American College of Emergency Physicians. Dr. Lawrence is Commandant in the School of Medicine, Uniformed Services

Stuart Swadron, MD, has been appointed Director of the Emergency Medicine Residency Program at Keck School of Medicine at the University of Southern California.

Attention Department Chairs, Research Directors and Grant submitters!

The NIH grant application process explained!

The Center for Scientific Review has a video download at their site, accessed at http://www.csr.nih.gov/video/video.asp. This 40 minute video provides an excellent overview of the NIH grant application process, as well as recommendations about what submitters can do to improve their chances of a favorable review. Actual grant reviewers and NIH staff participate in the video. Thanks to member Gary Krause for bringing this to our attention.

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2004 NAEPP Coordinating Committee Carlos A. Camargo, MD, DrPH Massachusetts General Hospital SAEM Representative to NAEPP 1998-2004 The 2004 meeting of the National Asthma Education and Prevention Program (NAEPP) Coordinating Committee was held on September 19-20 in Bethesda, MD. Ms. Diana Schmidt, NAEPP Coordinator, welcomed participants and introduced new representatives from the American Academy of Allergy, Asthma, and Immunology (AAAAI), the American College of Physicians, the National Association of School Nurses, the Society for Public Health Education, and the U.S. Department of Education. Ms. Schmidt also announced that Dr. Leslie Boss, Centers for Disease Control and Prevention (CDC), is retiring. Rotating off the committee are Dr. Barbara Yawn, American Academy of Family Physicians (AAFP) and Dr. Carlos Camargo, SAEM. The meeting continued with an update on the NIH Guidelines for the Diagnosis and Management of Asthma. The first “Expert Panel Report” was released in 1991, and the second in 1997. A newly assembled expert panel will begin work on the third Expert Panel Report (EPR3) in late 2004, with release of the new, national asthma guidelines in early 2006.

Next, the group heard about implementation of the current guidelines. The presentations included an innovative asthma management program in New York City (www.nyc.gov/html/ doh/html/cmha/index.html) and a community-based approach called Yes We Can: Toolkit for Community-Focused Chronic Care from San Francisco. Dr. Camargo discussed a CDC Workgroup on prehospital management of asthma exacerbation. Briefly, the Workgroup has conducted a literature review and designed a “model protocol” that can be made available nationally. The workgroup will complete its report in the Fall, and submit it for journal publication. Finally, Dr. Kevin Weiss discussed racial and ethnic disparities in asthma health care and his plans for a national Workshop to be held in Chicago in February 2005.

Next, asthma data and surveillance were addressed, with presentations on the asthma objectives in Healthy People 2010; the Asthma Initiative of Michigan (AIM), a model state/local program; the Behavioral Risk Factor Surveillance

System (BRFSS) Adult Asthma Module; and the Environmental Protection Agency (EPA)’s National Survey on Environmental Management of Asthma.

Dr. Robert Myer from the Food and Drug Administration presented an update on the ongoing transition from chlorofluorocarbon (CFC) metered-dose inhalers to inhalers that use non–ozone-depleting chemicals called hydrofluroalkane-134a (HFA). He discussed the importance of having a sufficient supply of the new inhalers before the CFC-based delivery inhalers could be considered nonessential. Companies are ramping up and say they can supply the market adequately by December 5, 2005. According to the postmarketing data, there is little evidence of problems for HFAs in safety, efficacy, tolerability, and patient acceptance.

Subcommittee chairs then presented reports from the subcommittee meetings that took place the previous day. The School Asthma Education Subcommittee discussed several projects, including a model protocol to encourage schools to have available albuterol inhalers for students without inhalers at school; and new “tip sheets” to be posted on the NAEPP website (e.g., for physical education teachers and coaches on exercise-induced asthma). The Professional Education Subcommittee described a partnership between the AAAAI and the American Academy of Emergency Medicine (AAEM) that will develop an educational program directed to health care providers in emergency departments who are involved in asthma care; a new EPA poster on air pollutants; and the work of the National Environmental Education and Training Foundation, which is developing a pediatric asthma initiative incorporating the environmental management of asthma into pediatric health care. Finally, the Patient-Public Education Subcommittee focused on the teaching opportunity presented by the CFC transition and their plans to create an ad hoc committee to explore this further. The next NAEPP Coordinating Committee meeting will be held in the Washington DC area on June 2627, 2005.

Advancement to Chair…(continued from page 13) tion. The value of fiscal savvy cannot be underestimated. It is vital that the chair knows his revenue sources, understands the revenue streams, and knows who makes fiscal decisions. In this regard, a close relationship with one’s own department administrator and the institution’s financial leaders is invaluable.

The workshop discussed elements that are critical to successfully leading faculty. It is important to define clear roles within the department and develop an organizational structure. Good com-

munication between the chair and the faculty is essential. The chair is usually well-served by identifying a core group of faculty leaders with whom open and frank discussions can be held, and who in turn present a strong and confident front to the other faculty members. The chair should strive to be fair, balanced, consistent, and direct in conflict resolution, and should generally avoid a “my way or the highway” attitude. Another key to success as a chair is maintaining interest and involvement from all faculty members. The chair should try to pre15

vent the emergence of a marginalized group who feel that their interests and career development are of secondary importance.

Prospective department chairs should consider reading these excellent references: Fisher and Ury’s “Getting to Yes”, Maxwell’s “The 21 Irrefutable Laws of Leadership”, and “The Successful Medical School Department Chair”, published by the American Association of Medical Chairs (www.aamc.org).

ACADEMIC RESIDENT News and Information for Residents Interested in Academic Emergency Medicine

Edited by the SAEM GME Committee

The Resident as a “Bedside Teacher” Jon Rittenberger, MD Charissa Pacella, MD University of Pittsburgh For the SAEM GME Committee Teaching can be thought of as a planned learning activity 1.

By contrast, the Emergency Department (ED) is unpredictable. Clinical teaching in the ED frequently takes place in a busy, even chaotic arena, and requires a special approach to bedside teaching as compared with other, more controlled patient-care settings. New emphasis has been placed on bedside teaching with the advent of the Accreditation Council for Graduate Medical Education Outcome Project 2. Residents are often at the forefront of medical student interactions in the ED, yet most residencies provide little, if any, formal training in effective bedside teaching techniques. This article provides an educational framework for resident teachers and specific suggestions to improve bedside teaching interactions.

Set Goals It is prudent to spend a few minutes on each “first day” discussing and developing some specific educational goals for new students. Students need to know what is expected of them and what to expect in return. For example, third-year medical students generally focus on the initial approach to specific, common ED complaints, and perhaps selected procedures like suturing or drawing blood. Guide the student through the process of focused patient evaluation and the regular assessment their understanding of key diagnostic and management decisions during their month in the ED. Fourth-year emergency medicine students are generally given an expanded role in patient care and begin to manage patients. Their focus may be on more complex differential diagnoses, higher acuity complaints and managing common emergencies. Many students also expect and hope to perform basic procedures in the ED and are grateful to have a resident teacher who will help identify potentially appropriate patients.

In order to accomplish educational goals, both the student and the teacher must be willing to invest their time. Students are expected to diligently attend their shifts, remain attentive and inquisitive, and dedicate outside time to reading. As teachers in an academic setting, residents must accept appropriate responsibility for a student’ training, even when high ED volumes or frustrating patient interactions might seem to preclude effective teaching interactions.

Lead By Example By nature, emergency medicine leaves physicians in the spotlight. From the moment a resident arrives in a patient’s room, students are watching their demeanor and interaction with others. Moreover, the attending physicians and residents set the tone for the department. Generating an open 16

and positive learning environment will encourage others to become involved and teach. As academicians, residents must demonstrate an understanding of accepting praise and criticism during training periods. Students expect appropriate feedback, both positive and negative, as part of their education. However, resident teachers must also learn from their students and actively seek out constructive feedback about teaching approaches and techniques. Educational interactions often leave the instructor with as many questions as the student, and these questions should be viewed as opportunities to read and advance our own education.

Teach Students to Diagnose The ED provides an ideal milieu for evaluation of the undifferentiated patient, with specific attention to complaint-based history-taking, examination and diagnosis. Students see patients as they initially present, with physical findings that are frequently pronounced and subsequently improve with treatment. Dedicating time to observe and evaluate students’ history and physical exam skills takes full educational advantage of the unique ED setting. A well-taught rotation in the ED can help provide students with important skills necessary to prepare for the Objective Standardized Clinical Exam (OSCE) and Clinical Skills Assessment (CSA).

A number of recurring themes are identified in the ED (chest pain, altered mental status, e.g.) Residents can provide relevant clinical pearls and guidance to medical students at the bedside by recounting their our own approach to these complaints. Recurring patient complaints also allow us to assess student learning from one encounter to the next and reiterate key points.

Diagnostic testing initiated in the ED can determine the disposition for the patient’s hospitalization. Students should be challenged to justify their choice of diagnostic test and determine if and how it will change the diagnosis or treatment that follows. For example, when ordering a CBC on a patient with chest pain, a “good reason” might be that significant anemia can contribute to myocardial ischemia, rather than the autopilot response, “because we always do.”

“Canned” Lectures Many academic physicians have several favorite topics they can present on a moment’s notice. Just about any required lectures prepared by residents can be adapted to serve as a “mini” lecture in the ED modified to suit a particular patient encounter. These lectures allow a transition to the Socratic method of teaching and test student’s knowledge of both the physiology and clinical application of their learning. These

lectures add a final academic note to the end of a patient encounter or enlighten the rare slow moment in the ED. They also may prompt further reading for the student (and even the instructor). A well timed didactic presentation can emphasize a clinical point. After teaching a session on blood gas interpretation, a blood gas from a patient seen in the ED allows the student to how someone who is markedly acidotic or alkalotic “looks at the bedside.” 3

is designed to allow the student to discover than one answer build on another an clinical constructs can be codified by the general principles elucidated when discussing a specific patient. Another method of assessing a students’ understanding is to ask the student why a patient is not likely to have disease x, y or z.

Each shift in the ED presents unique patients and the opportunity to learn from them and teach others. One of the challenges of academic emergency medicine is determining the teaching points that can be derived from each case. By developing a plan and goals for students, resident teachers can maximize the educational value of the unique ED environment.

References 1. D’Andrea V. Organising teaching and learning. In: Fry H, Ketteridge S, Marshall SA, editors. Handbook for teaching and learning in higher education: enhancing academic practice. London: Kogan Page. 1999: 41-57.

2. Accreditation Council for Graduate Medical Education.

ACGME, Outcomes Project. Website http://www.acgme. org/outcome/. Copyright 2000, ACGME. 3. Lockey AS. Teaching and learning. Emergency Medicine Journal. 2001;18:451-452.

Socratic Question and Answer Socratic questioning remains a cornerstone for evaluating the knowledge of both student and instructor. When students feel the purpose of a questioning session is to embarrass, intimidate, humiliate, or demonstrate their ignorance, they will often refer to the session as a “pimping session”.

These feeling lead to frustration, disdain for the instructors and stunt the educational interaction. When the “studentinstructor” relationship is built on trust and mutual respect, the “self discovery” encouraged by the Socratic method can lead to an indelibly useful academic encounter. Brief, open-ended questions allow the instructor to ascertain the student’s knowledge level and fill in the missing information. The questioning that occurs during a Socratic session is not designed to test the students knowledge per se, but

CPC Competition Submissions Sought Deadline: Feburary 11, 2005 Submissions are now being accepted from emergency medicine residency programs for the 2004 Semi-Final CPC Competition to be held May 21, 2005, the day before the SAEM Annual Meeting in New York City. The deadline for submission of cases is February 11, 2005 with an entry fee of $250. Case submission and presentation guidelines will be posted on the CORD website at www.cordem.org and it is anticipated that online submission will be required.

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 60 cases selected from the submis-

sions. A Best Presenter and Best Discussant will be selected from each of the six tracks.

Winners of the semi-final competition will be invited to participate in the CPC Finals to be held Washington, DC during the ACEP Scientific Assembly in September. A Best Presenter and Best Discussant will be selected.

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.

Nominations Sought for 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 SAEM Board of Directors. The deadline for nominations is February 4, 2005.

Candidates must be a resident during the entire one-year term on the Board (May 2005-May 2006) and must be a member of SAEM. Candidates 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, as well as the candidate’s CV and a cover letter. Nominations must be sent electronically to saem@saem.org. Candidates are encouraged to review the Board of Directors orientation guidelines on the SAEM website at www.saem.org or from the SAEM office.

The election will be held via mail bal17

lot in the Spring of 2005 and the results will be announced during the Annual Business Meeting in May in New York.

The resident member of the Board will attend four SAEM Board meetings; in the fall, in the winter, and in the spring (at the 2005 and 2006 SAEM Annual Meetings). The resident member will also participate in monthly Board conference calls.

AAMC Annual Meeting Report David P. Sklar, MD University of New Mexico James Hoekstra, MD Wake Forest University SAEM Representatives to the Council of Academic Societies of the AAMC The 115th AAMC Annual Meeting was held in Boston, November 5-10, 2004. The title of the AAMC meeting of November 5-10, 2004, was “Fulfilling the Promise: Tomorrow’s Doctors, Tomorrow’s Cures.” SAEM and AACEM held a joint session the morning of November 6. The first presentation was titled “New EMTALA Regulations and Their Affect on Medical Specialties Capabilities at Community Hospital: A Threat to Tertiary Care Centers.” Dr. Bob Bitterman, MD, JD began the session with an update of recent changes and interpretations of EMTALA and discussed whether they would result in less specialty care courage for emergency departments. His overview highlighted the strategies being utilized by specialty physicians to avoid call or institute selective call, and its effects on tertiary care centers. Dr. Timothy Flynn, a vascular surgeon from the University of Florida discussed the perspective of the specialist, particularly the surgical specialist. He noted that emergency department patients generally have a lower insurance rate than those visiting office-based practices and also represent a high risk for lawsuits due to the lack of an established doctor patient relationship and the uncontrolled nature of emergency surgical cases. Finally, as shortages of surgical specialists develop due to an aging work force and increased trends toward sub-specialization, the new EMTALA regulations will likely result in less ED specialty coverage and hospital payments for the coverage that does occur. Dr. Charlotte Yeh, the CMS Administrator from New England described the history of EMTALA and the role of the CMS and OIG in investigations concerning possible violations. She linked the EMTALA transfer rules with previously unacceptable behaviors by hospitals with regard to transferring uninsured patients with subsequent bad outcomes for these patients. Unfortunately the EMTALA law has contributed to the unintended consequence of overcrowding of our pres-

ent academic emergency departments.

The next presentation focused upon the phenomenon of observational or “acute care” medicine, which is becoming more prevalent in academic centers who are dealing with ED overcrowding due to limited hospital resources longer stays of emergency department patients who are either admitted or in observation status are giving rise to acute care activities by emergency physicians for conditions that would previously have been the responsibilities of inpatient physicians. Such conditions as diabetic ketoacidosis, pneumonia, pyelonephritis, and chest pain are now commonly treated by emergency physicians from presentation to discharge often in dedicated areas either adjacent to the ED or even remote from the ED. This represents both a threat and an opportunity to expand the practice of emergency physicians. Hospitalists were seen as potential allies and competitors depending upon the political forces of the institution. The speakers included Gabe Kelen, Louis Graff, Sandra Schneider, and James Hoekstra.

The rest of the meeting provided sessions for deans, hospital administrators, resident and student representatives, and researchers in medical education. Themes of particular relevance to emergency medicine can be summarized by the statement that clinical care and medical education both need radical change. Medical education models still focus on a few core specialty clerkships in hospitalized patients even though shorter stays, ambulatory services, and technological changes have reduced the relevance and dependancy on such educational venues. Clinical care models that emphasize teams, disease management, information systems, patient autonomy, and reduced cost and safety are needed to replace outmoded, uncoordinated, provider centered, unsafe systems of care. Core competencies for residents and students will drive some of this change as education programs are forced to

18

demonstrate achievement of skills rather than presentation of material.

The continuum of education from premedical education to continuing education for practicing physicians will be reengineered to demonstrate competencies and to improve connectivity to adjacent stages of education. Health disparities in minority and vulnerable populations were identified as public health and ethical deficiencies in the present health care systems. Diversity in the physician workforce was one solution that is seen as vulnerable due to the high cost of medical education and the debt load it imposed on students.

Public health concepts, such as injury prevention and surveillance should be viewed as part of the basic education for all medical students rather as a part of another discipline.

The national election had just occurred prior to the meeting. Although the results will clearly influence priorities in health care, medical education and research, there was a general consensus that the budget deficit would be the most critical influence. To reduce the deficit, it is likely that health care spending will be severely limited, leading to reduced support to medical schools and a greater burden of uninsured patients for emergency departments.

Overall, the mood of the meeting what somewhat subdued, perhaps due to the election and the venue of the meeting in Boston, but we also sensed apprehension concerning the effort that will be necessary to bring about the changes that will be needed to reduce cost and improve efficiency and safety of our systems. Emergency medicine has always been an innovative and creative specialty, willing to adapt to changing circumstances. We would suspect that the coming years will witness greater leadership for emergency medicine academicians in the overall medical education system than in the past as the skills that helped programs grow and flourish are applied to the future challenges for academic medicine.

The Patient Customer: Order’s Up Jason Hughes, MD Texas Tech University There has been an evolution of the nomenclature of patients, and one would have to consider who is behind the entire scheme. We called patients, oddly enough, patients back in the 1980’s, but from there it seems like we followed a trail of tears in trying to find a way in which we should not make patients feel inferior. Thus, the “namegame” began.

Patients were then called consumers for a while, and some still are; in fact, psychiatric patients seem to have been tagged with this name. Then we started calling patients clients, but the obvious problem there was that the country’s law professionals have used this name for those wishing to obtain advice. The advice usually comes in the form of a lawsuit and the medical field, for some strange reason, has a distaste for lawsuits.

In the 21st century, we now laud the use of the word “customer” when referring to patients. Apparently this nomenclature enables patients to feel as if they have some control over their waiting time in the emergency room, what medications they should have, and what doctor they should see. All physicians realize that spending time with patients may help avoid legal problems; however, time usually needs to be spent with those who have a more concerning problem at the moment. Finally, the word customer seems to allow for the randomization of patients who do not like the hospital, the food, the physician or the nurse to complain and cause the Press-Ganey score for the hospital emergency room to plummet.

The physician is now called a health care provider, and this name change apparently alludes to the fact that we should somehow provide excellent care for all patients and this should be done in a timely fashion. It may be possible to do this in a fantasy world, but even then the patient’s perception may not be the same as that of those administering the medical care.

There is an inherent problem with the system and the wording someone has chosen for it. A customer at a fast food chain stands in line and expects to be waited on when his or her turn comes up. This is not the case in emergency medicine, as triage takes precedence in this setting. The “customer is always right” motto does not appeal to health care providers as our patients do not have the right to ask for 125 mg of meperidine for a tension headache. The waiting time for seeing a patient and sending him or her home depends on the complexity of the case and the concerns of the physician, not the speed with which we should perform these tasks. No patient or physician would like a premature decision to be made when the result could be a missed pulmonary embolism.

The Press-Ganey Associates refer to the patients as customers and also are supposed to improve hospital care by showing weaknesses and strengths; employees in areas that are less satisfactory are told to “bump their scores up” or there will be problems. Nurses are shown where their percentile satisfaction lies with other hospitals, and physicians see their scores as well.

The entire problem of “customerization” of patients is that physicians have no power in the current emergency medicine scheme to make a difference.

In other words, leadership and power cannot be separated. An excellent leader in the emergency department can make a certain difference, but the concern should be centered around the quality of care given. If a leader has no power, then leadership eventually collapses on itself. Many emergency departments where I have worked as the sole physician have sent their nurses home early to save the hospital money, used paramedics essentially as nurses, and had consultants leave the patient “hanging” until enough phone calls were made to beg for the patient’s admission. Nurses have also had to beg

19

for patients to be accepted by nursing staff upstairs. Usually they are put on hold or are told to call back after change of shift.

The emergency department director in many hospitals simply does not have the power to stop the actions of other employees. Without it, as mentioned above, the ability to transform patients into customers is even more limited.

We have an obligation to treat patients through an appropriate triage system, explaining that system as best as possible. We should treat patients as if they were our own family members; we should practice the best medicine we can. Few relatives of mine would be angry at the wait for news about a potentially lethal medical problem.

Besides, the only “order” that is up is usually mine, sitting in a rack for an hour while busy nurses try to battle entropy.

If we decide to use Press-Ganey as the thermometer for the success of a hospital and customer satisfaction, then we must given the resources to attain the appropriate equipment, number of staff, and number of rooms. Until a physician and nurse can greet the patient at the door, avoid all interruptions, and have numerous other staff to take care of other patients, the triage system will be the only system we have.

It may not be the best, but it will at least not be misguiding those who are angry due to a waiting period or the inability of a physician to give large doses of narcotics to a patient who insists on having them.

Patients certainly have rights, but in the general scheme it would seem that if we use the word customer, they might feel as if they have the right to intrude upon the care of those who have a more difficult problem. Using such terminology is a slippery slope unless those with power to institute change can repair or rebuild a system that is already moving downhill.

Compiling a Database of Principal Investigators in Emergency Medicine Jason Haukoos, MD, MS Denver Health Medical Center Amy Kaji, MD, MPH Harbor - UCLA Jesse Pines, MD, MBA University of Pennsylvania Kevin Terrell, DO, MS Indiana University SAEM Research Sub-Committee Members Ever since the SAEM January/ February 2002 Newsletter, the SAEM Research Committee has compiled an annual, list of federally funded emergency medicine investigators. Last year, the list included 77 National Institutes of Health (NIH)-funded grants (18 career development awards and 59 project grants) and 45 non-NIH grants. Only principal investigators were included.

The list was compiled from various sources, including the Computer Retrieval of Information on Scientific Projects (CRISP) database available at www.nih.gov. CRISP is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other research institutions and is maintained by the Office of Extramural Research at the NIH. The projects that are listed include NIH , Substance Abuse and Mental Health Services Administration (SAMHSA), Health resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH) funded projects (http://ott.od.nih.gov/textonly/crispdb1. html accessed August 24, 2004).

Prior to this year, “Emergency Medicine” could not be entered as a query term into the CRISP search form.

Entering the query today will return 36 hits. While the CRISP database captures some of the investigators, it is not comprehensive. Moreover, last year, even after a thorough internet search of http://fdncenter.org, as well as from word-of-mouth, self-report, and electronic mail sent to the members of SAEM, we were unable to identify many of the emergency physicians who were grant recipients.

Non-NIH grants are even more difficult to identify because there is no central database. The NIH database does not include funding from other large sources such as The Department of Defense (DOD), Robert Wood Johnson Foundation (RWJF), and the Pediatric Emergency Care Research Network

(PECARN). RWJF projects are available at www.rwjf.org/programs/ grant.Detail. Created in October 2001, PECARN is the first federally funded national network for research in emergency medical services for children (EMSC). Other major organizations that are currently funding researchers in emergency medicine include the American Heart Association (AHA), the American Geriatric Association (AGA), the Firearm Injury Center (FICAP), the Children’s Health Insurance Project (CHIP), and the American Lung Association (ALA). As there are many foundations that are interested in providing financial support for emergency medicine researche, the SAEM research committee has made it a priority to maintain an up-to-date list of funded researchers in emergency medicine to provide information about potential resources for investigators.

Obtaining research funding is extremely competitive. Many consider the ability to obtain funding as a marker of a successful researcher. Novice researchers look to the more experienced for guidance in writing grants. An institution’s funding is often correlated with the level of expertise in a given study area. Thus, identifying projects and investigators who are funded may delineate the types of grants offered, areas of interest, and centers of academic excellence.

This year, we set out to provide a more comprehensive list of researchers in emergency medicine than last year.

First, Dr. Jesse Pines, a member of our committee, set up an interactive website for the chairpersons of all 132 US ACGME accredited emergency medicine residency programs, in which they were asked to list the federally funded investigators at their institution. The URL link is: http://intercom.virginia.edu/ SurveySuite/Surveys/SAEMSurvey/ind ex2.html. After contacting the Chairs by electronic mail 5 times over a period of 4 months, members of our subcommittee then contacted the chairs individually either via telephone, facsimile, or another electronic mail, in which we 20

stated: “As one of the objectives for the SAEM Research Committee, we are attempting to identify projects and principal investigators who are federally funded in Emergency Medicine. By doing so, we hope to maintain a current database of on-going projects that may be utilized as a resource for both novice and experienced investigators. While we have received a response from a large number of department chairs through our electronic survey, we are now contacting the non-respondents via e-mail. We have just a few questions that we would like to ask. Specifically, we need to know the following information regarding the PIs within your department: 1. The Principal investigator’s name 2. The Award Title 3. The Grant Amount 4. The Project Start and End Date 5. The Awarding Institution (National Heart, Lung, and Blood Institute (NHLBI) within the NIH, AHA, CDC, DOD, etc.)”

We chose to contact the chairpersons of each department, because they would be able to identify the federally funded investigators among their faculty. The final list is organized by state and ACGME institution in Table 1, “List of Federally-funded Investigators in Emergency Medicine,” below. Through our survey, we identified 85 emergency medicine researchers who had active federally funded grants as of July 1, 2004. Unfortunately, we were unable to reach many chairpersons and institutions. Of the 132 ACGME programs, there were 44 non-respondents, 14 programs that answered “yes” to whether they had investigators but did not disclose any further information, and 29 programs that stated that they did not have any researchers who received significant funding. We realize that we may have overlooked investigators. If you wish to provide information regarding your research or experience with grant writing or reviewing, please contact the Research Committee at saem@saem.org.

Table 1: List of Federally-funded Investigators in Emergency Medicine State/Institution Alabama University of Alabama at Birmingham

California UCLA - Olive View-UCLA Emergency Medicine

Investigator Thomas E. Terndrup

Larry Baraff

Grant Title

Granting Agency

Southeastern Resuscitation Consortium Innovative Strategies for Bioterrorism and Emerging Infection Education Rural Access to Emergency Devices.

Family Intervention for Suicidal Youth

Start Date

End Date

NHLBI U01

$3,500,000

09/01/04

07/01/09

AHRQ HRSA; co-P.I

$1,100,000 $750,000

10/01/00 10/01/01

09/30/04 09/30/06

Emergency Care, Centers for Disease Control

$900,000

06/24/05

06/27/05

Centers for Disease Control

$1,100,000

09/01/04

08/31/05

HRSA

$343,000

10/01/03

09/01/04

CDC National Institutes of HealthNINDS

$15,000 $15,300,131

09/30/03

06/30/07

National Institutes of Health

$5,000,000

01/01/04

present

$188,673

07/01/03

present

$1,433,783

09/01/04

08/31/06

CDC

$2,594,630

09/01/04

08/31/08

NIH/NINDS

$15,100,000

05/01/04

06/30/06

Maternal and Child Health Bureau

$1,637,000

01/01/04

12/31/06

Maternal and Child Health Bureau

$2,470,000

09/01/01

09/30/05

NIH NCRR

$618,284

$ 2,151,439

09/30/04

09/29/05

$

692,585

07/01/04

06/30/05

$

75,000

10/01/04

12/31/04

$2,216,157

09/13/01

07/31/05

$40,875

01/01/04

12/31/04

Subcontract to UCLA - CDC HRSA Georgia Dept. of Human Resources

09/30/96 07/01/03 02/01/04

10/31/04 06/30/05 12/31/04

CDC

10/01/02

09/30/05

CDC

09/30/01

09/29/04

CDC NIH/NIMH CDC

09/01/03 12/01/03 07/01/01

08/30/06 11/30/08 09/30/04

NIH/NINDS

08/01/01

07/31/05

US Dept of Justice

10/01/02

09/30/05

Nat'l Hwy Traffic Safety Admin NHTSA)

09/11/03

11/15/04

US Dept of Justice

10/01/00

08/31/04

NIH/NIAA

04/15/04

03/31/05

Steven Rottman

University of California, Irvine Medical Center University of California, Davis/Emergency Department/ U.C.D. Medical Center

Harbor-UCLA Medical Center

Colorado Denver Health And Hospitals

Connecticut Yale-New Haven Medical Center

Georgia Emory University

UCLA Center for Public Health and Disasters (CDC funded Center for Public Health Preparedness) Curriculum Development in Bioterrorism for Health Professions Schools David Schriger Maintenance Contract for www.needlestick.mednet.ucla.edu website Steve Starkman Field Administration of Stroke Therapy (FAST-MAG) Specialized Program of Translational Research in Acute Stroke (SPORTRIAS) Combined Approach to Lysis utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke (CLEAR) Jerome Hoffman Interactive ELSI Curriculum for Primary Care Residents Interventions to Improve Shared Decision Making: Prostate Cancer Screening Other researchers with funding not listed: William Mower, Eric Savitsky Samuel Stratton The Field Administration of Stroke Therapy – Magnesium (FAST-MAG) Phase 3 Trial Other researchers with funding not listed: Federico Vaca Nathan Kuppermann Childhood Head Trauma: A Neuroimaging Decision Rule

Grant amount

Kelly Young

Emergency Medical Services for Children (EMSC) Network Development Demonstration Projects (NDDP) for the development of a Pediatric Emergency Care Applied Research Network (PECARN) Posttraumatic stress and pain in children undergoing painful medical procedures: Ethnic differences and their effect on the benefit of interventions for alleviation

National Institutes of HealthNINDS National Human Genome Research Institute

Steve Cantrill

Bioterrorism Training and Curriculum Development Program (BTCDP): Colorado BNICE WMD Training Center DHHS HRSA Standardized 'Real Time' National Hospital Bed Availability and Patient Tracking System DHHS AHRQ Jason Haukoos Improving Identification of Patients Infected with HIV Using Rapid Testing in the Emergency Department: A Systems-Based Approach CHPHE Other researchers with funding not listed: Kelly Broderick Gail D'Onofrio

Emergency Physician Brief Interventions for Alcohol NIAAA NASD Yale New Haven Hospital Emergency Department 2004 NIAAA Sandy Bogucki Prefers not to publish information Other researchers with funding not listed: Linda Degutis Heilpern, Katherine

Heron, Sheryl

Houry, Debra

Isakov, Alexander Kellermann, Arthur

Emergency IDNET Emergency Nurse Practitioner Program Georgia emergeing infections program Group intervention for black female suicide attempters Domestic Violence and child maltreatment in black families Grants for Violence-Related Injury Prevention Research:PIV & SV Intimate Partner Violence and Mental Health Issues Intergovernmental Personnel Agreement Progesterone treatment of blunt traumatic brain injury Project safe neighborhoods/Research Partner/ Crime Analysis Prgm Graduated drivers licensing system: A Georgia Analysis SACSI Research Partnership with Northern District of Georgia Nat'l Alcohol Screening Day: Academic EM Collaboration

21

State/Institution

Investigator Lowery, Douglas/ Heilpern, Katherine Sasser, Scott Stein, Donald

Wright, David Illinois Northwestern University

University of Illinois College of Medicine at Peoria/OSF St. Francis Medical Center Indiana Indiana University School of Medicine

Grant Title

Granting Agency

Surveillance for Bioterroirism Intergovernmental Personnel Agreement The Effects of Progesterone and its metabolites on TBI Progesterone after traumatic brain injury Neurorehabiliation with progesterone and pregnenolone

John W. Hafner Jr

Injury Free Coalition for Kids

Dan Rusyniak

MDMA:Hyperthermia and the DMH to 0

Eric W. Dickson MD

Jon Mark Hirshon

Mitochondrial effects of the drug Ecstasy (MDMA) to Dennis W. Jahnigen Career Development Scholars Award

Hormonal Opioids in ischemic Preconditioning Perfluorocarbon Ventilation in the Treatment of Francisella Pneumonia Geographic Variability In ED Use For Pediatric Asthma

Unexplained Diarrhea Sentinel Surveillance

Johns Hopkins

Massachusetts Boston Medical Center/Boston University

Guohua Li Rothman, Richard

Fernandez, William Bernstein, Ed

University of Massachusetts Medical Center

Karin Przyklenk Edward Boyeredward

Michigan University of Michigan

Wayne State University/SinaiGrace Hospital

End Date

State of Georgia CDC

08/01/03 09/23/02

01/31/05 07/31/05

NIH/NINDS NIH/NINDS

12/15/01 01/01/01

11/30/04 01/31/05

NIH/NICHHD

08/01/03

07/31/04

07/01/04

06/30/09

Pretest probability assessment and D-dimer testing for PE NHLBI Lance Becker Optimizing Heart And Brain Cooling During Cardiac Arrest NHLBI Apoptosis And Oxidants After Murine Cardiac Arrest NHLBI Other researchers with funding not listed: Karin Rhodes, Terry Vanden Hoek, David Beiser

Kevin Terrell

Maryland University of Maryland

Start Date

Courtney, Mark

MDMA:Hyperthermia and the Hypothalamus

Iowa The Iowa Emergency Medicine Program

Grant amount

Pilot Aging And Aviation Safety Evaluation Of Febrile Iv Drug Users-Guidelines For Emergency Management Regional Center NIH grant for excellence: bioterrorism preparedness Brief Intervention to Reduce Alcohol Use in ED Patients National Alcohol Screening Day Data Coordinating Center ED National Alcohol Screening Day Alcohol Education Program ED National Alcohol Screening Day Alcohol Education Program - Supplemental Grant Center Grant Project RAP (Reaching Adolescents for Prevention) Project SAFE/ SSBNI - Brief Intervention to Reduce STDs in ER Cooperative Agreement of Public Preparedness and Response for Bioterrorism Role of inositol trisphosphate in preconditioning , 12/2001 - 11/2005 Examining the relationwhip between the internet and drug use

$40,000

07/01/04

06/30/05

$50,000

07/01/04

06/30/05

Clarian Values Fund Grant

$96,397

02/02/04

07/04/04

American Geriatrics Society, John A. Hartford Foundation and Atlantic Philanthropies

$200,000

07/01/04

06/30/06

NHLBI

$491,508

06/01/02

06/01/06

NIAID-RCE pilot grant

$84,321

01/01/04

01/01/05

$663,500

09/03/04

09/08/04

$1,045,150

09/01/04

09/04/04 06/30/08

Mentored Clinical Scientist Development Award (K08) National Heart, Lung and Blood Institute National Center for Infectious Diseases/Association of American Medical Colleges Cooperative Agreement National Institute on Aging

National Center For Research Resources National Center For Research Resources

NIH/NIAAA

30,324

NIH/NIAAA

26,315

03/01/04

02/28/06

NIH/NIAAA

237, 721

02/01/04

01/31/05

NIH/NIAAA

100,000

09/01/04

03/31/05

NIH/NIAAA

2,573,358 04/01/04

03/31/09

12/01/04

11/05/04

$456,000

10/01/01

09/30/04

$1,200,000

07/01/04

06/30/09

$1,250,962

07/01/99

10/31/05

NIH/NIDA CDC/HRSA

NIH/NHLBI, RO1 Award NIH DA-14929

C5a in defense against Gram-negative pneumonia NIGMS. R01 Optimizing Resuscitation for the Casualty with Combined Hemorrhagic Shock and Traumatic Brain Injury DOD - Navy Phillip Scott Combination approach to Lysis utilizing Eptifibatide And rt-PA in acute ischemic stroke (CLEAR trial) NIH/NINDS Brian Zink Short Term Training In Health Professional Schools NHLBI Other researchers with funding not listed: Ronald Maio, Jim Weber, Samuel McLean Suppression of Protein Synthesis in the Reperfused Brain Cell Survival & Translation Control in Brain Reperfusion

22

07/31/07 07/31/06

Biomedical Research Grant, Indiana University Society for Academic Emergency Medicine, Neuroscience Research Fellowship Grant

John Younger Susan Stern

Gary S. Krause

500,000

04/30/06

NINDS

2,146,442

06/21/05

06/26/05

NINDS

1,068,000

06/23/05

06/27/05

State/Institution Minnesota Regions Hospital/Healthpartners Institute of Medical Education

Investigator Brent Asplin Brad Gordon

New Jersey Cooper Hospital/University Medical Center Steve Trzeciak Brigitte Baumann

University of Rochester/Strong Memorial Hospital

Granting Agency

Emergency Department Crowding: Causes and Consequences NIH Repayment Program Grant

Grant amount

Start Date

End Date

AHRQ NIH

616,790 Variable

06/24/05

06/29/05

Career Development Grant ED Screening & Interventions for Hazardous Alcohol Use Tobacco Treatment Initiated in the ED Tobacco Treatment Initiated in the ED

EMF

50,000

06/26/05

06/27/05

NIAAA/NIH NIDA/NIH UMDNJ

32,525 830,000 25,000

06/26/05 06/25/05 06/25/05

06/30/05 06/26/05

Polly Bijur

Racial and Ethnic Disparities in Acute Pain Control

AHRQ

670,380

06/25/05

06/28/05

Lynn Richardson, MD

Research without Consent – the community perspective

NIH

07/15/03

06/30/06

09/01/01 07/01/04

09/30/06 06/30/06

07/01/04

06/30/05

01/01/03

08/31/05

06/23/05

06/27/05

06/26/05

06/29/05

06/24/05

06/28/05

06/24/05

06/27/05

Ed Boudreaux New York Jacobi/Montefiore Emergency Medicine Program Affiliate of Albert Einstein College of Medicine Mount Sinai School of Medicine Integrated Residency

Grant Title

Jeff Bazarian Brian Blyth Manish Shah

Epidemiology of Traumatic Brain Injury Mechanisms of Egr-1 Mediated Neuroprotection Dennis W. Jahnigen Career Development Scholars Award--Prehospital Screening to Prevent Injuries and Illnesses

NINDS SAEM Training Grant

$150,000

American Geriatrics Society, John A. Hartford Foundation and Atlantic Philanthropies

$200,000 New York State Bioterrorism Hospital Preparedness Program - Strong Memorial Hospital New York State Bioterrorism Hospital Preparedness Program Strong Memorial Hospital New York State Department of Health/HRSA $1,245,000 Callahan JM et. al.

EMSC Network Developmental Demonstration Project Health Resources and Services Administration, Maternal Child Health Bureau Other researchers with significant funding not listed: Brooke Lerner, Sharon Humiston, Sabine Brouxhon, Lynn Cimpello Janet Williams

State University of New York - Upstate

North Carolina University of North Carolina

Greg Mears

EMS Performance Improvement Center, Medical Director

The North Carolina Office of Emergency Medical Services from The Duke Endowment

$753,000

North Carolina Bioterrorism Preparedness and Surveillance Project with Maintenance of the North Carolina PreHospital Medical Information System (PreMIS)

North Carolina Department of Health and Human Services, Division of Public Health via the National Centers for Disease Control and Injury Prevention (CDC) and the U.S. Department of Health and Human Services (DHHS), Human Resource Services Administration (HRSA), Hospital Bioterrorism Program $4,500,000 National EMS Information System Project (NEMSIS) The National Association of State EMS Directors by the U.S. Department of Transportation (DOT), National Highway Traffic Safety (NHTSA), Division of Emergency Medical Services $475,000 Other researchers with significant funding not listed: Anna Waller, Charlotte Weaver, Brenda Cooper Carolinas Medical Center

Jeffrey Kline Alan E. Jones Michael Runyon

Wake Forest University

David M. Cline

William Bozeman

Surrogate Markers for Severe Pulmonary Embolism Diagnostic significance of emergency department hypotension Pulmonary Vascular Hyperplasia in Pulmonary Embolism TS-0769 Cardiovascular Surveillance via a Hypertension Registry

Injuries Produced by Law Enforcement Use of Less Lethal Weapons: A Prospective Multicenter Trial�

Empiric Thrombolytic Use in Sudden Cardiac Death Unresponsive to Advanced Cardiac Life Support Measures Changes in Intracranial Pressure and Cerebral Metabolism During Rapid Sequence Intubation

23

NHLBI

$1,084,007

07/08/03

07/31/06

EMF Career Dev Award

$50,000

07/01/04

06/30/05

EMF

$75,000

07/01/04

6/31/05

09/30/03

09/29/05

Centers for Disease Control and Prevention/Association of Teachers of Preventative Medicine COOPERATIVE AGREEMENT $630,754

$104,071

$40,500 $8,200

State/Institution Ohio University of Cincinnati Medical Center

The Ohio State University

Investigator

Grant Title

Granting Agency

Complementary Hyperbaric Oxygen for Brain Radionecrosis Arthur Pancioli The Combined Approach To Lysis Utilizing Eptibatide And Rt-Pa: The Clear Stroke Trial Other researchers with significant funding not listed: Edward Jauch Brain Hiestand BNP in pre-eclampsia.

Mark Angelos SAEM Institutional Training Grant Other researchers with significant funding not listed: Craig Key, Jason Stoner

Wright State University

Oregon Oregon Health and Science University

Scott Wilber

James Olson

Robert Lowe

Prediction of Short-term Functional Decline and Service Needs in Older ED patients Cell Volume Regulation in Neurons and Glia Regulation of the Neuronal Taurine Transporter Enhancing Efficiency of Radiotherapy

Emergency Prehospital Investigative Consortium Impacts of Benefit Reduction and Increased Cost Sharing in a Medicaid Program

Craig Warden K. John McConnell

A Quantitative Model to Determine the Causes of and Solutions for Hospital Overcapacity A Pediatric Falls Prevention Project in the Portland, Oregon Metropolitan Area Surviving the Perfect Storm: Impacts of Benefit Reductions and Increased Cost Sharing in a Medicaid Program (Economics of Benefit Design Substudy) A Quantitative Model to Determine the Causes of and Solutions for Hospital Overcapacity Predictors of Emergency Department Overcrowding

NIH R21

University of Pittsburgh

University of Pennsylvania Emergency Medicine Residency

Rhode Island Brown University

End Date

09/02/03

08/31/05

NINDS

2007 *

Strategic Initiatives Grant (internal Ohio State program)

$47,500

06/01/04

12/31/04

Strategic Initiatives Grant (internal Ohio State program) SAEM

$63,800 $150,000

01/01/04 07/01/03

12/31/04 06/30/05

American Geriatrics Society / Hartford Foundation NINDS Wright State University Wallace-Kettering Neuroscience Institute

$213,750 $10,000

07/01/03 07/01/02 04/01/04

06/30/05 06/30/07 03/30/05

$40,000

04/01/03

06/30/05

National Heart, Lung and Blood Institute

$2,998,698

09/01/04

Robert Wood Johnson Foundation Changes in Healthcare Financing and Organization Initiative

$194,871

06/01/04

08/31/09

Emergency Medicine Foundation

$50,000

07/01/03

05/31/06

Robert Wood Johnson Foundation

$156,000

11/01/03

2006 *

Robert Wood Johnson Foundation

$181,000

07/01/04

10/31/06

$50,000

07/01/03

06/30/06

$29,766

06/01/03

05/31/05

Emergency Medicine Foundation Medical Research Foundation of Oregon Other researchers with significant funding not listed: Jerris Hedges, Jonathan Jui, Kenneth Bizovi, Harold Thomas Pennsylvania Thomas Jefferson University Hospital/ Emergency Medicine

Start Date

Laurie Beth Gesell

Serial BNP measurements in congestive heart failure patients. January 2004 December 2004.

Summa Health System/ Northeastern Ohio Universities

Grant amount

Raymond Regan

Effects of Inducible antioxidants on hemoglobin toxicity NIH/NINDS R01 NS042273-01A1 12/01/02 11/30/06 Ma Xin-liang Role of peroxynitrate in myocardial reperfusion injury NIH/NHLBI R01 HL-63828 06/10/01 05/31/05 Clifton Callaway Hypothermia And Gene Expression After Cardiac Arrest NINDS 06/30/06 Other researchers with significant funding not listed: Henry Wang, James Menegazzi, Donald Yealy, Paul Paris, David Hostler, Thomas Auble, Ted Delbridge, Vince Mosesso Bob Neumar

Mechanisms of Cell Death after Traumatic Brain Injury Pathology of traumatic Injury to CNS Axons Caspase-Mediated Cell Death after Brain Trauma Calpain-Mediated Cleavage of the NMDA Receptor Caplain-Mediated Injury in Post-Ischemic Neurons Brain Resuscitation Research Fellowship Jesse Pines CERT Training Grant - Center for Epidemiology and Biostatistics Other researchers with significant funding not listed: Steve Thom Angela Anderson Gregory Jay Michael Mello

Ronald Merchant

Lynne Palmisciano

Kenneth Williams

Emergency Medical Services for Children Lubricin Function in Articulating Joints Pulsus Paradoxus Monitor Injury Free Coalition for Kids Risk Watch Phone Intervention for ETOH Use in MVC ED Patients Providence Safe Communities Partnership SOS: Screening for Our Safety Rapid HIV Testing for Emergency Department patients Science Based Substance Abuse Prevention Programs Rhode Island Disaster Initiative - Phase II RIDI Phase III

24

NIH/NINDS NIH/NINDS NIH/NINDS NIH/NINDS NIH/NINDS SAEM

$950,000 $175,000 $46,000 $19,000 $200,000 $75,000

09/01/00 12/01/02 07/01/02 02/01/03 07/01/00 07/01/04

08/01/05 11/01/07 06/01/07 01/01/07 05/01/05 06/01/06

ARHQ/CERT

$160,000

10/01/04

06/30/06

Rhode Island Department of Health Case Western Reserve University NIH/NHLBI Robert Wood Johnson Foundation National Fire Protection Association

10/01/96 07/01/03 09/01/04 11/01/02 04/01/01

02/28/05 06/30/08 08/31/06 10/31/04 Indefinite

NIH/Center for Disease Control Rhode Island Department of Transportation AAA Foundation for Traffic Safety

10/01/03

09/29/06

04/12/04 04/01/04

04/11/05 10/01/05

NIH/National Institute of Allergy and Infectious Diseases

07/01/04

03/31/05

Rhode Island Department of Mental Health Battelle Battelle

06/01/04 02/01/03 10/30/03

06/30/05 09/30/04 09/30/04

State/Institution

Investigator Robert Wollard

Grant Title

Granting Agency

Reducing Injury ETOH & THC Use Among ED Patients

NIH/National Institute on Alcohol Abuse and Alcoholism

SBIRT With At-Risk Drinkers in the Emergency Department Tennessee Vanderbilt University Hospital

Seth Wright Robin Hemphill

Texas University of Texas Southwestern

Ahamed Idris

Virginia University of Virginia Health Sciences Center

Medical College of Virginia Hospitals/ Virginia Commonwealth University

Wisconsin Medical College of Wisconsin

Circulatory Compromise: Opportunities to Improve Outcome Marcus Martin

Grant amount 08/01/03

07/31/07

03/22/04

02/28/05

National Center for Emergency Preparedness HRSA

04/01/04 04/01/04

09/30/04 08/30/04

DOD

Joseph Ornato

HRSA bioterrorism grant.

HRSA Resuscitation Outcomes Consortium, Co-Chairman. $38,500 per year NIH/NHLBI Other researchers with significant funding not listed: Kevin Ward, R. Wayne Barbee, Kyle Gunnerson, Marsh Cuttino Resuscitation Outcomes Consortium ResQValve Trial Other researchers with significant funding not listed: Steve Hargarten

End Date

NIH/National Institute on Alcohol Abuse and Alcoholism

Use of Computerized Simulation in Medical Education Claude Moore Charitable Foundation $180,000

Tom Aufderheide

Start Date

NHLBI SBIR/NHLBI

07/01/04

$3.5 million

06/26/05

06/27/05

$38,500 per year

06/26/05

07/01/05

$4,000,000 $3,000,000

09/01/04 09/01/04

06/30/09 06/30/07

EMF Grants Available The Emergency Medicine Foundation (EMF) grant applications are available on the ACEP web site at www.acep.org. From the home page, click on “About ACEP,” then click on “EMF,” then click on the “EMF Research Grants” link for a complete listing of the downloadable grant applications. The funding period for all grants is July 1, 2005 through June 30, 2006 unless otherwise noted.

EMF Directed Research Reducing Medical Errors Award This request for proposals specifically targets research that is designed to reduce medical errors in the Emergency Department setting. Although all clinical proposals will be considered, the highest priority will be given to proposals that directly evaluate interventions to reduce medical errors and utilize quantitative outcome measures to assess effectiveness. Proposals may focus on specific patient populations, disease processes or hospital system components. Studies that propose to only identify errors without a plan to evaluate outcomes or investigate interventions will not be considered. Applicants may apply for up to $100,000 funding. The funds will be disbursed semi-annually over the two-year cycle. Deadline: December 20, 2004. Notification: April 11, 2005.

Medical Student Research Grant This grant is sponsored by EMF and the Society for Academic Emergency Medicine (SAEM). A maximum of $2,400 over 3 months is available for a medical student to encourage research in emergency medicine. Deadline: February 7, 2005. Notification: April 11, 2005.

ENAF Team Grant This request for proposals specifically targets research that is designed to investigate the topic of ED overcrowding. Proposals may focus on a number of related areas, including: definitions and outcome measures of ED overcrowding, causes and effects of ED overcrowding, and potential solutions to the problem of ED overcrowding. The applicants must provide evidence of a true collaborative effort between physician and nurse professionals and must delineate the relative roles of the participants in terms of protocol development, data collection, and manuscript preparation. A maximum of $20,000 will be awarded. Deadline: January 10, 2005. Notification: April 11, 2005.

Research Fellowship Grant This grant provides a maximum of $75,000 to emergency medicine residency graduates who will spend another year acquiring specific basic or clinical research skills and further didactic training research methodology. Deadline: January 10, 2005. Notification: April 11, 2005.

Directed Research Acute Congestive Heart Failure Award This grant program is sponsored by the Emergency Medicine Foundation (EMF) and Scios, Inc. This request for proposals specifically targets research that is designed to improve the care of patients who present to the Emergency Department with acute congestive heart failure. Only clinical science proposals will be considered. Proposals may focus on methods of facilitating treatment through early diagnosis, intervention and treatment of acute congestive heart failure patients. Deadline: January 10, 2005. Notification: April 11, 2005.

Neurological Emergencies Grant This grant 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 annually. Only clinical applications will be considered - no basic science applications will be accepted. Deadline: January 10, 2005. Notification: April 11, 2005.

25

President’s Message…(continued from page 1) great ideas NOT to pursue. We are an organization of volunteers, all whom are busy people already. Our membership dues are reasonable. While our organizational overhead perhaps sets an efficiency standard, there will be only so many members willing and capable of providing their valuable time and energy, and there are only so many dollars in our operating budget. We hope to use the membership survey to assist future BOD’s in making the decisions about allocation of member resources (time and effort as well as money). If you are invited to serve as part of the survey sample, I hope that the 20 minutes will be considered time well spent.

Over the summer and the fall the BOD has quietly interacted with the Institute of Medicine’s (IOM) Committee working on the project “The Future of Emergency Care in the United State’s Health Care System”. For those who are not aware of this project, or who wish to follow developments, I strongly encourage you to visit their web site at http://www.iom.edu/project.asp?id=16107. Past IOM Committee reports have heavily influenced policymaking and funding of health care initiatives, and this promises to be no different.

It is anticipated that this committee report will significantly impact EM from many facets, including education and research. SAEM has been very careful to avoid “lobbying” efforts, which are believed to be counterproductive. Instead, we have sought to provide the committee with informational resources illuminating issues that impact the educational and research aspects of EM. Both our immediate Past President, Don Yealy, and I have attended open sessions, and SAEM members have made presentations to the committee. The Board of Directors compiled a series of informational resources (with assistance of many members who responded on very short notice!) for the committee. These examine the status of EM education in medical school curricula, clinical

research and basic science research endeavors within the specialty, and special operational features associated with academic EDs. The BOD will continue to closely monitor IOM activity, and provide information as requested or needed.

The BOD also reviewed all of the organization’s policy statements (these describe the process for decision making) and position statements (these describe beliefs about selected issues of importance to academic emergency medicine and SAEM’s mission). Look for updates soon in the next Newsletter, as well as on our web site. Each will now carry its own review date and will undergo periodic examination by future BODs. This process included BOD 3-member subcommittees, discussion of subcommittee recommendations by the entire BOD, and subsequent revision by subcommittee workgroups if consensus was not reached. The BOD will finalize action during our December meeting.

Planning for the Annual Meeting in New York City is progressing wonderfully. SAEM is anticipating its largest meeting ever. Remember the January 5 deadline for your abstract submissions! Some new features include a Silent Auction (proceeds will go to the Research Fund) and a “Breakfast with the Board” Q&A session.

Finally I’d like to draw your attention to the Research Fund brochure that you’ve recently received. Please take an additional minute to read through this brochure. In building a foundation, one important component in convincing external donors that the cause is worthwhile is the percentage of members who contribute. To those who have already made a commitment, we thank you. To those who are uncertain, I’d ask you to make the commitment, as every contributor makes a difference not only in dollars, but in reaching that important member contributor percentage.

Call for Advisors

West Virginia University School of Medicine has outstanding open rank opportunities available for BE /BC Emergency Medicine Physicians. Practice opportunities include a high volume community hospital (Level 2 Trauma Center - 42,000 annual ED/fast track visits). Duties include direct patient care, teaching, and supervising medical students, and Emergency Medicine / Family Medicine Residents with ample opportunity for quality clinical research. The department has efficient support systems including twenty-four hour radiology readings, rapid lab and x-ray turnaround times, bedside registration, template-based charting, and generous mid-level and nursing coverage. Opportunities are also available in the newly renovated Emergency Department at West Virginia University Hospitals (40,000 annual ED/fast track visits). Duties include direct patient care, teaching and supervising post graduate physician assistant masters students, medical students, and residents in a Level 1 Trauma Center that also houses a busy aero medical program and serves as the Regional EMS Medical Command Center. Significant research opportunities exist in the areas of stroke and injury prevention. Faculty physicians enjoy the benefits of practicing in a progressive tertiary care facility, state-of-the-art technologies, and a collaborative academic atmosphere conducive to professional growth. North Central West Virginia offers culturally diverse, large-city amenities in a safe, family-like setting with excellent school systems and an abundance of recreational opportunities. Salary and academic rank will be commensurate with experience. WVU offers a highly competitive and comprehensive employment package which includes occurrence based malpractice. If interested, please submit a letter of interest, electronic curriculum vitae, and three references to:

The inaugural year for the SAEM Virtual Advisor Program was a tremendous success. Almost 300 medical students were served. Most of them attended schools without an affiliated EM residency program. Their “virtual” advisors served as their only link to the specialty of Emergency Medicine. Some students hoped to learn more about a specific geographic region, while others were anxious to contact an advisor whose special interest matched their own.

As the program increases in popularity, more advisors are needed. New students are applying daily, and over 100 remain unmatched! Please consider mentoring a future colleague by becoming a virtual advisor today.

We have a special need for osteopathic emergency physicians to serve as advisors. It is a brief time commitment – most communication takes place via e-mail at your convenience. Informative resources and articles that address topics of interest to your virtual advisees are available on the SAEM medical student website. You can complete the short application on-line at http://www.saem.org/advisor/index.htm. Please encourage your colleagues to join you today as a virtual advisor.

Faculty Search Committee c/o Ann S. Chinnis, M.D., Chair WVU Department of Emergency Medicine PO Box 9149 Morgantown, WV 26506-9149 (304) 293-2436 ecs@hsc.wvu.edu West Virginia University is an Affirmative Action /Equal Opportunity Employer.

26

FACULTY POSITIONS

EMERGENCY MEDICINE

COLORADO: Denver Health Medical Center academic attending staff position.

Applicants must be ABEM certified and EM residency trained. Experience in EM research is strongly preferred. Denver Health Medical Center is a level I trauma center, paramedic base-station and receiving facility for the City and County of Denver, and the base hospital for a PGY 1 – 4 EM residency. Denver Health Medical Center is an equal opportunity employer. If interested, please send CV to: Vince Markovchick, MD, Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Mail Code 0108, Denver, Colorado 80204, Tel: (303) 436-7144, Email: vince.markovchick@dhha.org.

Academic Positions Available in the

Department of Emergency Medicine of

Allegheny General Hospital, Pittsburgh, PA

INDIANA: Indiana University School of Medicine, Department of Emergency Medicine is recruiting a clinician teacher to provide care at public hospital ED located on medical center campus. Wishard Hospital is Level One Trauma Center, base for busy pre-hospital emergency transport services, and regional burn center. The ED recorded 108,000 visits in 2003. Wishard complements Methodist in providing clinical experiences for IUSM EM residents. Enthusiasm for medical education, clinical research, and patient care in busy public hospital ED are expectations. Residency training, certification/preparation in EM are required. Rank and tenure dependent upon 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.

Practice Emergency Medicine in Western Pennsylvania’s Most Dynamic Emergency Department ✩ ✩ ✩ ✩ ✩ ✩

Emergency Medicine Residency Training Program Level I Trauma Center Level I HAZMAT Receiving Facility 20% Pediatrics Medical Toxicology Treatment Center Fellowships - EMS, Sports Medicine, Administration, Research, Toxicology, Patient Safety ✩ Salary Commensurate with Experience

OHIO: The 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, 146 Means Hall, 1654 Upham Drive, Columbus, OH 43210, email Dailey.1@osu.edu, or call (614) 293-8176. Affirmative Action/Equal Opportunity Employer.

Contact: Fred Harchelroad, M.D. via Michelle Malsch, Executive Asst.

(412) 359-3961 mmalsch@wpahs.org

OREGON: TOXICOLOGY FELLOWSHIP: Oregon Health & Science University – Two-year Toxicology Fellowship. Fellowship includes EM residency program, EM observation unit to admit Tox patients, weekly Tox didactic conferences, Toxicokinetics course, Pediatric EM and PEDs Tox. We also have linkages with EMS, HAZMAT, AHLS course, certificate program or MPH in research, and pesticide surveillance program. The Oregon Poison Center serves Oregon, Nevada, Guam and Alaska, and receives 70,000 calls/year. For a full description see our website: http://www.ohsu.edu/som-EmergMed/fellowship/tox/index.htm. For an application please call 503-494-8600 or email Dr. Zane Horowitz at horowiza@ohsu.edu

✩✩ West Penn Allegheny Health System, an Equal Opportunity Employer ✩✩

PENNSYLVANIA: University of Pittsburgh: Full-time emergency medicine faculty positions are available at the Instructor through Associate Professor levels.

Candidates must be residency trained and board certified/prepared in emergency medicine. We offer career opportunities as a clinician-investigator or clinician-teacher. Our faculty have local, national and international recognition in research, teaching and clinical care. The ED serves a primarily adult population with a volume of approximately 50,000 per year, and is a Level I trauma center with both toxicology and hyperbaric medicine treatment programs housed within our Department. Salary is commensurate with experience. For further information write to: Donald M. Yealy, MD, Vice Chair, Department of Emergency Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 500, Pittsburgh, PA 15213. The University of Pittsburgh is an Affirmative Action, Equal Opportunity Employer.

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

WASHINGTON, DC: Washington Hospital Center (WHC), Georgetown University Hospital (GUH), Franklin Square Hospital (FSH), and Union Memorial Hospital (UMH) in the Washington, D.C. – Baltimore, MD corridor seek physicians board-certified or residency-trained in emergency medicine to join their faculty. WHC is the largest Washington, DC hospital, seeing more than 67,000 annual visits; GUH is a renowned academic institution; and FSH and UMH emergency departments in Baltimore are very busy. Contact Mark Smith, MD, FACEP, Chairman of Emergency Medicine, at 202-877-0808, fax 202-8772468 or write to him at the Washington Hospital Center, Department of Emergency Medicine, 110 Irving Street, NW, Washington, D.C. 20010.

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

The SAEM Newsletter is mailed every other month to approximately 6000 SAEM members. Advertising is limited to fellowship and academic faculty positions. The deadline for the March/April issue is February 1, 2005. All ads are posted on the SAEM website at no additional charge.

Advertising Rates: Classified ad (100 words or less) Contact in ad is SAEM member Contact in ad non-SAEM member Quarter page ad (camera ready) 3.5" wide x 4.75" high

$100 $125 $300

To place an advertisement, email 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: Carrie Barber at carrie@saem.org

27

University of Virginia Department of Emergency Medicine

Yale University School of Medicine, Section of Emergency Medicine

UVa Department of Emergency Medicine is seeking a board certified faculty member who is interested in an academic career in Emergency Medicine. Opportunity exists for a new faculty member who has an interest in teaching residents, medical students and pre-med students (academic research associates) and computerized simulation education. The position carries a faculty appointment in the School of Medicine at the University of Virginia. Tenure and non-tenure clinical tracks are options in the rank of Assistant or Associate Professor commensurate with qualifications, etc. There is an annual ED census of 60,000. The department includes a chest pain center, adult and pediatric ED, fast track (Express Care), active air and ground transport programs and a poison control center/center for clinical toxicology. There is an established emergency medicine residency program, fellowships in EMS, Toxicology and Cardiovascular Emergencies and an associates degree paramedic training program. The UVa Health System is a tertiary care and level 1 trauma center located at the foot of the Blue Ridge Mountains. Position is open until filled. Send CV, letter of interest, list of references to: Marcus L. Martin, MD, Chair, Department of Emergency Medicine, University of Virginia Health System, P. O. Box 800699, Charlottesville, Virginia 22908-0699, E-mail: mlm8n@virginia.edu

The Section of Emergency Medicine at Yale University School of Medicine is currently seeking qualified candidates to join its faculty at both the Assistant and Associate Professor levels.

The Section of Emergency Medicine, established in 1991, has become a leader in resident education and research. The Residency Program (1-4) was established in 1996 and has 10 residents per year. Fellowships in Ultrasound and EMS are also offered. The Research Division, supported by doctorate level scientists, is actively engaged in several NIH studies and other research funded by foundations, such as the Robert Wood Johnson Foundation.

Faculty practice at Yale New Haven Hospital, an urban level I trauma center with over 70,000 Adult ED visits, and at a satellite ED on the Connecticut shoreline.

Candidates must be Emergency Medicine trained, board eligible or board certified. Positions are available for both new graduates and faculty with experience to join either the education or research divisions. Senior faculty should have a record of excellence in teaching, demonstrated leadership skills, strong interpersonal skills, and a strong commitment to medical education and clinical excellence. Rank and salary will be commensurate with education, training and experience.

For more information, contact Dr. Gail D’Onofrio at (203) 785-4404 or gail.donofrio@yale.edu. To apply, please forward your CV and cover letter via fax at (203) 785-4580, email: jamie.petrone@yale.edu, or mail at Yale University School of Medicine, Department of Surgery, Section of Emergency Medicine, 464 Congress Ave, P.O. Box 208062, New Haven, CT 06519-1315.

Women, minorities, disabled persons, and veterans are encouraged to apply. The University of Vi rginia is an Equal Opportunity/Affirmat ive Action Employer.

Yale University is an affirmative action, equal opportunity employer and women and members of minority groups are encouraged to apply.

Department of Emergency Medicine - Faculty JR #7236

Emergency Medicine

NEW MEXICO: Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, seeks additional faculty in either the clinician educator or tenure track. Clinical responsibilities include direct patient care and attending supervision in the University Hospital Emergency Department. Academic responsibilities include full participation in the teaching and research activities of the department. Minimum requirements: board certified or board eligible in emergency medicine. Preference will be given to candidates with strong clinical skills in emergency care, demonstrated experience in teaching, demonstrated experience in EMS and/or disaster medicine, and prior research productivity. Applicants should demonstrate clinical capabilities, teaching potential, interest in EMS and/or disaster medicine, and potential for original research. These positions may be subject to criminal records screening in accordance with New Mexico law. Qualified applicants are invited to send a signed letter of interest, CV, and three letters of recommendation to: David Sklar, M.D., Professor & Chair, Department of Emergency Medicine, MSC10 5560, 1 University of New Mexico, Albuquerque, NM 87131-0001.

Position(s) will remain open until filled. For best consideration, submit application materials before January 31, 2005.

EEO/AA

Academic University Physician Associates, the faculty practice plan for the University of Missouri-Kansas City School of Medicine, is recruiting for faculty physicians in the Department of Emergency Medicine. Opportunities exist at the Assistant or Associate Professor level for residencytrained and board-eligible or board-certified emergency physicians to join a growing department. A fully-accredited EM residency was established in 1973 and currently accepts 9 residents per year. Truman Medical Center, the primary clinical site, is undergoing an extensive ED renovation that will nearly double its capacity and create a modern, state-of-the-art facility. Research areas of focus and/or need include EMS, medical simulation, asthma, cardiovascular disease, and ultrasound. University Physician Associates offers competitive salary and benefits. Contact: Robert A. Schwab, MD, Professor and Chair, Department of Emergency Medicine, 2301 Holmes Street, Kansas City, Missouri 64108.

Robert.Schwab@tmcmed.org.

An Equal Opportunity Employer

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Vice Chair for Research Rochester, Minnesota The Department of Emergency Medicine, Mayo Clinic College of Medicine, is pleased to announce a national and international search for Vice Chair for Research. This opportunity includes: •Extensive research opportunities; •Dedicated research staff •Collaboration with extensive Mayo Clinic research laboratories and programs •Access to the Rochester Epidemiology Project, a unique population-based patient database •Dedicated time for research activities; •Full departmental, administrative and secretarial support; •Practice in a high-acuity, high-volume tertiary hospital ED with a wide variety of patient pathology; •Leadership of dynamic faculty with ongoing clinical research.

The successful candidate must be an established investigator with a track record of publications and extramural funding, be board certified in emergency medicine and have demonstrated ability to implement and grow research programs.

Competitive salary with an outstanding benefit package and academic appointment through the Mayo Clinic College of Medicine.

To learn more about Mayo Clinic and Rochester, MN, please visit www.mayoclinic.org For further information, contact: Wyatt Decker, M.D. Chair, Department of Emergency Medicine Mayo Clinic College of Medicine 1216 Second Street SW, Rochester, MN 55902 Phone (507) 255-6501 email: decker.wyatt@mayo.edu Mayo Foundation is an affirmative action and equal opportunity employer and educator.

Post offer/pre-employment drug screening is required.

EMERGENCY MEDICINE OPPORTUNITY IN CENTRAL CALIFORNIA Central California Faculty Medical Group, affiliated with the University of California San Francisco Fresno Medical Education Program is seeking additional core faculty members as we expand to open a new Level 1 Trauma Center. These positions are located in Fresno at University Medical Center and will move to a new 30,000 sf ED upon completion.

A new UCSF Fresno 70,000 sf education and research building opens in early 2005. Fresno’s Medical Education Program is home to approximately 180 residents. The EM Residency began in 1974 and is a fully accredited 1-4 program, graduating 6 residents/ year. The ED sees approximately 60,000 culturally diverse patients / year. The hospital is a Level 1 trauma and burn center serving the Central San Joaquin Valley.

We are also the major Base Station for the Fresno EMS System and provide medical control to the adjacent Sequoia/Kings Canyon National Parks. We are seeking faculty with interest in (but not limited to) clinical teaching and research, postgraduate medical education, toxicology, wilderness medicine, and pediatric emergency medicine.

Must be Board Eligible/ Certified in Emergency Medicine Send CV and 3 references to: Gene Kallsen, M.D., Chief C/o Shirley White, CCFMG FAX: (559) 453-5233 E-mail: Shirley.White@ccfmg.org Visit our websites at www.ccfmg.org and www.ucsfresno.edu UCSF undertakes affirmative action to assure equal employment opportunity for underutilized minorities and women, for persons with disabilities and for Vietnam-era veterans and special disabled veterans.

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Academic Emergency Physician Rochester, Minnesota The Department of Emergency Medicine, Mayo Clinic College of Medicine, is seeking a full-time Academic Emergency Physician.

The opportunity includes: • Practice in a 70,000 visit/year, high-acuity tertiary referral center, with over 12,000 pediatric visits; • Teaching in an emergency medicine residency program, as well as teaching of off-service residents and medical students; • Extensive prehospital/aeromedical program including paramedic base station, 3 rotor and 1 fixed wing aircraft; • Numerous opportunities in research, with administrative support and intramural funding available; • Dynamic faculty with commitment to practice, education and research.

The successful candidate must be an individual with a demonstrated interest in academic emergency medicine as proven by performance in residency or fellowship training or faculty positions. EM residency trained, ABEM/ABOEM board certification/preparednesss and eligibility for Minnesota medical license required.

Competitive salary with an outstanding benefit package and academic appointment through the Mayo Clinic College of Medicine.

To learn more about Mayo Clinic and Rochester, MN, please visit www.mayoclinic.org For further information, contact: Wyatt Decker, M.D. Chair, Department of Emergency Medicine Mayo Clinic College of Medicine 1216 Second Street SW, Rochester, MN 55902 Phone (507) 255-6501 email: decker.wyatt@mayo.edu Mayo Foundation is an affirmative action and equal opportunity employer and educator. Post offer/pre-employment drug screening is required.

Newark Beth Israel Medical Center An Affiliate of the St. Barnabas Health Care System

Department of Emergency Medicine Arnold Palmer Hospital for Children and Orlando Regional Medical Center Faculty Positions – Pediatric Emergency Medicine Emergency Physicians of Central Florida, a stable democratic multi-hospital group of over 30 emergency physicians, is seeking 4 board-certified or boardprepared pediatric emergency medicine physicians. Double-boarded emergency medicine/pediatric emergency physicians will have the opportunity to work in both the children and adult emergency departments. The Orlando Regional Medical Center Emergency Medicine faculty are preparing to migrate from our current conjoined pediatric emergency / adult emergency department to a new pediatric ED with Arnold Palmer Hospital for Children. The new department will have a total of 33 beds (13 acute care, 16 urgent care, and 4 trauma/resuscitation rooms), and expected to have a volume of more than 40,000 visits within the first two years. The new Children’s Emergency Department will be a level 1 trauma center with air transport. Subspecialty coverage is excellent.

This career will include academic appointments with the University of Florida College of Medicine and Florida State University College of Medicine. Full-time teaching duties will be with Arnold Palmer Hospital for Children Pediatric Residency Program (41 residents - 34 pediatric and 6 internal medicine/pediatric, 1 chief) and Orlando Regional Medical Center Emergency Medicine Residency Program (36 residents with currently14 full time faculty, 2 doubleboarded in em/pem). The amicability and stability of our democratic partnership, community hospital teaching with eight established residency programs, academic appointments, research opportunities, and a beautiful location with access to year-around outdoor activities and natural resources offers a wonderful opportunity. Compensation and benefits are excellent. Please call Mark Clark, MD FACEP, FAAP at (321) 841-1518 or email mcclark@orhs.org.

EM Teaching Attending Position We are seeking a dynamic, experienced clinician BC EM to join our diverse, energetic faculty. Fully accredited EM residency training thirty emergency physicians.

82,000 patients per year, one-third children. We are dedicated to teaching, research, and clinical excellence and seek to deliver the highest quality emergency medical care in an way that patients leave with an experienece of being cared for and valued as human beings. Very competitive salary and benefits. Please submit resume and letter of interest via mail, fax, or e-mail: Marc Borenstein, MD, FACEP Chair and Residency Program DIrector Department of Emergency Medicine Newark Beth Israel Medical Center 201 Lyons Avenue Newark, New Jersey 07112 973-926-7562 office 973-282-0562 fax mborenstein@sbhcs.com Take Pride. Take Ownership. Deliver Excellence. Patients 1st.

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Call for Abstracts Southeastern SAEM Regional Meeting

Call for Abstracts 9th Annual SAEM New England Regional Meeting April 27, 2005 Shrewsbury, Massachusetts

April 8-9, 2005 Chapel Hill, NC

The Program Committee is now accepting abstracts for review for oral and poster presentations. The meeting will take place April 27, 2005, 8:00 am – 3:30 pm at the Hoagland-Pincus Conference Center in Shrewsbury, MA. For information: www.umassmed.edu/conferencecenter/.

The deadline for abstract submission is Wednesday, January 5, 2005 at 3:00 pm Eastern Time. Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notification will be sent mid-March 2005.

Send registration forms to: Linda Quattrucci, Research Assistant, Department of Emergency Medicine; Rhode Island Hospital, Coro West, Suite 106, One Hoppin Street, Providence, RI 02903. Email contact is lquattrucci@ lifespan.org.

Registration Fees: Faculty = $100; Residents/Nurses = $50; EMTs/Students = $25. Late fee after April 8, 2005 = add $25. Make checks payable to Brown Medical School, Department of Emergency Medicine.

The 2004 Southeastern Regional SAEM Meeting will be held at the Friday Center in Chapel Hill, North Carolina on April 8-9, 2005. The program committee is now accepting abstracts for review for oral and poster presentations.

Abstracts may be submitted electronically via the SAEM web site at www.saem.org until January 5, 2005 at 5:00 pm Eastern Time. Please use the SAEM submission form found at www.saem.org.

There will be oral and poster research presentations, sessions for medical students, hands on workshops, round table discussions with leaders in Academic Emergency Medicine, keynote presentations by Dr. Glenn Hamilton and Dr. Ian Stiell, and time to socialize with colleagues in the southeast.

Registration: medical students and residents are particularly encouraged to attend, and receive a discounted registration fee: $50 (medical students) and $75 (residents or nurses). Registration for attending physicians is $125.

For assistance with registration contact: Julie Vissers at (866) 924-7929 or (503) 635-4871 or via fax: (404) 7950711 or email jvissers@theairwaysite.com.

Call for Abstracts Western SAEM Regional Meeting

Call for Abstracts 5th Annual New York State SAEM Regional Meeting

April 9-10, 2005 Marina Del Rey Marriott Marina Del Rey, California

April 3, 2005 Brooklyn, NY

The program committee is now accepting abstract submissions for poster and oral plenary sessions. Accepted posters will be previewed on Saturday April 9, 2005 and moderated poster sessions will be on Sunday, April 10.

There will also be an oral plenary session for the region’s best 4 or 5 abstracts. The deadline for abstract submissions is January 31st at 5pm PST. Only electronic submissions using the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notification will be sent mid-March, 2005.

This conference’s didactic segments will focus on understanding and managing the role of uncertainty in multiple aspects of clinical and academic EM practice. For more information, contact Dr. Pam Dyne at pdyne@ucla.edu. The conference will conclude with an fun and interactive game-show format of audience participation.

Please send registration forms to: Mr. Wayne Hasby, Residency Coordinator, UCLA/Olive View-UCLA EM Residency, 924 Westwood Blvd., suite 300. His email is whasby@mednet.ucla.edu.

Registration fees: $125 for faculty, $50 for residents, nurses, and paramedics, and $10 for medical students.

Please make checks payable to UCLA Division of Emergency Medicine.

The program committee is now accepting abstracts for review. All accepted abstracts will be for oral presentation. The meeting will take place on Sunday, April 3, 2005, 8:00 am-4:00 pm at State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203.

The deadline for abstract submission is January 5, 2005 at 3 pm Eastern Time. Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notifications will be sent in late February.

Registration forms are available from Richard Sinert, DO, Department of Emergency Medicine, Box 1228, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203 or nephron1@bellatlantic.net Registration Fees: Faculty--$35; Other health care professionals--$30; Fellows/residents $25 Charge.

Late fee after Tuesday, March 1, 2005: add $10.

For questions or additional information, call 718245-2973.

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S A E M

Newsletter of the Society for Academic Emergency Medicine

Board of Directors Carey Chisholm, MD President

Glenn Hamilton, MD President-Elect Katherine Heilpern, MD Secretary-Treasurer Donald Yealy, MD Past President Leon Haley, Jr, MD, MHSA James Hoekstra, MD Jeffrey Kline, MD Maria Raven, MD Robert Schafermeyer, MD Susan Stern, MD Ellen Weber, MD

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

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

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

Call for Abstracts 2005 Annual Meeting May 22-25, 2005 New York, New York Deadline: January 5, 2005 The Program Committee is accepting abstracts for review for oral and poster presentation at the 2005 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obstetrics/gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The deadline for submission of abstracts is Wednesday, January 5, 2005 at 5:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instructions will be available on the SAEM website 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.

Only reports of original research may be submitted. The data must not have been published in manuscript or abstract form or presented at a national medical scientific meeting prior to the 2005 SAEM Annual Meeting. Original abstracts presented at national meetings in April or May 2005 will be considered.

Abstracts accepted for presentation will be published in the May issue of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine. SAEM strongly encourages authors to submit their manuscripts to AEM. AEM will notify authors of a decision regarding publication within 60 days of receipt of a manuscript.