March-April 2001

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE Five Sometimes Not So Helpful Habits of Academic Emergency Physicians

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

March-April 2001 Volume XIII, Number 2

Emergency Center Categorization — Are You Ready to Become a Level One? Brian J. Zink, MD SAEM President One of the six recommendations of the 1994 Macy Foundation’s report on emergency medicine was that a new classification system for emergency departments (ED’s) should be developed. The SAEM Emergency Center Categorization Task Force carefully developed the Emergency Center Categorization standards and methods for application and review of programs. SAEM limited its categorization process to the academic ED’s that could qualify for a Level One designation. We felt that we could best advance the Macy recommendations, in keeping with our mission, by promoting and designating centers of excellence in academic emergency medicine. We reasoned that by ensuring that enough programs met Level One status, the overall quality of care in academic emergency centers would be improved, and that the efforts of Level One centers in education and research would improve care in non-academic ED’s. While a Level One Emergency Center may benefit from this designation, the underlying purpose in ED categorization is patient-based. Emergency patients who come to academic ED’s deserve high quality care.

Emergency Center Categorization is an attempt to provide standards by which all academic ED’s can be judged, and to inform the public that the ED they choose has achieved those high standards.

The Emergency Center Categorization process is still in its early stages, with only one emergency medicine program, New York Methodist Hospital, fully completing the application and review process and obtaining Level One Emergency Center status. At least one other program has filed an intent to apply. Obviously, the categorization process will not work if more programs do not apply. Programs that have been reluctant to apply may have some misconceptions about the process, which are addressed below.

The book, The Seven Habits of Highly Effective People, by Stephen R. Covey has been highly influential in the business world, but its message can also be appreciated by those in academics.1 After Brian Zink, MD reading this book, I considered some of the traits and habits of academic emergency physicians. While I could think of many examples of good habits (e.g. kindness to strangers, able to stay awake all night), I could also identify some habits that are not so helpful.

Covey points out that effective habits are behaviors that develop from a combination of knowledge, skill and desire.1 Much like the “garbage in, garbage out” maxim, a habit will only be helpful and lead to success if the basic ingredients are good. Good habits result from excellent knowledge and training, refined skills, and a desire that is based on fair, honest and just principles. Conversely, bad habits often stem from incomplete knowledge and training that limits the development of skills that are essential to form good habits.

Bad habits also spring from unhealthy motivations such as over-competitiveness or greed. Habits are not immutable, but they are by definition, ingrained, repetitive behaviors that are hard to change.

I would offer the following five not so helpful habits that I have observed in academic emergency physicians. With each habit is an example, and suggestions on how to change the habit.

1. Activity for the sake of activity — My wife and I like to refer to our youngest son, as “pure ATP”. He was born active, never napped much, and is always in full gear. One of the techniques that helps preserve the sanity of parents with high energy kids is to keep those kids busy — very busy. Emergency medicine has always attracted individuals who produce lots of energy, and constantly seek stimulation.

As energetic kids we were very active (most likely with our parents’ help), but some of us never learned how to be comfortable with idle time. We find comfort in constant motion.

Clinical ED practice requires an active mind and body, and a certain thrill-seeking mentality. Many emergency physicians are self-described “adrenaline junkies”. As this term implies, there is a downside to being addicted to activity. If our nature is to be always doing, seeking that next rush or crisis, when do we find the time to think and plan? Outside

1. We could never meet those onerous standards. The ECC standards set a high bar, but programs should look carefully at the critical criteria and relative criteria. It is not necessary to meet all relative criteria, but is important to have a plan in place to move toward meeting them. In some cases, the changes that are required to meet ECC standards involve institutional involvement, and the challenge of obtaining ECC Level One status may persuade the institution to provide resources or make changes that will allow the ED to meet the standards. If the EM program approaches ECC Level One status as something that is required for national credibility, the institutional roadblocks may be easier to overcome.

(continued on page 18)

(continued on page 12)

Scholarly Sabbatical Grant Recipient Announced The SAEM Grants Committee is pleased to announce that Daniel P. Davis, MD, has been selected as this year’s recipient of the SAEM Scholarly Sabbatical Award. This award will provide $60,000 to the Department of Emergency Medicine at the University of California, San Diego beginning in July. This support will release Dr. Davis from 50% of his clinical responsibilities to spend twelve months under the mentorship of Piyush Patel, MD, investigating animal models of brain injury research and developing expertise in an array of basic laboratory, and research methodologies.

Dr. Davis received his Doctor of Medicine in 1995 from the University of California, San Diego School of Medicine.

He stayed on and did his residency at USCD where he was chief resident and named most outstanding resident in 1998-99. After completion of his residency he joined the faculty at UCSD in 1999. In addition to the practical laboratory methods he will acquire during the sabbatical, Dr. Davis’ experience will be supplemented with courses on neurobiology, neurochemistry, biostatistics and research methodology training through the UCSD research center and Department of Neurosciences.

Dr. Patel is an Associate Professor of Anesthesiology at UCSD. He is head of the VA Medical Center Neuroanesthesia Laboratory. He is the director of the Neuroanesthesia fellowship at UCSD and has been recognized as an outstanding teacher, and a leader in brain injury research.

This selection is the result of a review of the applicants by the SAEM Grants Committee. The process included an extensive NIH style review of four strong finalists.

The SAEM Scholarly Sabbatical Grants are intended to help emergency medicine faculty obtain release time to develop skills that will advance their academic careers.

The ultimate goal being the development of more independent career researchers who may further advance research and education in emergency medicine. Contact the SAEM office or the SAEM website for information on the next grant cycle.

Medical Student Interest Group Grants Deadline: August 15, 2001 SAEM recognizes the valuable role of EM Medical Student Interest Groups to the specialty and has established grants of up to $500 each to help support these groups’ educational activities. Established or developing clubs, located at medical schools with or without EM residencies are eligible to apply. The deadline for this year’s grants is August 15, 2001. Applications can be obtained at www.saem.org or from the SAEM office. Information on the grants approved for funding earlier this year can be found in the September/October 2000 issue of the SAEM Newsletter.

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

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

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

2

Register Online for the Annual Meeting!

The “brochure” for the Annual Meeting which will be held on May 6-9 in Atlanta is now online at www.saem.org. The site includes a complete schedule of events, as well as online registration, and will be updated continuously.

Annual Meeting Registration Form on pages 14 & 15.

Constitution and Bylaws Amendments Proposed Brian Zink, MD SAEM President The C&B Committee has prepared, and the Board of Directors has approved, that the proposed amendments to the SAEM C&B be sent to the membership for vote via mail ballot. The entire C&B with the proposed amendments, a cover letter, a ballot, and a postage-paid envelope were mailed to all active members on February 14. These items have also been posted on the SAEM web site at www.saem.org. All completed ballots must be returned to the SAEM office and postmarked by March 16 in order to be counted.

The Board of Directors realizes that these amendments propose fundamental changes in the some of the long-standing SAEM processes. The proposed changes include conducting the SAEM elections via mail ballot, providing resident members (along with the active members) the right to vote for the Resident Board member, discontinuing ex-officio members of the SAEM Board, and providing for language about the SAEM journal.

Therefore, the Board of Directors has developed a discussion board on the SAEM web site to allow members to read what other members think about the proposed changes, or to make their own opinions known. Contact SAEM at saem@saem.org or 517485-5484 with any questions.

Thank you for carefully considering the proposed C&B changes, and I hope that you will choose to vote.

Preview: 2001 Annual Meeting, Atlanta, May 6-9 Its been a very exciting year for those of us on the Program Committee. We wanted to give you a preview of what you will find at this year’s meeting. The chairs of the subcommittees of the Program Committee are really the ones that have put this together, so I thought I would let them tell you how it went this year and some of their innovations this year. I think you’ll agree they’ve done a terrific job. I’m looking forward to seeing all of you in Atlanta. Ellen Weber, MD, Program Committee Chair Bob Neumar, Scientific Subcommittee: The Scientific Subcommittee instituted several changes this year that have modernized abstract submission, review and presentation. Most obviously we moved from elective to mandatory electronic submission of abstracts. Last year was the first year that members were given the option of submitting abstracts electronically. The success of that endeavor encouraged us to proceed to electronic submission entirely.

The Scientific Subcommittee and SAEM staff utilized the many helpful suggestions provided by last year’s electronic submitters to revise and streamline the online submission form.

The result was a relatively uneventful abstract submission process with a few less dollars spent on express mail and a few more trees left standing. This also facilitated electronic dissemination of abstracts to reviewers. Keeping in form, investigators were notified of abstract acceptance and award consideration by email. Finally, LCD projection will be available for limited number of oral abstract sessions this year. If successful, it will be made available for all oral session next year.

Another important change was a move towards more coherent oral and poster sessions based on related studies rather than the abstract submission category. The purpose of submission categories is to assemble groups of abstract reviewers that have expertise in the specific area of investigation. Although this is ideal for critical scientific review, abstracts submitted to different categories often have more in common than those in the same category. This year an effort was made to group related abstracts into more thematic oral or poster sessions. Because the themes were dictated by the research abstracts that were accepted, the membership will notice many new session titles. Examples include “Procedural Sedation”, “ED Overcrowding”, and “Substance Abuse”.

The goal is to provide a more coherent picture of our latest research. To further this goal, we will continue the “topic discussion poster sessions” and “oral papers with open discussion” which are geared towards synthesizing the research results presented at these sessions into our fundamental knowledge base, finding the critical gaps in our understanding, and exploring future research directions.

Finally, the award system adopted last year will be continued this year.

Award committees for each category will be made up of scientific subcommittee members. Authors of the top scoring abstracts in each category will be invited to submit a full manuscript prior to the Annual Meeting. Awardees will be selected based on the overall quality and impact of the submitted manuscript as well as their oral or poster presentation at the Annual Meeting.

emergency medicine.

While I must defer to the Annual Meeting program for a more thorough description of this years didactic program, the subcommittee is confident the membership will be pleased with the scope, depth and quality of the offerings. We are looking forward to seeing you at what promises to be a great meeting in Atlanta.

David Guss, Didactic Subcommittee: The Didactic Subcommittee received almost 100 proposals for presentation at the 2001 Annual Meeting. As a result of a concerted effort to focus the membership on the desired parameters for submission, the quality of the proposals was excellent. This made the task of selection all the more daunting. A number of marathon meetings, several conference calls and hundreds of hours of individual effort went into the selection process.

The product yielded a slate of 40 sessions that reflect the broad interests and objectives of our society. The program is about equally represented by offerings in each of four major categories: education, research, state of the art and faculty development. Session formats range from 60 to 120 minutes and include formal lecture, luncheon sessions and workshops. A number of invited nationally recognized authorities in a variety of disciplines will be supplementing the primarily expert emergency medicine faculty as presenters. We have made a particular effort to avail ourselves of the talents unique to the Atlanta area with experts from the local government, universities and the CDC. This year we are featuring an Evidenced Based Medicine program that will span the entire four days of the meeting with two hour sessions offered each day. The nature of this offering and its curriculum will limit the number of participants for the entire course however several of the presentations are suitable for larger audiences. There will be a series of programs on basic and intermediate statistics and epidemiology that will allow interested members to build a core understanding in these areas over the 4 days of the Annual Meeting. A 2 hour state of the art presentation on shock research will be coupled with a oral abstract presentation. This should allow participants to learn about the most recent advances in this exciting and evolving field and hear about new cutting edge advances being explored by our colleagues in

Diane Gorgas, Resident/Medical Student Subcommittee: The Resident/ Medical Student Subcommittee is putting together an informative and interactive program this year. Highlights include a Medical Student forum on Sunday, May 6 and The Chief Resident Forum on Saturday May 5. In addition, this subcommittee is planning two didactic sessions. These will be entitled “A Roadmap for a Successful Academic Career” will be held May 6 and “Academic Emergency Medicine as a Career: Opportunities at the Entry and Mid-level Positions” is scheduled for May 9. We anticipate an extensive array of clinical diagnoses to be presented in both the Photo Diagnosis Contest and the Clinical Pearls sections of the Photo exhibit, and are hoping to have these posted and indexed in June on a web page. We are also proud to announce our Spivey Lecture this year will be presented on May 7 by Arthur Kellermann, MD, MPH, Chairman and Professor of Emergency Medicine at the Emory University School of Medicine and winner of the Hal Jayne Academic Excellence Award in 1997.

His topic will be “Why Do Research?”

We encourage all conference attendees to take advantage of these offerings.

While they are specifically aimed at medical students and residents, we believe their messages will be widely applicable to anyone interested in academic emergency medicine.

3

Other Program Innovations: • Opening Banquet, May 6 at 6:30 PM. Speaker: Jerris Hedges, “If Forrest Gump Performed Emergency Medicine: Personal Historical Perspectives.”

• “Meet the Presenters” Happy Hour Monday May 7 • Evening Activity: Getting the Most of Your Palm Top, 9:30 PM, Monday May 7 • Complimentary lunch buffet Tuesday May 8 and Wednesday, May 9 • Keynote Speaker: William H. Foege, MD; Tuesday May 8, 4PM Reception to follow.

America’s Health Care Safety Net: Intact or Unraveling?

AEM Consensus Conference — May 9, 2001, Atlanta Lynne Richardson, MD SAEM Public Health and Education Task Force Mt. Sinai Medical Center The ED is a unique practice setting in many respects. One of the most important is its singular accessibility: immediate care is available to all who seek it twenty-four hours per day, seven days per week. Access to ED care is guaranteed not only by the professional and ethical standards of emergency physicians but by federal law.1 Indeed, emergency care is the only type of health care to which access is guaranteed by law in this country.

In virtually every community in this nation, the ED is an integral part of the health care safety net. Historically, the ED has served as the only available point of access to the health care system for many vulnerable and disenfranchised individuals. Individuals without primary care physicians, those without insurance, those with Medicaid, and members of racial and ethnic minorities disproportionately utilize emergency departments to obtain care.2,3,4,5 The ED is sometimes the sole provider of care to those who, because of financial, cultural, medical, environmental or organizational barriers, are unable to obtain adequate health care from other providers.6,7 ED utilization is thus a multifaceted reflection of the many forces impacting on the health care delivery system. 8 We believe the ED offers a unique and important perspective from which to study factors that limit access to other sources of care and the effect of limited access on patient outcomes. During periods of impending crisis, it is also an important barometer of the status of the health care delivery system.

In March of 2000, the Institute of Medicine (IOM) issued a disturbing report: America’s Health Care Safety Net: Intact but Endangered.9 The report described three important trends that threaten the survival of traditional safety net providers.

1) The number of uninsured individuals has increased by more than 11 million over the past ten years. Approximately 18% of the non-elderly population lack health insurance, and this number is expected to continue to increase.10 2) Despite this unprecedented burden of uncompensated care, widespread pressures to reduce health care costs have resulted in changes to health care reimbursement that reduce direct and indirect funding for uncompensated care, and limit the ability of providers to offset the expense of charity care.11,12

3) The rapid growth of managed care and the proliferation of Medicaid managed care programs has created a relentlessly competitive environment in which safety net providers are losing their revenue-generating Medicaid patients to other providers, leaving them with an even greater burden of completely uncompensated care.13 As traditional core safety-net providers such as public hospitals and federally qualified health centers fail, the patients who have relied on their services are further disenfranchised.

The IOM report defined “core safety net providers” as having two distinguishing characteristics: 1) they offer “access to services for patients regardless of their ability to pay” and 2) “a substantial share of their patient mix is uninsured, Medicaid and other vulnerable patients”. 9 Emergency departments clearly meet these criteria. Unfortunately, the IOM report largely overlooked the critical role of EDs in the nation’s safety net. It also failed to examine the impact of the changing health care environment on ED practice.

The unprecedented number of uninsured, gate-keeping by managed care organizations, bed reductions and hospital closures, nursing shortages, and fierce cost reductions by hospitals have placed overwhelming stresses on many of our emergency departments. Emergency physicians across the country are familiar with the results: sustained (and in some cases, unprecedented) increases in ED visits, provision of more uncompensated and undercompensated care, growing shortages of acute and critical hospital beds for ED patients, planned or forced understaffing of nurses and housestaff, inadequate specialty back-up coverage for ED patients, and shrinking referral capacity for both primary and specialty follow-up care. These conditions threaten the operational and financial viability of our emergency departments, and compromise our ability to deliver high quality care to all of our patients.14, 15 The IOM report contains a number of recommendations regarding additional evaluation and ongoing monitoring of the safety net as well as the allocation of substantial resources to safety net providers. It is imperative that emergency departments and emergency physicians be included as these recommendations are implemented.

SAEM, particularly through its Public Health Task Force, has long been involved in identifying and understanding the impact of access issues on emergency medicine; and in facilitating the 4

potentially powerful role of emergency medicine organizations and individual emergency physicians in improving access to all forms of care for our patients.16 In response to the IOM report, Academic Emergency Medicine is convening a national consensus conference on safety net issues, on May 4, 2001 in Atlanta.

Practicing emergency physicians, EM academicians, health services researchers, research methodologists, health care advocates, and representatives from governmental agencies will be brought together to engage in a focused, creative discussion of this critically important topic. This conference will allow us to explore the role of emergency departments in the safety net and to examine the complex relationships between ED utilization and access to other sources of care. We will review data on the growing ED overcrowding crisis and attempt to identify the contributing factors. The goal of the conference is to collectively frame the important questions raised by these issues and to develop a research agenda on safety net issues for emergency medicine.

Emergency physicians interested in participating in this important event should contact Michelle Biros, MD, AEM Editor, at biros001@maroon.tc. umn.edu References 1. Emergency Medical Treatment and Active Labor Act (EMTALA), codified as amended at 42 U.S.C. §1395dd, 1990; Health Care Financing Administration EMTALA Regulations, 42 C.F.R. Parts 488, 489, 1003, 1994 2. National Comparative Survey of Minority Health Care, New York, The Commonwealth Fund, 1995.

3. General Accounting Office. Emergency Departments: Unevenly Affected by Growth and Change in Patient Use, Publication No. B251319 (1993).

4. U.S. Department of Health and Human Services, Office of the Inspector General, Use of Emergency Rooms

by Medicaid Recipients (1992).

5. Young GP, Wagner MB, Kellerman AL, Ellis J, Bouley D. Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 hours in the ED Study Group. JAMA. 1996; 276(6):460-5.

6. Lowe RA, Young GP, Reinke B, White JD, Auerbach PS. Indigent health care in emergency medicine: an academic perspective. Ann Emerg Med. 1991; 20(7):790-4. (continued on page 12)

Academic Excellence Award

Academic Leadership Award

How could one characterize the career of Emanuel P. Rivers, MD, MPH? Born with the initials ER, his mother gave him no other choice than to become an emergency physician. He was an original ambulance chaser (no, not a lawyer) but a kid on his bike who often motored to the scene guided by the sirens piercing the polluted air of the industrial town of River Rouge, Michigan. He viewed the injured from car accidents, house fires, gunfire, and tear gas canisters piercing the legs of protesters of the1967 riots. This youthful voyeur had no idea that this pastime of curiosity would lead to a career of treating the infirmed on their first presentation to the hospital.

His eventual career was “interrupted” by aspirations of pro basketball, accounting, and computer science as an undergraduate. Realizing he would not be a Dr. J on the basketball court, he chose to be a doctor of another kind and graduated with honors in microbiology from the University of Michigan.

He remained at the same institution graduated with a Doctorate of Medicine and Masters of Public Health as a Kaiser Merit Award Scholar in 1981. During his Emergency/Internal Medicine residency at Henry Ford Hospital, he served as chief resident in both programs. A critical care fellowship at the University of Pittsburgh concluded his formal training and he returned to Henry Ford Hospital in 1988 as Research Director in the Department of Emergency Medicine, and attending senior staff in the ED and surgical intensive care unit. It was the enormous exposure to reanimation, organ failure support and transplantation during his fellowship that led to the phrase “They Come For Life Not Death” which has now become his mantra at Henry Ford Hospital.

His drive for and view of Emergency Medicine led to a research odyssey after fellowship where he lived for 6 years in an apartment on the hospital grounds and performed research in over 1,500 cardiac arrests and shock patients. In addition to attending in the ED and ICU, day and night with fellows, he responded to cardiac arrests, compiling some of the largest studies involving the physiology and therapy of human cardiopulmonary resuscitation. Cardiopulmonary bypass, high dose epinephrine, balloon pump counter-pulsation, aortic occlusion, open chest CPR and post-resuscitation disease are just a few of these research interests. The studies performed provide some of the scientific basis for current ACLS guidelines. His current outcome study of early goal directed therapy in the treatment of severe sepsis and septic shock establishes the ED as a key player in improving outcomes from this disease.

As a product of these efforts he is board certified in Emergency Medicine, Internal Medicine and Critical Care Medicine. He has 35 peer-reviewed publications, 150 abstracts and 5 book chapters. His recent awards include the SAEM Best Faculty Clinical Science Award, Best Critical Care Clinical Science Presentation at the American College of Chest Physicians and Michigan’s Emergency Medicine Teaching Award. He is also a recipient of the “most prestigious” SAEM Imago Obscura Award. His other activities include serving on committees in the Society of Critical Care Medicine, ABEM, and SAEM helping develop the concept, specialization and credentialing of critical care for Emergency Medicine.

While his feats and contributions are legendary, his greatest hope is that he is a role model for subsequent individuals who will in turn provide the same dedication to scientific advancement of the specialty. His constant message to all the trainees in Emergency Medicine is that “residency is a privilege to learn and treat patients, not a right”. As we enter a new century, he endeavors to further the view of the emer-

It is a pleasure to write this testimonial for my colleague, Lou Binder. Lou has consistently demonstrated a pure love of SAEM as an organization, its mission, camaraderie and traditions. He has served as chair of many SAEM committees, as well as a member of the Board of Directors and President. He was instrumental in the founding of Academic Emergency Medicine and served as an Associate Editor. He has continually chaired at least one SAEM committee annually since 1986, and currently serves as chair of the SAEM Consultation Service Task Force.

Lou has also held positions of institutional leadership in two medical schools including Assistant Dean for Medical Education at the Texas Tech University Health Sciences Center at El Paso from 1988 to 1995, and Associate Dean for Academic Student Affairs at the University of Illinois at Chicago College of Medicine from 1995 to 1998. He was also the first full professor of Emergency Medicine at three medical schools (Texas Tech University, University of Illinois at Chicago, and Case Western Reserve).

Lou was one of the earliest voices with academic Emergency Medicine promoting Emergency Medicine involvement in the medical school curriculum and demonstrating that Emergency Medicine had much to offer in the general professional development of all medical students. This ideal was subsequently supported by the Macy Foundation Report, and remains an integral part of SAEM’s mission.

But that’s all the serious ‘stuff’ that all testimonials contain.

Lou deserves more than that. As you can tell just by looking at him, much much more. He is a man who amazed us by swimming well (in a Speedo, no less) in the Corporate Challenge Swim Meet, who writes three page emails to say hello and who routinely doubles back after a 6:00 pm–1:00 am shift to attend conference at 7:00 am. While most of us go to the gym to work out, Lou gets his exercise by hauling around all his documents in two satchels. They are with him at all times.

True to Lou’s Minnesota roots, he is a populist. Lou is someone that you just can’t help but like. Everyone wants Lou to do well. Congratulations Lou, on this prestigious honor.

Nicholas Jouriles, MD MetroHealth Medical Center

gency physician as an expert in “robbing death” irrespective of the disease presentation. Let me join the rest of my colleagues in congratulating Emanuel in this most prestigious and well-deserved award.

Gerard B. Martin, MD Henry Ford Hospital 5

What Have We Done For You Lately?

SAEM Offers Many Resources to its Resident Members Patricia Short, MD SAEM Board of Directors Indiana University The Society for Academic Emergency Medicine’s (SAEM) mission is to foster emergency medicine’s academic environment in research, education, and health policy through forums, publications, inter-organizational collaboration, policy development, and consultation services for teachers, researchers, and students. This mission includes both a commitment to the development of EM residents as compassionate, qualified physicians and support to nurture future academicians, researchers and leaders in emergency medicine.

The SAEM’s commitment to residents is demonstrated through an abundance of opportunities focused on their needs. Several of these are highlighted below. If you are already a member, take advantage of these resources. If you’re not yet a member, these are some of the reasons why you should consider joining.

• Participation — Residents have the unique opportunity to hold positions of leadership within SAEM including the resident member of the Board of Directors and as members of the many committees and task forces.

In addition, residents are encouraged to join the various interest groups that SAEM offers to its members. This opportunity is especially useful for residents involved in specific areas of research, or who have specific topics of interest.

• Mentors — Through participation in the Annual Meeting and on committees, you have the opportunity to develop mentoring relationships with faculty who have a variety of interests from around the country.

These relationships can help with research directions, career decision making, and even through your junior faculty years should an academic career be your ultimate niche.

• Academic Emergency Medicine Journal — Free to all members, both on-line and in hard copy. AEM is one of the premier informational resources for EM specialists. It not only presents the latest in EM research (laying the foundation for how we will practice our specialty in the future), but includes educational and health policy information important to your life long learning and advocacy role as an EM practitioner.

• Web Page — There are numerous educational offerings available on the SAEM home page, including teaching/self instruction sections

dealing with interpersonal/domestic violence, geriatrics, ethics and professionalism. A dedicated resident section lists resident opportunities on committees, and for grants, fellowships, and awards. Articles and publications of particular interest are included such as the co-authored with EMRA Emergency Medicine: An Academic Career Guide. The information for medical students, including the Residency Catalog, could be a tremendous assistance to those of you who provide career counseling to students. In addition, the site is currently under construction in an effort to make it more useful for you.

Plans include the incorporation of useful links to both educational and organizational sites. Your suggestions as to how to further improve this area are welcome.

• Job Connection — Faculty and fellowship positions are listed for your convenience on the SAEM home page at www.saem.org and in the journal.

• Annual Meeting — The SAEM Annual Meeting each May is the largest forum for the presentation of original research and many presenters are Emergency Medicine residents. The Annual Meeting includes many didactic sessions designed for residents, especially those interested in a career in academic emergency medicine. Awards are given for the Best Resident Paper and Poster. In addition, there is a Visual Diagnosis Contest open to medical student and resident attendees. The Chief Residents’ Forum, offered in conjunction with EMRA at the beginning of the Annual Meeting, is directed at getting

the new chief residents together to exchange ideas and expose them to speakers on topics such as leadership skills, time management, and scheduling. The Forum has traditionally been very well received. Registration fees for resident members of SAEM are extremely inexpensive for the four-day conference ($75 early bird and $100 after April 6). More than 500 residents and fellows attended the 2000 Annual Meeting.

• Advocacy — SAEM representatives lobby nationally on resident issues such as moonlighting, GME funding, and licensure. In an attempt to keep you updated on the hot topics affecting your training and future career, we are adding a special section to the resident portion of the web page that will highlight or link you to information about such issues.

Currently SAEM has over 2,000 resident members. Most of them joined through the Group Discount Rate which is available to all EM residency programs. Through this program, which reduces the annual dues to $75, the residency programs provide the funds for their residents to become members of SAEM. More than half of the residency programs participate in the Group Discount Program. Contact SAEM if your program would like to participate.

This is a brief summary of what SAEM offers its resident members. I encourage you to take advantage of as many opportunities as possible. The Board of Directors is committed to facilitating the training of residents and is interested in ways we can better serve you.

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

6

Young Investigator Award Recipients Announced Dr. David Wright obtained his bachelor’s degree from Samford University in Birmingham, and his MD degree from the University of Alabama, Birmingham. While at UAB, he was awarded a 1-year Howard Hughes Fellowship, and subsequently won a 2year Howard Hughes Medical School Scholarship. Following residency training in Emergency Medicine at the University of Cincinnati, he joined the Department of Emergency Medicine at Emory University in 1997. Within six weeks of his arrival, he established fruitful collaboration with Donald G. Stein, then Dean of the Graduate School of Arts and Sciences and Vice Provost for Research and an international expert on brain injury and neuroplasticity. Under Stein’s mentorship, Dr. Wright won the SAEM’s first “Scholarly Sabbatical” grant in 1999. This enabled him to spend extensive time in the lab developing the skills required to conduct cutting-edge brain injury research.

During his time at Emory, Dr. Wright has had a profound impact on scholarship at our department. In 1997, he founded the Emory “Brain Injury Group”, a team that has become the catalyst for interdisciplinary brain injury research and education at Emory. At the 2000 SAEM annual meeting, he won the “Best Young Investigator” award for his presentation, “Progesterone Reduces Cerebral Edema After Traumatic Brain Injury in Male Rats”.

Recently, he played a central role in helping our department conceive, write, and successfully submit a large-scale clinical trial pilot grant proposal to the NINDS. While David is one of the most brilliant young researchers I have ever met, he is also one of the most unassuming. His cherubic face and choirboy demeanor hides a burning drive for excellence. He is also a man of many talents. In addition to being an outstanding researcher, he is an excellent clinician and educator. In his spare time (what little he has) he plays drums for the Tone Mutts, a local rock band, and SCUBA dives with his wife. Truly, he is the complete academic emergency physician!

Arthur Kellermann, MD Emory University

Dr. Robert O. Wright is a rare individual in EM having continued training through his tenth postgraduate year.

He received his Bachelor of Science degree with highest distinction in Biochemistry in 1985 from the University of Michigan-Dearborn and his MD in 1989 from University of Michigan, Ann Arbor.

He completed his Pediatric Residency at Northwestern University in 1992 and his Emergency Medicine Fellowship at Brown University in 1995. Dr. Wright completed a second fellowship in Clinical Pharmacology/Toxicology at Children’s Hospital, Harvard University in 1997 and his MPH from Harvard in Quantitative Methods/Epidemiology in 2000. He has received awards from the American Academy of Clinical Toxicology and the International Society of Environmental Epidemiology. While training in public health, Dr. Wright conducted research at the Channing Laboratory, working with Dr. Howard Hu on Lead Toxicity. His research interests are focused yet his interests and capabilities are broad, including environmental health, genetics, heavy metal poisoning, epidemiology and statistics. Dr. Wright has been awarded 8 grants, 5 of which focus on laboratory investigation of lead toxicity. Recently, Dr. Wright received a 5-year Mentored Clinical Research Scientist Award (K23) by the National Institute of Environmental Health Sciences, entitled “Neurochemical and Genetic Markers of Lead Toxicity”. During his current grant work, he will gain further expertise in Genetic Epidemiology. This combination is uniquely suited to study Gene-Environment Interactions, a field that is going to expand substantially with the work of the Human Genome Project. Dr. Wright is a principal investigator on a NIOSH grant examining interactions of occupational neurotoxins with Apolipoprotein E isoforms in cognitive dysfunction. He is a co-investigator on an R01 application on “Gene-Metal Interactions in Parkinson’s Disease”. Dr. Wright has broad expertise while remaining singularly focused. He represents a group of young EM investigators who will rival and compete effectively with the best and brightest academicians from other disciplines.

Robert Woolard, MD, FACEP Brown University 7

Dr. Terry Vanden Hoek received his medical degree in 1991 with honors from the University of Chicago, and was elected to the Alpha Omega Alpha Honorary Medical Society. He completed his Emergency Medicine Residency at the University of Cincinnati, and served as Chief Resident from 1994-1995. During his residency, he also worked in the laboratory to develop a cell culture model of cardiac ischemia, and received an EMF Resident Research Grant. Since becoming an attending physician in Emergency Medicine at the University of Chicago in 1995, his basic science research has been published in such prestigious and high impact journals as the Journal of Biological Chemistry and Circulation Research. As a Co-Investigator and Principal Investigator, he has received well over 1 million dollars in research funding from the National Institutes of Health (NIH), the American Heart Association (AHA), and private/corporate donations and grants. Terry Vanden Hoek is highly regarded as a lecturer and speaker, and has received a number of speaking awards, including the SAEM Best Young Investigator and Best Basic Science Oral Presentation Awards, and was selected to be a speaker and finalist by the AHA during the 1999 Cournard and Comroe Young Investigator Competition in Cardiopulmonary & Critical Care.

He is also appreciated as an outstanding teacher by the residents who work with him clinically, and was honored recently by their award as “Attending Physician of the Year.” He has served nationally as an ad hoc reviewer for the NIH, and currently serves on the national Advanced Cardiac Life Support (ACLS) Committee for the AHA and on the Scientific Program Subcommittee for SAEM. Dr. Vanden Hoek recently Co-Founded and serves as the Co-Director of the Emergency Resuscitation Center at the University of Chicago and Argonne National Laboratory, which includes about 100 physicians, biologists, chemists, physicists, and engineers committed to improving survival from sudden cardiac death. We are most fortunate to have a person in our midst with such a passion for patient care, resident education, and science — Dr. Vanden Hoek is a bright tribute to academic emergency medicine.

Lance Becker, MD University of Chicago

SAEM Response to MedPAC As required by the Balanced Budget Refinement Act of 1999, the Medicare Payment Advisory Commission (MedPAC) has initiated a study to review the regulatory burdens placed on Medicare providers. They have asked for input regarding 1) the costs that these regulations place on the health care system and 2) the complexity of the current regulatory system and its impact on providers. SAEM welcomed the opportunity to respond to MedPAC’s request.

Jim Hoekstra, MD Chair, National Affairs Task Force Ohio State University SAEM represents approximately 5000 practicing academic emergency physicians. The majority of its members are faculty in teaching hospitals, involved in graduate medical education and medical student clinical education programs. As such, SAEM’s concerns as listed here are centered on the effects of Medicare regulations on the practice of academic emergency medicine in the clinical teaching setting. While a number of Medicare regulations have affected practice and patient care in the academic Emergency Department, two areas seem to have had the greatest negative impact: EMTALA mandates and Medicare documentation requirements.

• EMTALA Medical Screening: EMTALA laws require that every patient who presents to the emergency department (ED) is required to undergo at least a medical screening examination. This requirement maintains the ED as the medical safety net for all patients, regardless of their ability to pay. As such, emergency medicine has born a significantly higher burden of uncompensated care than any other health care specialty. Academic health centers, which tend to be tertiary care centers that are often located in inner cities, bear an even higher burden of uncompensated care than community hospitals. Medicare has not provided a mechanism for compensating for these burdens.

Medical screening exams are not well reimbursed, and Medicare reimbursement for emergency physicians does not take into account the costs of uncompensated care, even in academic health centers. As such, EMTALA has provided an unfunded mandate for emergency medicine, which is born disproportionately by academic emergency departments. SAEM does not wish to relinquish its responsibility for uncompensated care. On the contrary, we believe that academic emergency departments should be open to all patients at all times, regardless of their ability to pay. It is our duty. We should, however, be compensated for it in some fashion.

• EMTALA 24-Hour Coverage: A second effect of EMTALA is the requirement that EDs remain available and staffed 24-hours-a-day. While this mandate maintains the ED as a

medical safety net, the present Medicare reimbursement guidelines, APC’s, and practice expense calculations do not adequately take this factor in account. There is no mechanism in the present Medicare reimbursement system to offset the cost of 24-hour availability. This problem is especially acute in small hospitals and EDs where patient volumes are low.

Without an appropriate compensation mechanism, this regulation becomes another unfunded EMTALA mandate.

• Medicare Documentation Requirements: Medicare documentation requirements for reimbursement do not adequately reflect the practice of emergency medicine. In emergency medicine, patients present at the most acute stage of their illness, where critical actions must be undertaken in a timely manner. These critical actions are often initiated with minimal history, physical, or other clinical information available. Medicare documentation guidelines stratify patient reimbursement based on the completeness of burdensome details of the history, physical, past history, review of symptoms, social history, etc. None of these details may have anything to do with either the patient’s illness or the clinical decisions and treatment that are crucial to their care. In addition, they do not take into account the acuity of the patient’s illness. As such, emergency physicians spend an inordinate amount of time and effort documenting irrelevant historical information for billing purposes. This takes them away from providing actual patient care. In academic health centers, the time spent in needless documentation takes emergency physicians away from teaching as well. The result is less efficient patient care and less effective clinical teaching. Medicare documentation guidelines must reflect the practice of emergency medicine. At present, they do not.

• Medicare Documentation Requirements for Clinical Teaching: Medicare documentation guidelines require that attending emergency physicians document the critical portions of the history, physical, and medical decision making on all patients, despite whether or not a resident or medical student has already provided this documentation. This is done to assure that an attending physician is present and integrally involved in the patient’s care. This regulation seems to pre8

sume that resident physician’s commonly practice without supervision, but in academic ED’s, it has been an accepted standard, and an RRC mandate for at least a decade, that trained, attending emergency physicians are on duty 24 hrs. a day providing patient care and supervision of resident physicians. Teaching physician documentation in the ED setting places an undue burden on academic emergency physicians and academic health centers. The duplication of documentation adds to the inefficiency of clinical teaching sites. As such, physicians are less willing to take on teaching responsibilities and less able to spend time in clinical teaching.

SAEM is especially concerned that the added burden of duplicate documentation that Medicare requires is negatively impacting the clinical teaching that has made academic medical centers what they are today — the providers of the highest quality care and medical education in the world.

These are just a few of the concerns that SAEM has voiced over the past few years in numerous communications with MedPAC, HCFA, and Congress.

Other issues can also be raised, but in the interest of brevity and clarity, these points deserve special mention. SAEM appreciates the opportunity to speak on behalf of academic emergency physicians on this important topic

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

Resident Research Grant Award Recipients Announced The Grants Committee is pleased to announce the winners of this year’s Resident Research Awards: Dr. Jason Haukoos from the Harbor-UCLA Department of Emergency Medicine and Dr. Richard Spitz from the University of Chicago.

Dr. Haukoos’ study will test the hypothesis that incentives will improve compliance of emergency department (ED) patients referred for HIV-counseling and testing as outpatients. A previous study of an existing HIV counseling and testing referral system in the Harbor-UCLA ED found that only 13% of patients referred for HIV counseling and testing completed testing. The specific aims of Dr. Haukoos’ project are (1) to assess patient characteristics used to select patients for HIV counseling and testing and to test for associations between these characteristics and HIV infection; (2) to assess ED physicians’ ability to predict HIV seropositivity; (3) to measure the effect of an incentive on compliance with HIV counseling and testing referrals; (4) to measure the effect of the incentive on the number of new HIVinfected patients identified; (5) to measure the effect of the incentive on the number of HIV infected patients who enter HIV care; (6) to apply the Health Belief Model to identify barriers which reduce compliance with HIV counseling and testing; and (7) to estimate the cost of this system, per new HIV-infected patient identified. The results of this project will guide attempts to improve the effectiveness of ED referral systems for HIV counseling and testing by quantifying the effects of barriers to compliance. The project involves co-investigators from the Division of HIV Services within the Department of Internal Medicine and the UCLA School of Public Health. Dr. Haukoos will be mentored by Dr. Roger Lewis.

Dr. Spitz’s project will seek to draw parallels between ischemic preconditioning in cardiac myocytes and in primary neuronal cultures. The work will specifically extend upon ongoing research at the University of Chicago indicating an important role for reactive oxygen species produced in mitochondria during ischemic preconditioning. Dr. Spitz’s work will begin by determining the timing of injury and oxidant generation in neuronal cells during simulated ischemia and reperfusion. Next, he and his mentors will test whether hypoxic preconditioning decreases injury and oxidant generation and whether any such protection proceeds through mitochondria-mediated mechanisms. This work has the potential to substantially increase understanding of post-ischemic neuronal injury and may one day suggest new strategies for the treatment of stroke, cardiac arrest-associated global cerebral ischemia, and traumatic brain injury. Dr. Spitz’s training proposal, directed by Dr. Terry Vanden Hoek, involves a team of four co-mentors from Emergency Medicine, Pulmonary Critical Care, and Neurology at the University of Chicago.

The Resident Research Year proposals received by SAEM this year were simply remarkable in their scope. The research focus of these applications spanned the body of knowledge in Emergency Medicine from public health policy to the fundamental mechanisms of disease pathophysiology. The winning applications were remarkable for the multidisciplinary research teams brought together for resident training. And, for the first time ever, every submitted application included a federally funded research mentor. These developments underscore our specialty’s progress in developing real centers of academic excellence wherein important multispecialty research collaborations and successful pursuit of extramural funding are changing the face of research in Emergency Medicine.

For residents and their mentors considering applying for a Resident Research Year award for the 02-03 academic year, now is the time to begin planning. If you have any questions regarding the award or the application and review process, please contact the SAEM office for more details.

9

EMS Research Fellow Grant Recipient Selected SAEM is pleased to announce the selection of Gina W i l s o n Ramirez, MD, as the 12th Annual Research Fellow in Emergency Medical Services. Dr. W i l s o n Ramirez, a third year resident at the University of New Mexico, has selected New Mexico as the site for her fellowship training.

The EMS Task Force selected the 2001-02 EMS fellow during its recent review of fellowship individual and institutional applicants. The task force also approved two new institutions as sites for the fellowship: State University of New York, Syracuse and the University of Chicago. Additionally, Albert Einstein Philadelphia, Houston EMS, University of New Mexico, Boston EMS, Carolinas Medical Center, and the University of Texas Southwestern were previously approved and received continued approval as sites. This brings to 21 the number of institutions that have been approved to be host sites for SAEM EMS research fellows. Such approval is currently the standard for recognizing quality EMS fellowship programs.

By sponsoring the 12th annual EMS research fellowship, Medtronic Physio Control Corporation has appropriated $600,000 for the purposes of encouraging formal academic training for EMS physicians and the development of EMS fellowship programs. The Society for Academic Emergency Medicine is extremely grateful to Medtronic Physio Control for its long-standing support.

Erratum In my President’s Message in the January/February issue of the Newsletter, I mistakenly noted that Dr. Steve Hargarten was from the University of Wisconsin. Dr. Hargarten is the Professor and Chair of the Academic Department of Emergency Medicine at the Medical College of Wisconsin.

Brian Zink, MD SAEM President

Academic Career Profile The following interview is part 2 of a series of interviews of experienced and accomplished researchers that focus on issues of interest to the young investigator. On behalf of the Career Profiles sub-committee of the SAEM Research Committee, Dr. Jim Pribble interviewed Dr. Gabe Kelen who shares with us how he began in research and advice for the young investigator. We thank Dr. Kelen for sharing his time and experiences.

Gabor D. Kelen, MD, is chair of the Department of Emergency Medicine at Johns Hopkins University in Baltimore, Maryland.

Would you tell us about your educational and research background?

I attended undergraduate school at Carleton University in Ottawa, Canada, which did not have a medical school.

My degree was in Experimental Physiological Psychology. The courses were very heavily weighted toward research.

I spent two years in the lab as part of this work. My research training began at Carleton University where I learned basic science techniques. During the 1970’s, drug use and drug abuse was a major social problem, and my focus of research training back then was on neuro-hormonal conditioning of the brain.

I went to medical school at the University of Toronto. My previous residency training included both internal medicine and some surgery. Emergency Medicine was not a specialty in Canada at the time, and there were no approved training programs. I decided to go to Johns Hopkins to train in the specialty of emergency medicine.

I did almost no research during medical school, but commenced research again during my emergency medicine residency. I began to become aware of my deficits in research methodology in the clinical arena, although my background in psychology came in very handy as the rigor that psychologist researchers had used in their approach to both clinical and physiologic studies vastly surpassed that in biomedical academia. Still, my initial research was actually related to clinical research techniques and thus, through this research, I gave myself a fairly deep education on clinical research methodologies.

What has been your research focus?

My research focus is in infectious diseases related to emergency medicine. I was fortunate in that I was able to develop my research program right at the beginning of the HIV epidemic in the early to mid-1980’s. The Emergency Department was really an epidemiologic window on the world, and thus I was able to do epidemiologic research on HIV that was absolutely unapproachable from any other population angle. For example, our work was the first to show how widespread hidden HIV infections were in the population and showed which sub-segments of the

population were first at risk. We were the first to show the need for universal precautions, as those who were infected could not be predicted with any accuracy based upon standard risk factor analysis. We also showed, from a healthcare worker safety point-of-view, that testing patients for HIV alone did not excluded the vast majority of other infections that could pose a hazard to the healthcare worker, such as hepatitis B and hepatitis C. Our work helped put a stop to the growing demand that all patients be tested prior to receiving certain types of procedures. Since that time, I have turned my energies toward creating and now developing a research center that focuses on health services related to acute and episodic care.

What excites you about research?

There are several things that are particularly fulfilling in research. Research is a very creative process that forces one to think both pragmatically and philosophically in a way that ends in the creation of new knowledge that has the potential to truly impact medical care in our society. Also, when working in a lab for example, the cohesiveness of this “second” family can often be a secondary but substantial reward. Working with others who bring their own ideas to the table on research projects is a major aspect of the interest for me. I would not do very well as an isolated scientist, as I do not find that type of work fulfilling, although there are many that work this way very successfully. I also very much enjoy the teaching and mentoring role that scientists get to play. It is wonderful to watch others develop under one’s stewardship.

What has been the significance of research on your career?

This is a very difficult question to answer when research is one of the main foci of one’s career. However, in an environment such as Johns Hopkins, it is difficult to advance one’s career without meaningful academic endeavors. Being a good clinician and even a great teacher is usually in and of itself insufficient for advancement in this environment. Clearly, I would not be a full professor without my research endeavors, and it is very unlikely that I would have risen to the level of academic chair at an institution such as ours.

Perhaps more important than these outward measures of success has been the internal excitement of the work that I do. When I went to medical school, I did not enjoy the experience and could 10

hardly wait for the day when lectures and clinics were over so that I could leave. Once academic life started here at Hopkins and now for almost 20 years, I can hardly wait until the day gets going, and there are not enough hours in the day to do what needs to be accomplished. “Work” does not seem like work, but rather something that I would wish to do regardless.

What would you consider the advantages and disadvantages of a career in academic emergency medicine?

First, let’s be clear on what academic emergency medicine is. Most people mistakenly believe that a career in academic emergency medicine means being at a place where there is a residency program or at an affiliate institution working clinically and teaching residents. That may well be fun and may be fulfilling, but as an academic endeavor, it is incomplete. The true definition of academics includes involvement in discovery and scholarship.

This does not mean that one’s research has to be rocket science or even Nobel Prize-winning work. However, if you are not contributing to new discovery then, in my view, you are not an academician. So, in the following, I am referring to my definition of an academic career.

The advantages are legion. One has the opportunity to work with highly intelligent, creative people, many of whom are quite gifted and, surprisingly, wonderfully nice people. The academic environment is one in which further learning and excelling at what you do well is not just highly encouraged and fostered, but simply expected. Rather than fighting the clock in terms of how much time you need to spend at work, you are fighting time because you can not spend enough of it enjoying the work that you do. The sense of creativity and adding to new areas of knowledge is not dissimilar in fulfillment to that of an artist who creates a new painting or statue. The sense that one may actually be contributing to the betterment of society (although most research does not) is also compelling.

In our field, apart from the clinical practice, it seems quite important to have another area of enjoyment to balance the clinical side of life, be it in the political arena, administration, committee work, EMS, or research.

The only disadvantage of an academic career is financial. Academicians

(continued on next page)

Academic Announcements Michael Brown, MD, Grand Rapids MERC/Michigan State University Program in Emergency Medicine, and a colleague in the Department of Epidemiology at MSU, have received a three-year Centers for Disease Control and Prevention grant of $755,086 for a study on, “Asthma Surveillance and Interventions in Hospital Emergency Departments.”

The project will be conducted at three EDs in the Grand Rapids area and involves a collaboration between MSU, Spectrum Health, a local asthma coalition, and the Michigan Department of Community Health.

The Robert Wood Johnson Foundation has awarded a $174,791 grant to the Massachusetts General Hospital for a project concerning the Children’s Insurance Program (CHIP). The objective of this trial is to evaluate the effectiveness of child health insurance outreach through the nation’s emergency departments. The Principal Investigator is James A. Gordon, MD, MPA, and the Co-Investigator is Carlos A. Camargo, MD, DrPH; both from the Department of Emergency Medicine at Massachusetts General Hospital and the Division of Emergency at Harvard Medical School.

Gregory D. Jay, MD, PhD, Assistant Professor of Medicine in the Department of Medicine, Section of Emergency Medicine, Brown University School of Medicine, has received a KO8 Mentored Clinical Scientist Development Award from the National Institute of Aging. Dr. Jay will be the Principal Investigator on the project, “Immunoprobes for Lubricin from Human Synovial Fluid.” Dr. Jay has also received $34,700 from the McCutchen Foundation to support related work entitled, “Study of Nanotribological Characteristics of Lubricin by Atomic Force Microscopy.”

Marco Shapiro, MD, Clinical Assistant Professor of Medicine and Gregory D. Jay, MD, PhD, Assistant Professor of Medicine, in the Section of Emergency Medicine at Brown University School of Medicine received a grant award from the Champlin Foundation in the amount of $100,000 to support the project, “Renovations and Medical Equipment for a Medical Simulation Center at Rhode Island Hospital.

SAEM members are invited to send their Academic Announcements to SAEM to saem@saem.org.

Submissions may be edited to accommodate space available.

Academic Career Profile (Continued) tend not to be remunerated at similar levels as those who work purely clinically. This is not too surprising as most money in emergency medicine (or any part of medicine) is generated through clinical effort. On the other hand, there are endless examples of people having done research in various areas who then patent certain techniques or technologies and form businesses to supplement their earnings.

Thus, there certainly is that angle to financial success, should that be important to you.

What advice would you give to young researchers?

The likelihood of becoming a major player as a researcher is almost nil if a resident has not participated in research prior to their residency. This does not mean that without this background one will not do any studies.

However, exceedingly few, if any, make meaningful contributions.

Residents interested in research pretty much need to complete a fellowship these days. Anyone who believes that they can do it the hard way by joining a faculty and somehow develop as a researcher is completely deluding themselves. Although they may publish and engage in some scholarship, they will never do significant research nor make meaningfully contribute to discovery, simply because their focus and skill level can never attain an appropriate level.

When choosing a fellowship, one does not need to get it absolutely right, but it is important to choose an appropriate mentor. An exemplary track record of mentorship is a must. There are actually very

few people in the field of emergency medicine who can lay claim to this level of expertise, but they do exist. Don’t be afraid to go outside the field for your research training, however don’t be afraid to come back either. Some places are associated with schools and programs that allow you to get master’s degrees, or better yet, PhD’s. I am not aware of what the situation is at most institutions, but here at Hopkins, we offer a Masters in Health Science, as well as a PhD in Clinical Investigation.

Many residents, upon graduating, feel an acute need to go out into the real world to complete the honing of their clinical skills or simply because they need to make a lot of money to pay back debts. Many intend to come back to academics after a year or two, yet this virtually never occurs. Some do return to an academic environment, but there are almost no examples of those who develop a meaningful research career.

So if someone is really thinking of an academic career, they should dive into it straight from residency. Truly committed people do not hedge their bets by going out to the community first. If you are going to be an academician, be one.

Dr. Kelen’s Final Thoughts: I’ll end with these guiding thoughts (none of them original): 1) Less is more.

2) Do one thing well before going on to the next.

3) If you want to make important discoveries, do important work.

Thank you for the opportunity to express my views.

5th Annual New England Regional SAEM Conference April 6, 2001 Hoagland Pincus Conference Center Shrewsbury, Massachusetts Registration fees: Faculty $200, Residents/Nurses $50, Students/EMTs $35. Make checks payable to NERD Regional Meeting and mail to Rose Unwin, MC-1930, Uconn Health Center, Farmington, CT 06030-1930.

Contact Beechwood Hotel at 508-754-5789 for hotel reservations. Be sure to mention the conference to receive the group rate of $119-129.

11

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

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

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

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

No rate increases in 2001!

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

Emergency Center Categorization (Continued) 2. The application process is too complicated. EM Chairs who are considering applying for ECC Level One status may find the application procedure to be fairly daunting.

However, unlike the process for RRC or other reviews, the program can communicate with the ECC Task Force and SAEM throughout the process, and we will help the program through steps that are difficult or confusing. Much of the information that is required in the application is already available in other administrative reports, or through the ED nurse manager, or hospital data sources. The best approach may be for the Chair to appoint a small committee and designate members to come up with components of the essential information needed for the application. Once the written application is submitted, a senior ECC reviewer will go over the materials and can ask for clarification and additional materials before a final decision is made to approve a site visit. Therefore, this is not an all or none process — programs have the chance to communicate with the reviewer about their application and to work to meet the standards prior to the site review. The site review functions as a confirmation visit to ensure that the written materials accurately describe the program.

3. It costs too much. The charges for ECC application and site visit are in the range of $3,000 to $4,000. The application fee is $500. For financially strapped departments, this may represent resources that could be used for education and research.

The program’s hospital or institution may be able to cover some or all of the cost of the ECC application.

Since a ECC Level One designation would stand to benefit not just the

academic EM program, but the entire institution, it is reasonable to cost share the upfront expense.

4. It won’t really help us much. It is true that unless a significant percentage of academic emergency programs apply for ECC Level One status, the process will not work. However, the benefits of being able to tell our hospital administrators, state legislators, residency applicants, and funding agencies that we have been designated as a Level One Emergency Center by the national academic EM organization are not insignificant. But remember that this is not primarily about emergency physicians — it is about our patients. If we can adopt a system and mindset like our colleagues in trauma surgery, we will improve patient care.

While some would argue about the individual standards required for Level One Trauma Center designation, most would acknowledge that in terms of patient care, education, research, and community service, trauma care has been improved in our country since the advent of this system.

The ECC process is at a crucial early stage. Like a new store in a busy part of town, we need customers in order to succeed. If ECC is to work, we will need some collective resolve to get beyond the minor sticking points, and have a majority of academic EM programs apply. The ECC Task Force is ready and willing to review applications, and to work with programs on any logistical problems. The SAEM Board of Directors and the ECC Task Force encourage our national EM leaders to advance the process with the goal that it will help first, our ED patients, and secondarily our field. ECC materials are on the SAEM website at www.saem.org, or call SAEM at 517-485-5484.

America’s Health Care Safety Net (Continued) 7.

Pane GA, Farner MC, Salness KA. Health care access problems of medically indigent emergency department walk-in patients. Ann Emerg Med. 1991; 20(7):730-3.

8. Richardson, LD. Access, the emergency department and asthma. In Brenner BE, ed. Emergency Asthma. New York: Marcel Dekker; 1999:557-563.

9. Lewin ME, Altman S, eds. America’s health care safety net: intact but endangered. Institute of Medicine. Washington D.C., National Academy Press 2000.

10. Mann J, Melnick G, Bamezai A,

Zwanziger J. A profile of uncompensated hospital care, 1983-1995.

Health Affairs. 1997; 16(4):223-232.

11. National Association of Community Health Centers. Compromise delays phase-out of health center payment systems-orders congressional report on impact and alternative payment mechanisms. [www document] URL http://www.nachc.com/FSA/Federal /Agenda/PPS/Compromise%20Ann ouncement.htm.

12. Cunningham P, Grossman J, St. Peter R, Lesser C. Managed care and physicians’ provision of charity care. JAMA. 1999; 281(12): 108712

1092.

13. Cunningham P, Tu H. A changing picture of uncompensated care.

Health Affairs 1997; 16(4): 167-175.

14. Position Statement on the Critical State of Emergency Care in Arizona, Board of Directors, Arizona College of Emergency Physicians, December 6, 2000.

15. Bustillo M. “Treating an Emergency Care Crisis”. The Los Angeles Times. 2000 Feb 15;Sect. A:12.

16. Schneider SM, Hamilton GC, Moyer P, Stapczynski. Definition of emergency medicine. Acad Emerg Med 1998; 5(4):348-351.

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

Edited by the SAEM GME Committee

THE PERSONAL DIGITAL ASSISTANT IN THE ACADEMIC ED Douglas Brunette, MD Hennepin County Medical Center

able (see below), my “medication” category is limited to newly released medications not found in the commercially available medication databases, and medications whose use is either emergency medicine specific and/or non- FDA approved. An example is the use of calcium for hydrofluoric acid skin exposure. My “patients” category contains names and hospital numbers of patients that I want to obtain follow-up on at a later date (just what was that weird rash anyway?). My “conditions” category contains treatment options for rare, unusual, or difficult conditions in which treatment is needed immediately or treatment options are not likely to be easily found. Examples include shoulder dystocia during vaginal delivery (best if four hands are available: two for the delivery and two for the PDA), current HIV post-exposure treatment guidelines, and labyrinth re-positional techniques for benign positional vertigo. Finally, my “interesting patients” category has names and hospital numbers of patients that I want presented at various conferences, such as Morbidity and Mortality.

Personal digital assistants (PDA’s), also known as handheld computers, are available from a variety of companies (including Compaq, Palm, Sharp, and Sony) in many versions, with different bells and whistles, such as color screens, wired and wireless internet connectivity, and modems. In my opinion, the most important point in choosing a model for academic EM utilization is making sure you have enough memory. My Palm™ has 8.0 MB of memory, and I will upgrade for increased memory when it becomes available. My advice is to obtain a model which affords the most memory. All the other choices are personal preference.

There are standard software programs that come built into the PDA, and non-standard programs that the user obtains from a variety of sources (generally on the web) and installs into the PDA. Let’s begin with the basic software programs that are built into the typical PDA.

Other standard PDA programs include an address book, a calculator, and a to-do list, each of which has academic emergency medicine applications.

A “date book” or scheduling program keeps track of your committee meetings, conferences, and shifts (and that shift change you otherwise would have forgotten about). This function has been taken to another level by one of our faculty computer wizards. Our faculty schedule, done in 3 month block increments, is made using a homegrown scheduling program. The quarterly schedule is posted on our departmental website, accessible only to faculty. Each faculty can download from the website a file that contains his or her individual shift schedule for the given quarter in a file format (Windows.csv) that can be imported into Microsoft Outlook. The PDA can be configured to synchronize with Microsoft Outlook, and our shift schedule for the entire upcoming quarter is placed into the PDA in seconds. Any changes made to our schedule manually will be synchronized in both places.

There are a whole host of PDA software applications and databases specific for medicine available over the internet. Visiting one site, http://www. handango.com produced 296 such applications and/or databases, including the following sample medical categories: Pediatric and adult dosing calculators and interactive code cards Pediatric normal values by age HCFA E/M coding guidelines Cardiac emergencies quick reference Medical calculators for common medical formulas (e.g. Anion Gap, Water deficit, A-a gradient)

The memo pad is another standard PDA program.

A multitude of information can be stored by writing memos to yourself. Memos can be assigned to a list of personalized categories. Among others, I have categories for medications, patient follow-up, interesting cases, and difficult conditions. As there are several excellent medication databases avail-

Drug interaction databases Condensed clinical consult databases Arterial blood gas interpretation and acid-base disorders (continued on page 16) 13

Save Time! Register online instead at www.saem.org.

REGISTRATION FORM Online registrants receive an immediatel e-mail confirmation. The Annual Meeting brochure is also on the SAEM website. The website will be updated continuously.

2001 Annual Meeting Atlanta Hilton and Towers May 6-9

To contact SAEM: e-mail: saem@saem.org fax: 517-485-0801 phone: 517-485-5484 address: 901 N. Washington Avenue Lansing, MI 48906

Do not use this form if you have registered online. Do not submit duplicate registration forms.

PLEASE PRINT OR TYPE Send this form and appropriate fees to SAEM by fax, email, or mail. No phone registrations. This form may be photocopied.

Name and title for badge: MD, DO, PhD, etc. _________________________________________________________________________ Institution, City and State for name badge ___________________________________________________________________________ Address (where confirmation will be sent) ___________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ City, State, Zip ________________________________________________________________________________________________ Telephone (

)_____________________________________

Fax (

)____________________________________

E-mail ______________________________________________________________________________________________________

M I am a faculty member of this didactic or lunch session: _____________________________________________________________ M I will present abstract(s)# _____________________________________________________________________________________

BASIC FEE SCHEDULE Contact SAEM if you are unsure of your membership status. Non-members who wish to join SAEM and receive the discounted member registration rates must submit a completed membership application (including payment of dues) by April 2, 2001.

SAEM Members (please circle) Active or Associate Resident or Fellow Medical Student One-Day Registration (Date: _________)

Non-Members Physician Resident, Fellow Medical Student or Undergrad Nurse, EMT, PA, other Non-Physician One-Day Registration (Date: ________)

Early Registration (Received by 4/6)

Registration (Received after 4/6)

M $295 M $ 75 M $ 25 M $200

M $325 M $100 M $ 50 M $225

M $650 M $225 M $ 50 M $325 M $300

M $675 M $250 M $ 75 M $375 M $325

14

BANQUET TICKETS The Banquet will be held on the evening of May 6. Tickets must be purchased by May 1.

Active and Associate Members and Guests.....................................................................................______x $50 Residents, Fellows and Medical Students .......................................................................................______x $30

$ _______ $ _______

LUNCH SESSIONS Lunch sessions have limited enrollment and are $35 per ticket. Based upon space availability, limited spectator seating may be available for those wishing to attend, but not purchase a lunch. However, if an event is sold out, there may not be room for spectator seating (note: all lunches will be at the time each day, so do not register for more than one lunch per day).

May 6

M Women in Academic Medicine ...................................................................................................______x $35

$ _______

May 7

M Career Development for Clinical Chiefs ......................................................................................______x $35 M Ethics and Professionalism ........................................................................................................______x $35

$ _______ $ _______

May 9

M Lunch with Research Experts.....................................................................................................______x $35

$ _______

PRE-DAY WORKSHOPS AND SPECIAL SESSIONS Limited enrollment and an additional registration fee.

May 5

M Chief Residents’ Forum (limited enrollment, includes lunch) ..............................................................______x $100

$ _______

Your program’s name:______________________________________________________

May 6

M Medical Student Forum (limited enrollment, includes lunch and reception) ..............................................______x $75

$ _______

May 7, 9:30 PM

M Getting the Most Out of Your Palmtop (limited enrollment, pre-registration requested) ...........................______x $ 0

$ _______

May 8, 8:30-10:30 AM

M Evidence Based Medicine Workshop (limited enrollment, pre-registration required) ...............................______x $ 0

$ _______

May 9

M Evidence Based Medicine Workshop 9:00-11:00 AM (limited enrollment, pre-registration required) ...........______x $ 0 M Conflict Negotiation Workshop 1:00-4:00 PM — plus intro session at 11:00-12:00 (enrollment limited to 60)...______x $50 M IRB Certification for NIH Workshop 1:00-4:00 PM (enrollment limited to 50) ........................................______x $40

$ _______ $ _______ $ _______

TOTAL FEES DUE Basic Fee.................................................................................$______________ Banquet Tickets.......................................................................$______________ Lunch Sessions.......................................................................$______________ Special Sessions .....................................................................$______________

Payment can be made by check (payable to SAEM in U.S. funds) or credit card

Total ..............................$______________ CREDIT CARD INFORMATION M American Express

M MasterCard

Amount $ ________________

M VISA

Card Number: ___________________________________________ Exp. Date: __________________

Name as it appears on card: ____________________________________ Signature: ________________________________________ Full refund of fees will be made if cancellation is received by April 13, 2001. Cancellations after April 13 will have a 25% service fee deducted. No refunds after May 1.

15

Evidenced based medicine tables Predicted peak flow charts Medical Spanish terms Pregnancy dates calculators Immunization schedules ACLS and ATLS algorithms Electrolytes imbalance treatment guidelines Patient logs Procedures logs Anatomy databases

for the entire academic year, and a pediatric workup of the febrile infant/child algorithm.

J-File v.3.0 (Land-J Technologies) is an exceptional program that stores data in a spreadsheet-like fashion that can be organized in a searchable format. There are many J-File formatted databases available over the internet for the emergency physician, such as cerebral spinal, pleural, and synovial fluid interpretations, and normal lab values tables. Additionally, the user can create his or her own J-File databases for data storage. My PDA JFile homegrown databases include the entire faculty quarterly clinical schedules (as discussed earlier in scheduling section), a database of all of our past graduates (name, year of graduation, and spouse name), and pediatric databases which store data on drug dosing, normal values, and equipment size based on age and/or weight.

So whatâ&#x20AC;&#x2122;s in my PDA? 5 Minute Clinical Consult 2000 (Skyscape.com ) contains over 1,000 medical conditions, and provides their basic pathophysiology, laboratory and diagnostic testing, differential diagnosis, treatment and medication options, appropriate followup, and miscellaneous data including associated conditions, pregnancy and pediatric considerations, and references. The user can also add personal topics to the database in the same organized format. Clearly not a comprehensive reference text, it nonetheless provides quick and readily available information.

MedCalc v.2.8 (Mathias Tschopp, MD) is a program that contains formulas for commonly (and uncommonly) performed medical calculations. Examples include gestational age, water deficit, predicted peak flow, absolute neutrophil count, various corrected lab values, IV drip rate, anion gap, A-a gradient, creatine clearance, likelihood ratios, pre and post test probabilities, the all-important HendersonHesselbach equation, and many more. Just plug in the values and MedCalc automatically calculates your answer using the given equation.

Apothecarium 2000 (Skyscape.com) is a drug interaction database for 1,500 medications found in the LexiDrugs 2000 medication database that provides the significance level of a particular drug - drug interaction, as well as the mechanism of action, clinical effects, predisposing factors, patient management, and a discussion and references section.

Finally, there is a whole host of programs available for the PDA that although not specific to the practice of an academic emergency physician, nonetheless make the use of the PDA much more efficient and fun. Examples on my PDA include Quicknotes v.1.02 (Communication Intelligence Corporation) which provides a place to jot down temporary notes, RecoEcho v.1.0 which (Communication Intelligence Corporation) allows use of the entire PDA screen for graffiti writing and shows the ink pattern of the characters the user is writing, and Word Complete v.1.0 (Communication Intelligence Corporation) which creates a pop-up list of potential words as soon as two or more letters are traced on the PDA screen, allowing the user to simply pick the correct word instead of spelling out the rest of the word. This program allows the user to enter new medical nomenclature into its dictionary and significantly speeds up data entry.

Lexidrugs 2000 (Skyscape.com) contains over 1,500 medications, and provides brand names, indications, dosages, drug interactions, warnings/ precautions, contraindications, pregnancy risk factors classification, and dosage forms. Personal notes on any given medication can be added by the user, and new medications can also be added in the same organized fashion to a folder entitled Personal Drugs. Other drug databases Epocrates (Epocrates.com) and Tarasconâ&#x20AC;&#x2122;s Pocket Pharmacopeia (Tarascon.com).

Kidpack v.2.0 (Medical Data Solutions, Aaron E. Carroll, MD) is an integrated pediatric dosage calculator and code card, including emergency medications, antibiotics, equipment, lines, drips, etc.

Needed information can be searched via patient age and/or weight, and the complete formulary contains over 150 commonly used medications.

In summary, there are many ways in which the PDA can assist the academic emergency physician. A little bit of time spent on the internet, and perhaps a local departmental computer wizard, are all that is needed in beefing up your PDAâ&#x20AC;&#x2122;s capabilities. Good luck in your handheld computing!

Image Viewer v.2.1 (Arthur J. Dahm III, 1997) allows Windows.bmp files to be stored and read on your PDA. Images that I have on my PDA handheld are the EM1, EM2, and EM3 resident rotation schedules 16

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

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

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

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

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

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

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

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

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

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

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

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

CAS Sessions at the AAMC Annual Meeting David Sklar, MD University of New Mexico SAEM Representative to the AAMC/CAS The Association of American Medical Colleges met in Chicago on October 27-31, 2000. The theme of the meeting “Making a Difference” referred to the many ways that academic medical centers make a difference in the communities and lives of individuals they serve. The organization provides a forum for deans, hospitals, and specialty societies to exchange information and address areas of concern related to medical education, medical research, and clinical care of the most complicated and vulnerable populations.

At this meeting the issue of medical error and approaches to reduce it was presented in several settings. Jim Adams presented a synopsis of material that was developed from the May Academic Emergency Medicine Consensus Conference in May 2000.

The Association of Academic Chairs met in conjunction with the meeting and discussed the problem of over-

crowding, nursing shortages, and sponsored research. Proposals concerning overcrowding were given to SAEM President, Brian Zink and ACEP President, Robert Schafermeyer to develop a research agenda and task force development.

The keynote speaker of the conference was Colin Powell, who presented an entertaining discussion concerning leadership, community and commitment to the youth of the country. There were several presentations concerning the core competencies being developed for all residency programs and how they will be measured. The competencies are patient care, medical knowledge, practice-based learning and improvement, interpersonal skills and communication skills, professionalism, and systems based care. Emergency Medicine is probably further ahead at incorporating these principles into residency education but still will need to do a lot of work to measure success in achieving them. All residency programs should begin to consider how to incorporate those competencies into training.

17

Another interesting presentation was by Myrl Weinberg, President of the National Health Council. She discussed issues of importance from the patient perspective-timely care, enough time with a physician, involvement of family in care, honesty and clarity in discussing health issues, confidentiality and better treatment of pain. All of these issues are relevant to emergency medicine, and as we attempt to define value in our ED encounters it is important to understand the patient perspective.

Dr. Jordan Cohen, President of AAMC, addressed conflicts of interest in research; mostly relating to industry sponsored research. He suggested that a more stringent set of guidelines would be necessary to regain the public’s trust.

Overall, the meeting was stimulating, very big and a great place for networking with deans, CEOs, and other luminaries. Presentations of innovations in medical education and education research were also very interesting and useful. Next year it will be held in Washington, DC on November 2-7, 2001.

President’s Message (Continued) the ED, impulsively jumping into activities before considering all the ramifications may expend valuable time and energy in areas that do not prove to be meaningful for individual or departmental development.

One consequence of having energy to burn is that it is tempting to start a lot of little fires. I have already harped on this lack of focus in EM as it relates to research, but it goes beyond this area.

An example might be the academic emergency physician who is asked to serve as an expert witness in a malpractice case. The initial activity may be quite fun and instructive — a bit of review and research, the air of authority, an adrenaline rush on the witness stand, competitive interchanges with attorneys, and a nice financial benefit.

However, this type of work has great potential to expand, and the person who likes activity and stimulation can easily be drawn into devoting significant time to expert witness activities. When examined in the light of career development, contribution to the academic department, or time taken away from other important life activities, the activity may not be beneficial.

The end result of having too many activities and overextending is a decrease in the quality of professional life.

I was speaking with a colleague the other day who has achieved considerable success and is highly regarded as a clinician, researcher, teacher, and leader in academic EM. Seemingly, this person has every reason to be satisfied and proud of this “triple threat” success.

Instead, this person feels that by being involved in too many activities, in too many arenas, that nothing is done well.

The fulfillment that comes from careful and meaningful participation in an activity is diminished. This person expressed a loss of passion for academic EM due to feeling constantly overextended, and noted how hard it is to pull out of activities and projects once a commitment is made. Wellness experts would read this scenario as a classic case of burn out. Although some studies suggest that the attrition (burn out) rate in the field of emergency medicine is no higher than in other specialties, most of us know someone in academic emergency medicine who was a high energy, rising star, but could not effectively deal with too much activity and was lost to the field.2 Just as concerning to me as those who are lost to the field, is what I fear is a significant percentage of academic emergency physicians who are functioning at a less than optimal level, with diminished satisfaction in their careers due to being overextended. The fire that made them well-suited to academic EM, has been carried off like hot embers in so many

different directions that the central hearth is cold.

One of Covey’s effective habits is that a successful person “begins with the end in mind”. By looking before we leap, and fitting all activities into our master plan, we will more effectively use our energy.

In order to break the “activity for the sake of activity” habit, an academic emergency physician must carefully consider each potential new activity before agreeing to participate, and learn to say “no” to nonessential activities. It is also key to regularly schedule some down time into a hectic lifestyle.

2. A reactive rather than proactive approach — Although the history of emergency medicine is one of innovative and creative thinking, in the academic world we too often slip into the role of responding to others’ actions and decrees rather than initiating our own. Part of this is the new kid on the block syndrome. We are faced with decades and layers of academic hierarchy where emergency medicine has been absent, or an afterthought. In some academic centers, the concessions that were made to achieve the initial foothold for emergency medicine left the department with compromised, limited resources and power.

An example of taking a proactive approach is the way that one EM program worked to improve documentation of patient encounters. The program’s main teaching hospital, concerned about HCFA documentation requirements, made a new requirement that expanded history elements and medical decisionmaking be included on every ED chart.

The ED chart was hand-written by resident physicians, and many off service residents had poor documentation on ED charts. The EM faculty expressed concern that they would not be able to comply with the added documentation requirements with their current format. It would have been easy for them to be reactive and complain that they could not do the extra work required for this mandate. Instead, they came up with a proposal, that was accepted, for the institution to provide rapid turn around on dictated ED charts, and for in-service training of all resident physicians who work in the ED on including the key elements in a dictated note. These changes benefited both the EM department and the institution. The department had rapid access to a more legible, complete ED chart, and could increase its billings based on better documentation. The institution, at a cost that was considered reasonable, could ensure compliance with HCFA documentation requirements from the ED, and have a higher quality ED chart available to use for hospital billing and for communication with other physicians and clinics.

18

In many other areas, EM thinks outside the box, and has been an innovative field. As we become more established in academic medical centers, it is essential that we use the same approach when dealing with resident and medical student education, research programs, and faculty development. Administrators are much more likely to listen to those who point out a problem and propose a solution. If we can use our broad-based knowledge of the state of medicine, and our strategic position as the gateway to academic medical centers to come up with practical, proactive solutions to our clinical and academic problems, we will be much more likely to be asked to participate in institutional planning and policy-making. We will also be less likely to be served mandates, or forced into a reactive position.

3. I’ll do it my way- excessive independence — The nature of the EM beast is to have a strong independent streak. Many of us who went in to EM before it was well-established delighted in the perplexed looks on our medical school advisors’ faces when we announced that we were entering the field of emergency medicine. The founders of academic EM were truly mavericks — fiercely independent souls who had to constantly justify their existence.

While it was essential for the development of the field, this level of independence is no longer necessary in EM, and may be detrimental.

An example of this bad habit of excessive independence is a junior level academic emergency physician who is developing a teaching module for EM residents on the difficult airway, including alternative airway techniques. A few years back, the EM and anesthesiology departments at this institution had a turf battle over ED intubations that was eventually resolved. One of the Department of Anesthesiology senior faculty, is an internationally known expert on the difficult airway, and has extensive experience with developing educational programs in this area. Because of perceived ill will between the departments, the junior EM faculty member independently develops his educational course without consulting or collaborating with the person in the institution who is best positioned to help him. If he had asked, the junior faculty member would have found out that the Anesthesiology faculty member had no negative feelings about EM airway experts, and had in fact used EM faculty from other institutions as instructors in his off-site airway management courses. The Anesthesiology faculty member would have been delighted to meet someone with his interests, and would have been happy to work with the EM faculty member — if (continued on next page)

President’s Message (Continued) he had been asked. The end product could have been much better with collaboration.

Academicians thrive on collaboration — for many it is the main reason for being in the academic world. The ability to work together, to use the special knowledge and talents of non-EM faculty to complement our work, is absolutely essential for the continued growth of academic EM. Our behavior is analogous to that of some U.S. immigrant populations of the 19th and 20th centuries — stick together, don’t make waves, struggle to carve out a space.

The difference is that those immigrant populations usually assimilated within a couple generations, but we have not.

We can retain our independent spirit and be free thinkers, but we must develop a more synergistic relationship with other academic faculty. When we use the term “colleagues” our minds should envision all the other faculty in our institutions, not just those in our own departments.

4. Failure to think win/win — Management and negotiation experts advocate for a “win, win” approach to working with others.3 Emergency medicine is not very good at this — we sometimes take an umbrageous, uncompromising stance when we participate in institutional negotiations. Like the little stray dog that has been thrown scraps all its life, our first instinct in coming across a porterhouse steak may not be to share with the other dogs. An example of how failure to compromise can hurt is a young faculty member who has done some research in brain injury, and has a novel idea for a neuroprotective strategy.

The faculty member’s chair suggests that the faculty member consult with a noted brain injury researcher who is in the Surgery department. This experienced researcher meets with the faculty member, likes his idea, and offers to incorporate experiments on this new neuroprotective strategy into a grant that he is writing. He offers to bring the EM faculty member on as a co-investigator for the grant, but he will be the principal investigator. The EM faculty member is suspicious about this, and backs out of any collaboration. This short-sighted approach prevented a potentially valuable collaboration and mentoring relationship from developing. The EM faculty member was not experienced enough to be a principal investigator, and later found out that he could not independently get significant grant support for his idea. A win/win strategy in this case would have allowed the experienced Surgery faculty member to capitalize on a new idea, while the EM faculty member would have gained financial support, training, and access to research resources through the relationship.

The ability to compromise and think win/win is a big part of success as an academic department and an individual faculty member. While EM is good at improvising and making do with limited resources, we often have lingering suspicion toward those who were not welcoming to us years ago. It is time to dump this old baggage and get over the “us, them” mentality toward those who hold the power strings in our institutions. We have a highly visible, important position in teaching hospitals, and will be increasingly involved in the negotiations that are part of the big picture of the institution. If we can collaborate, work synergistically, and compromise, we will reach solutions that will help our institutions, our ED patients, and our EM education and research programs.

5. Failure to renew and retool — This final bad habit is one of omission.

Some of the other bad habits contribute to this one. People who are always on the go, active, unfocused, independent, may not take the time to develop a personal mission and plan for the future, or to regularly reassess their progress.

Contemplation, introspection, and planning for the future take a back seat to a continuous stream of clinical, academic, and family activities. This can also happen on a departmental level. The early years of a developing EM department are consumed with forming a stable clinical ED environment, getting a good residency up and running, and collecting a group of productive academic faculty. The years rush by and it can be half a decade before a blearyeyed department has reassessed itself and set goals and plans for the future.

I recently had the chance to visit an academic department that was the antithesis to this habit. The department, already regarded as having a fine, very competitive EM residency training program, was in the process of reassessing its resident and medical student teaching programs. The process started with a realization that resident and medical student education had slipped a notch.

Faculty members were having a harder time adapting to the pressures of increased ED patient volumes, increased documentation requirements, and the maturation into different roles that did not emphasize teaching. The chair of the department developed a new set of goals for education, and held an all day faculty retreat focused on teaching.

Faculty reviewed the goals, and their teaching activities, and decided both individually and collectively how teaching could be improved. A number of innovative ways to enhance teaching were discussed — from patient simulators to hiring an educational associate to assist faculty teaching. A number of good 19

habits were evident in this department.

First, there was a commitment to regular assessment, retooling, and refining activities to meet the department’s mission — this is what Covey calls “sharpening the saw”. Second, the chair mandated that faculty take the time for renewal by scheduling an offsite faculty retreat.

Third, the retreat looked at the big picture and did not get bogged down in daily details — it was mission-based. In this department the good habits fed on each other, and seemed to keep some of the inherent bad EM habits at bay.

Mission-based management, as advanced by the AAMC, is being incorporated into many academic health centers.4 It is imperative that we learn these principles, and how to adapt them to our academic departments.

The five bad habits I have observed may not be news to many of you, and they are certainly not as vile as the seven deadly sins. Some of you may take pride in your bad habits, and may have learned them from respected founders of emergency medicine. You may feel that changing these habits will turn you into an internist or neurologist.

My take on this is that it is possible to retain strong, active independent personalities as emergency physicians, but to smooth the edges of our approach, and move toward a more mature and refined position in the academic world.

If we can examine each activity in the light of a personal and departmental mission; if faculty and departments can collaborate with their academic brethren and negotiate with a proactive, win/ win posture; and if individuals and departments can regularly take the time out to reassess, retool, and sharpen their blades, we can prosper in the academic environment. When academic emergency physicians and departments of emergency medicine can expunge some of these old, bad habits, and practice the converse, we will be a stronger, happier, more productive specialty.

Acknowledgement: I would like to thank Dr. Susan Stern for her help in developing the ideas and organization of this essay.

References 1. Covey, SR. The Seven Habits of Highly Effective People. Simon and Schuster, NY, 1989 2. Reinhart MA, Munger BS, Rund DA. American Board of Emergency Medicine longitudinal study of emergency physicians. Ann Emerg Med 1999; 33:22-32.

3. Fisher R, Ury W, Patton B. Getting to Yes. 2nd edition. Penguin Books, NY, 1991.

4. American Association of Medical Colleges: Mission-Based Management.

Washington, D.C., 2000.

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

Candidates must be board certified or prepared in emergency medicine.

Established emergency medicine residency program with eight residents per year. Spacious ED facilities. Childrenâ&#x20AC;&#x2122;s hospital and beautiful pediatric ED. Over 50,000 visits per year. Level I trauma center for pediatric and adult patients. Energetic young faculty with diverse academic backgrounds. Augusta is an excellent family environment and offers a variety of social, cultural, and recreational activities. Compensation and benefits are excellent and highly competitive. Please contact: Larry Mellick, MD, Chair and Professor, Department of Emergency Medicine, 1120 15th St. AF 2036, Augusta, GA 30912; 706-721-7144; e-mail: Lmellick@mail. mcg.edu EOE/AA

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

Join an independent democratic group of board certified emergency physicians staffing 2 hospitals including a large trauma center and a community hospital. WakeMed emergency department sees over 90,000 visits annually, includes a separate Childrenâ&#x20AC;&#x2122;s Emergency Department, and is a major teaching site for emergency medicine residents. Affiliated with the University of North Carolina at Chapel Hill emergency medicine residency. Academic appointment based on credentials. Excellent mix of clinical, research, educational, and administrative duties.

Excellent compensation and benefit package with ample protected academic time. Interested applicants should send CV to Lance Brown, MD, MPH, Interim Director of Education, Department of Emergency Medicine, WakeMed, PO Box 14465, Raleigh, NC 27520-4465. (919) 350-8823, fax (919) 350-8874; e-mail: LBROWNMD@AOL.com.

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

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

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

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

Salary and benefits are extremely competitive.

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

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

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

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

20

UNIVERSITY OF CONNECTICUT: Community Faculty. Excellent new opportunity for clinically inclined EM physician looking for community practice with teaching affiliation. New hospital with modern 38,000 visit ED, 9-hour shifts, dictation, and Fast Track coverage by PAs. Central location allows easy access to beaches, cities, schools, countryside and all other benefits of New England lifestyle. Clinical and academic relationship with EM residency and tertiary care hospital. Inquiries to Robert D. Powers, MD, MPH, Professor & Chief, Hartford Hospital/UCONN Emergency Medicine. Please use email: Rpowers@Harthosp.org.

MICHIGAN:

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

CONNECTICUT Medical Director. Community ED affiliated with large tertiary care system. MidState Medical Center has 41,000 visits, new physical plant, generous compensation and benefits. Opportunity for faculty appointment and residency involvement at UCONN/Hartford Hospital. Convenient to NYC, beaches, mountains. Inquiries/CV to: Robert D. Powers MD MPH, Professor & Chief of EM, UCONN/Hartford Hospital. Please use email: Rpowers@harthosp.org UNIVERSITY OF FLORIDA/JACKSONVILLE is expanding its Emergency Medicine operations. Full and part-time clinical opportunities available at Orange Park Medical Center and Shands Jacksonville (formerly Methodist Medical Center and University Medical Center). Positions are nontenure accruing; salary is negotiable. Full-time (1.0 FTE) positions offer faculty appointments to the University. Part-time positions pay competitive hourly rates. If interested, fax current CV to Dr. Robert Luten, Chairman, Search Committee, (904) 549-5666 or e-mail luten.robert@ufl.edu.

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

NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM

DUKE UNIVERSITY DUKE UNIVERSITY HEALTH SYSTEM

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

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

Please forward resumes and inquires to: Andrew Sama, MD, Chairman Department of Emergency Medicine North Shore University Hospital 300 Community Drive Manhasset, NY 11030 (516) 562-3090 Phone â&#x20AC;˘ (516) 562-3680 Fax E-Mail: asama@nshs.edu

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

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

Faculty at all academic levels are invited to apply.

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

21

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

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

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

UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS: Unique academic opportunity in EM. EM faculty will have an opportunity to be involved in the establishment of a first-rate EM division committed to excellence in patient care, education and clinical research.

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

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

WAYNE STATE UNIVERSITY/SINAI-GRACE HOSPITAL Department of Emergency Medicine is now hiring BC/BE Emergency Physicians. Great opportunity for academic growth (Basic Science Research, Clinical Research, Toxicology and Administration). Well established EM Residency accepting 9 residents annually. Newly built Emergency Department seeing approximately 60,000 visits annually. High acuity, Detroit area Trauma Center. Join energetic, highly motivated faculty with diverse backgrounds. Compensation and benefits are highly competitive. Please contact: Brooks F. Bock, MD, Professor and Chair, Wayne State University School of Medicine, Department of EM, 4201 St. Antoine, Detroit, MI 48201, (313) 745-3330, bbock@med.wayne.edu.

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

The University of Alabama at Birmingham Emergency Medicine Fellowship We are seeking an emergency medicine residency graduate for an injury control research fellowship. This well-compensated position provides the Fellow with training required for a Masters in Public Health. In addition, training in research methodology, publication and grant preparation is provided. Course work includes computer applications, biomedical statistics, principles and applications of research design, data acquisition and analysis. We will also provide excellent opportunities for collaborative laboratory and clinical research.

The University of Alabama at Birmingham is an 851-bed teaching hospital, Level I Trauma Center with 42,000 ED patient visits annually. Our Department of Emergency Medicine has more than one million dollars per year in extramural research funding and the School of Medicine ranks 13th among all NIH-funded programs. Our Injury Control Research Center is fully funded through the Centers for Disease Control and our Departmental Sponsor is well-funded with extramural support of this position. Moreover, under the direction of our newly appointed Chair, Dr. Thomas Terndrup, our department is growing rapidly and plans to begin an emergency medicine residency program soon.

For more information about this opportunity please contact: Kurt R. Denninghoff, M.D., Research Director Department of Emergency Medicine University of Alabama at Birmingham 266 N. Jefferson Tower 619 South 19th Street Birmingham, Alabama 35233-7013 (205) 975-7458 • FAX (205) 975-4662 E-Mail: Kdenning@uabmc.edu

22

RESEARCH FELLOWSHIP POSITION The Department of Emergency Medicine at Carolinas Medical Center is offering a one-two year research fellowship starting after July 1, 2001.

The training focus can concentrate in three areas: 1) Rapid clinical diagnosis of fatal disease processes; 2) Combined clinical and laboratory study of cardiovascular adaptation to acute stress; 3) Laboratory research in the development of metabolic therapy for treatment of shock. The Fellowship Director is Jeffrey A. Kline, MD. A 38month MD-PhD option is available.

The first-year salary is $40,000 plus benefits. Applicants must be boardcertified or board-eligible in Emergency Medicine from a U.S. residency program. Contact Jeff Kline at Jkline@ carolinas.org for further information.

Highland General Hospital

HARVARD INTERNATIONAL MEDICINE

Department of Emergency Medicine Associate Residency Director Position

Fellowship

We are seeking a committed academic emergency medicine physician with aspirations to pursue an administrative role related to the ongoing growth and development of our residency training program. The position is based in the Alameda County Emergency Department at Highland General Hospital with an academic appointment at the University of California San Francisco Medical School. Our program is based in an emergency department that treated over 60,000 patients in 2000 and serves as the trauma center and base station for Alameda County. The residency program recently celebrated its 20-year birthday and has grown from 12 residents in 1980 to 40 in 2001.

This opportunity exists to fill the void left by our prior associate residency director who has accepted the position as program director at another institution. Qualified candidates must have completed an approved Emergency Medicine Residency Training Program with ABEM board eligibility or certification. Experience in an academic setting beyond residency training is preferred. The successful candidate will join 12 full-time academic emergency physicians in an active clinical department with a successful ongoing research program. Generous academic/administrative protected time, a competitive salary and benefit package in addition to a unique and stimulating environment make this an attractive opportunity in academic emergency medicine.

Inquiries should be accompanied by a curriculum vitae and may be addressed to: Barry Simon, MD, Chairman E-mail: barrys@hghed.com Highland General Hospital Phone: 510-437-4564 Department of Emergency Medicine Fax: 510-437-8322 1411 E. 31st Street Oakland, California, 94602

The section of International Medicine and the Division of Emergency Medicine at Harvard Medical School are now accepting applications for their International Medicine Fellowship.

Fellowship involves: • Two-year track combining clinical emergency medicine, international fieldwork and project • Academic classes lead to a master degree at the Harvard School of Public Health • Academic appointment at Harvard Medical School • Clinical emergency medicine at affiliated teaching hospitals* • Participation in training of medical students and residents • Competitive salary, benefits, CME, international travel funds, and training course expenses • Opportunity to tailor experience to meet interest in disaster response, medical neutrality, human rights, health emergencies in large populations, international public health, and refugee relief Requires: • Residency Training Emergency Medicine or Internal Medicine • Completion of application process, interview, and selection Inquiries should be sent to the fellowship director: Daniel Gurr, MD, Section of International Medicine, Department of Emergency Medicine, Brigham and Women’s Hospital, PBB-Ground-Pike, 75 Francis Street, Boston, MA 02115 or by e-mail dgurr@partners.org, (617) 732-5989, or (617) 264-6848 fax.

23

IOWA: emergency medicine faculty positions are available. We have a wonderful opportunity to build emergency medicine excellence in a superb academic setting. Iowa is a level I trauma center with an active air medical program. Emergency medicine faculty are positioned in a tenure or non-tenure clinical tract within the Program in Emergency Medicine, College of Medicine, University of Iowa. Comprehensive back-up is readily available. Growing volume (29,000/year), with interesting patient mix. There is 30 to 36 hours of attending coverage daily plus PAs. Residents from IM, FP, OB/GYN and pediatrics rotate in the ED. There are opportunities in curriculum development, EMS, telemedicine, ALS education, paramedic training, and research. Salaries and schedules are competitive, fringe benefits are excellent. Both part-time and full-time positions available. Iowa City offers a superb school system and a great life style.

Applicants should send a CV to Andrew Nugent, MD, Program in Emergency Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Room 1193-Carver Pavilion, Iowa City, IA 52242.

The University is an Equal Opportunity and Affirmative Action Employer. Women and minorities are strongly encouraged to apply.

11th Annual Midwest Regional SAEM Research Forum

Advertising Positions Available at Annual Meeting

Hyatt Regency Hotel-Union Station St. Louis, Missouri September 15, 2001

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

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

The Program Committee is now accepting abstracts for oral and poster presentation at the 11th Annual Midwest Regional Research Forum to be held at Hyatt Regency HotelUnion Station in St. Louis, Missouri on September 15, 2001. Deadline for abstract submission is Saturday, June 30, 2001. Information about the meeting and hotel reservations can be obtained by contacting Linda Barth or Michael Mullins, MD, at the Division of Emergency Medicine, Washington University in St. Louis, Campus Box 8072; 660 S. Euclid Avenue; St. Louis, MO 63110-8072.

Telephone: 314-362-8971; Fax: 314-362-0478; e-mail: barthl@msnotes.wustl.edu or mullinsm@msnotes.wustl.edu

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

$300

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

$350

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

$450

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

24

SAEM Membership Application Please complete and send to SAEM with appropriate dues, $25 initiation fee, and supporting materials.

SAEM • 901 N. Washington Ave. • Lansing, MI 48906 • 517-485-5484 • 517-485-0801 Fax • saem@saem.org Name_________________________________________________________________ Title: MD

DO

PhD Other____________

Home Address_________________________________________________________ Birthdate____________________ Sex: M

F

___________________________________________________________________________________________________________ Business Address ____________________________________________________________________________________________ ___________________________________________________________________________________________________________ Preferred Mailing Address (please circle):

Home

Business

Telephone: Home (_______)________________________________

Business (_______)________________________________

FAX: (_______)____________________________________________

E-mail:__________________________________________

(Required for Active Membership) Medical School or University Faculty Appointment and Institution ________________________________________________________ Membership benefits include: • subscription to SAEM’s monthly, peer-reviewed journal, Academic Emergency Medicine • subscription to the bimonthly SAEM Newsletter • reduced registration fee to attend the SAEM Annual Meeting Check membership category:

□ Active

□ Associate

□ Resident

□ Fellow

□ Medical Student

Active: open to individuals (a) with an advanced degree who hold a medical school or university faculty appointment and actively participate in acute, emergency, or critical care in an administrative, teaching or research capacity; (b) with similar degrees in active military service or (c) who otherwise meet qualifications but who do not hold a faculty appointment and who petition the Membership Committee. Annual dues are $295 plus a $25 initiation fee payable when the application is submitted. The application must be accompanied by a CV. Associate: open to health professionals, educators, government officials, members of lay or civic groups, or members of the public who have an interest in Emergency Medicine. Annual dues are $275 plus a $25 initiation fee payable when the application is submitted.

The application must be accompanied by a CV. Resident/Fellow: open to residents and fellows interested in Emergency Medicine. Annual dues are $90 plus a $25 initiation fee payable when the application is submitted. The application must be accompanied by a letter from the director verifying that the applicant is a resident or fellow and the anticipated graduation date. (A group discount resident member rate is available. Contact SAEM for details.)

Medical Student: open to medical students interested in Emergency Medicine. Annual dues are $75 (includes journal subscription) or $50 (excludes journal subscription), plus a $25 initiation fee payable when the application is submitted. The application must be accompanied by a letter verifying that the applicant is a medical student and the anticipated graduation date.

Interest Groups: SAEM members are invited to join interest groups. Include $25 annual dues for each interest group: M airway M CPR/ischemia/reperfusion M clinical directors M clinical skills M diversity M disaster medicine M domestic violence

M ems M ethics M evidence-based medicine M geriatrics M health services & outcomes research M injury prevention M international

M medical student educators M neurologic emergencies M pain management M pediatric emergency medicine M research directors M substance abuse M toxicology

M trauma M ultrasound M web-educators M youth violence prevention

My signature certifies that the information contained in this application is correct and is an indication of my desire to become an SAEM member.

Signature of applicant___________________________________________________________________ Date__________________ 25

Medical Student Forum May 6, 2001, Atlanta

Untapped Opportunities for Emergency Medicine in Healthy People 2010

The Medical Student Forum is intended to help the medical student understand the residency and career options that exist in emergency medicine, evaluate residency programs, explore research opportunities, and select the right residency. Enrollment is limited so register now. The registration fee is $25 for the Annual Meeting (May 6-9), plus $75 for the Medical Student Forum. Register on-line at www.saem.org 9:30 am Introduction 9:45 am Emergency Medicine: Present and Future.

John Marx, MD, Carolinas Medical Center, and Judith Tintinalli, MD, University of North Carolina, Chapel Hill The speakers will discuss the current status of EM in academic health centers, the job market, healthcare and legislative reform. The future of EM will be discussed in regards to job opportunities, research foci and societal impact.

10:30 am Is A Career In Emergency Medicine a Good Fit for You? Rita Cydulka, MD, Metrohealth Medical Center, and Steven Dronen, MD, University of Michigan The characteristics of a good emergency physician and the appeal of the specialty will be discussed. The difficult aspects of a career in EM will also be discussed, as well as the wrong reasons to seek a career in the specialty.

11:30 am Research Opportunities in Emergency Medicine. Michelle Biros, MS, MD, Hennepin County Medical Center Dr. Biros will provide an overview of research in EM and discuss how medical students can become involved in EM research.

Linda DeGutis, MD SAEM Public Health and Education Task Force Yale University The National Healthy People Consortium Meeting, “Implementing Healthy People 2010” was held on November 11, 2000 in Boston. Healthy People 2010 sets the nation’s health agenda for the next decade. This includes objectives for disease prevention and reduction of morbidity and mortality in a broad range of areas, and issues of concern to specific population subgroups. The objectives address the primary threats to health in our country. Three representatives of emergency medicine; Lynne Richardson, MD, Jon Mark Hirshon, MD, MPH and Linda C. Degutis, DrPH, participated in the meeting. The breakout sessions were geared toward moving from the final objectives, which were released at the meeting, to implementation of strategies for achieving these objectives.

The areas covered by HP 2010 include many that are of interest to emergency medicine, including but not limited to access to quality health services, heart disease and stroke, HIV, injury and violence prevention, medical product safety, respiratory diseases, mental health and mental disorders, sexually transmitted diseases, substance abuse, occupational safety and health, and tobacco use. These topics as well as implementation issues related specifically to adolescents and young adults, older adults, children, people with low socioeconomic status, gays and lesbians, women, men, and rural health were addressed at the November meeting.

Emergency medicine has an important role in this process, as we see the results of failed attempts at prevention and intervention. There are opportunities for preventive strategies in the ED, as well as potential for designing community-based efforts in collaboration with other health professionals and community-based organizations. The HP 2010 objectives can be used on a local level to drive these efforts, and to measure their impact.

HP2010 objectives also provide a focus for research and evaluation. As these objectives are an integral part of the Department of Health and Human Services (DHHS) efforts to improve the health of our nation, they are very useful tools that can be used when applying for funding from federal agencies as well as foundations.

It is important that we continue to be involved in these efforts, as we can make major contributions to this initiative, and can also benefit the field of emergency medicine. The SAEM Public Health Task Force plans to continue to take an active role in this process and we encourage other members of SAEM to become knowledgeable about HP 2010 and to use this document in their practice and research.

12:00

Lunch with Program Directors

1:30 pm

Taming the Residency Application Process.

Sam Keim, MD, Arizona Health Science Center, Carey Chisholm, MD, Indiana University, and Peter DeBlieux, Charity Hospital, LA-LSU Division This discussion is geared toward third year medical students who will be applying for a residency position in EM. General qualifications for an EM applicant will be discussed, as well as how to prepare the ERAS application.

3:00 pm

How to Select the Right Residency for You. Robert McNamara, MD, Temple University Hospital An overview of EM residency programs will be discussed. Dr. McNamara will describe important factors to consider in the selection process: length of training; geographical location; patient demographics and academic versus clinical emphasis.

4:00 pm

Career Paths in Emergency Medicine Academics, Private Practice and Fellowship Opportunities. Scott Syverud, MD, University of Virginia, Eric Kardon, MD, Athens, GA, and Leslie Wolf, MD, Wright State University The speakers will provide information about career paths in academics, private practice and fellowship training. Each discussant will describe their type of practice, including the benefits and drawbacks.

5:30 pm

Reception with Program Directors and Chief Residents

Additional information about Healthy People 2010, including copies of the objectives, are available through DHHS at: http://www.health.gov/healthypeople/Implementation/.

26

Chief Residents’ Forum May 5, 2001, Atlanta 8:05 am

Professional Growth and Success as a Chief Resident, Steven Dronen, MD, University of Michigan This session will describe the advantages and pitfalls of being a chief resident, the importance of developing short and long term goals, with specific examples; the importance of selecting a role model and developing a mentoring relationship; and the challenges of transitioning to the role of Chief Resident and mechanisms to facilitate this change.

8:30 am

Characteristics of Good Leaders, Scott Syverud, MD, University of Virginia This session will discuss the qualities of a good leader, (e.g., organizational skills, honesty, communication skills, consistency), the methods to incorporate leadership skills into one’s daily life, and methods to motivate others.

9:00 am

Ethics and Professionalism, Jim Adams, MD, Northwestern University This session will discuss ethical and confidential issues that involve other residents, how to set professional examples for others, and how to represent your department in the hospital setting.

9:30 am

Small Group Discussion Each group will consist of 15 chief residents and a faculty member. Case scenarios will be used to teach and review problem-solving techniques that may be used during one’s term as chief. The cases will be used to discuss ethical dilemmas (e.g., ethics and professionalism) and methods of dealing with the biomedical industry.

11:00 am

Staying Organized/Time Management Skills, Carey Chisholm, MD, Indiana University This session will discuss benefits of time management, methods for efficient time management, and activities and attitudes that cause disorganization.

11:45 am

Scheduling Tips, Kevin Rodgers, MD, Indiana University This session will discuss RRC mandates as they apply to resident scheduling, different methods for scheduling shifts (e.g., varying shift lengths, advancing shifts), and factors that can affect a schedule and how to deal with sudden changes (e.g., illness or injury).

12:15-1:30 pm

Lunch/Question and Answer Session This session is an opportunity for chief residents to meet the speakers and ask questions in a relaxed atmosphere. Each speaker will sit at a table with a group of residents.

1:30 pm

The Resident in Crisis, Robert McNamara, MD, Temple University During this session chief residents will learn how to define an impaired resident, become familiar with ways to identify an impaired resident, and review roles and responsibilities of the chief resident as they pertain to the impaired resident, including reporting responsibilities, confidentiality.

2:00 pm

The Chief Resident as a Teacher, Steve Hayden, MD, University of California, San Diego This session will include the advantages and disadvantages of the lecture format, and alternatives to this method; effective speaking and presentation techniques; and effective clinical bedside teaching techniques.

3:00 pm

Management Techniques, Felix Ankel, MD, Regions Hospital, Michelle Grant Ervin, MD, Howard University, and Carey Chisholm, MD, Indiana University The panel will discuss how to run an effective meeting; delegation skills, including the importance of clear communication, firm deadlines, not over delegating and following through after delegation has occurred; techniques for conflict resolution, and the importance of consensus building and methods of achieving consensus on specific issues.

3:45 pm

The Role of the Biomedical Industry in GME, Sam Keim, MD, University of Arizona This session will examine the relationship of the physician to the biomedical industry, the ethical conflicts arising from the relationship of the physician to the biomedical industry, and how to develop an ethical relationship with the biomedical industry.

The Chief Residents’ Forum will be held the day before the SAEM Annual Meeting and is sponsored by EMRA and SAEM. Enrollment is limited and over 200 registrants are expected, so register today. The registration fee for the Annual Meeting is $75 for SAEM resident members, plus $100 for the Chief Residents’ Forum. Annual Meeting registration fees increase $25 after April 6. Register on-line at www.saem.org

27

NEWSLETTER

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

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

Presorted Standard U.S. Postage P A I D 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 Jennifer Mastrovito Jennifer@saem.org

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

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

1st Annual New York State Regional SAEM Conference March 12 & 13, 2001 University of Rochester Medical Center

4th Annual Mid-Atlantic Regional SAEM Conference March 31, 2001

Guest Lecturer: Brian Zink, MD

Adam’s Mark Hotel — Charlotte, NC

President, SAEM Associate Professor of Emergency Medicine Assistant Dean University of Michigan

Keynote Addresses: Judith Tintinalli, MD; and John Marx, MD, “The Editor’s Perspective” For information, contact Jeff Kline, MD: JKline@carolinas.org

Questions regarding the logistics of the meeting should be addressed to Sheila K. McCart, Assistant Director for Conferences, URMC, 601 Elmwood Ave., Box 677, Rochester, NY 14642-8677; fax: (716) 275-3721; email: skmccart@cpe.rochester.edu.

SAEM Western Regional Research Forum March 17-18, 2001

Southeastern Regional SAEM Conference March 23-25, 2001

Hyatt Newporter Hotel Newport Beach, California

Radisson Hotel New Orleans, Louisiana

HOTEL: The meeting will be held at the Hyatt Newporter, 1107 Jamboree Rd., Newport Beach, CA 92660, phone 949.729.

1234 or fax 949.644.1552. Room rates for March 16-18, single $210/double $235.

HOTEL: The meeting will be held at the Radisson Conference Center Hotel, 1500 Canal Street, New Orleans, LA 70112, phone (504) 522-4500. Room rates, single/dougle $129, triple $144.

FEES: Checks should be made payable to “LSUHSC Foundation” and mailed to Stephanie Dudenhefer, Residency Coordinator, Emergency Medicine Residency Program, 1532 Tulane Avenue, Suite 1351, Charity Hospital, New Orleans, LA 70112.

For more information, contact Peter DeBlieux, MD: pdebli@ lsuhsc.edu

FEES: Checks should be made payable to “Center for Health Education” or CHE and mailed to Long Beach Memorial Medical Center, Attn: Center for Health Edu., 2801 Atlantic Ave., Long Beach, CA 90806. Visa and MasterCard only. Our tax ID# is 95-3527031