May-June 2001

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE What a Great Meeting!

Atlanta was Grand!

I am honored to serve as the 2001-2002 SAEM President. I am honored to represent the Society for Academic Emergency Medicine and I am looking forward to the “March to the Arch at St. Lou in 02” for the 2002 meeting.

Marcus Martin, MD I have the great opportunity to learn from the many great SAEM presidents who served before me. My term on the Board extends over the following 10 presidents: Barsan, Ling, Binder, Sklar, Goldfrank, Dronen, Marx, Syverud, Schneider and Zink. Much has been accomplished by SAEM during this period of time. It has also been my great fortune to witness the academic quality/caliber of our young SAEM members grow over the years. As Chair of the Nominating Committee this past year, I was very much impressed by the educational and research accomplishments of the nominees for the Young Investigators award. I congratulate the Young Investigator award winners, as well as all the SAEM award winners recognized at the annual business meeting and to those who were elected to SAEM positions.

Thanks to all the nominees who did not win awards or who were not elected to positions. You are all winners.

The SAEM Annual Meeting in Atlanta was just grand.

When I arrived in Atlanta I felt warm and welcomed. Atlanta is a culturally rich city. At the airport in Atlanta, a large mural on the wall at the main terminal caught my attention. It was a picture of children of many races/ethnicities representing “Rainbow Atlanta”. An article, appeared in the Atlanta Journal-Constitution on Sunday, May 6, 2001 while the meeting was taking place, entitled “Rainbow Atlanta: Census shows racial barriers disappearing in the city, suburbs.” The people of Atlanta and the hotel, staff and amenities, were all top-notch. People were friendly and they provided outstanding services.

The meeting was well attended and well organized. The atmosphere was exciting and enthusiasm was evident everywhere. The membership took advantage of the many opportunities offered.

The SAEM family is diverse and talented. As I attended committee and task force and interest group meetings, I saw people involved who may not have been involved in the past.

Residents and faculty were mingling and working harmoniously together. This is a sign of a great SAEM family. Meeting participants were advancing research and education in emergency medicine, which hopefully will improve patient care. (continued on page 19)

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

May-June 2001 Volume XIII, Number 3

Update on SAEM Research Funding Programs Brian J. Zink, MD Past President, SAEM University of Michigan James Quinn, MD Chair, SAEM Grants Committee University of California, San Francisco SAEM began funding research over a decade ago when Medtronic Physio Control began supporting the EMS Research Fellowship. But for many years this was the only SAEM research training grant. In 1989 SAEM reserves were used to create the Fund for Academic Emergency Medicine (FAEM), and we began funding a Resident Research Year Award and a Scholarly Sabbatical Grant. In the past year the SAEM designated research as a focus area. After a great deal of discussion with SAEM members, investigators, and past grant recipients the Board decided to drop the FAEM designation, which we think may have been confusing to some members and potential contributors. Now our research funding program will be referred to simply as that: the SAEM Research Fund.

More has changed than just the name — we decided to increase research funding this year by forming two new grants. The Resident Research Year Award has been renamed the SAEM Research Training Grant, and the award period is now two years with funding of $150,000. This is a research fellowship grant available to EM residents and junior faculty. A totally new grant, the Institutional Research Training Grant, will allow an EM program to develop a two year research fellowship, also funded at $150,000, at their site, and to recruit for a fellow to fill that position. As has been previously announced, we also have a new grant this year, the one year $50,000 Neuroscience Research Fellowship that is supported by AstraZeneca. The EMS Research Fellowship, sponsored by Medtronic Physio Control, will also be offered, and we are pleased to announce that the amount of this grant has been increased from $50,000 to $60,000 per year. For a full listing of SAEM grants, see the summary on the last page of this Newsletter.

SAEM is committed to providing even more research training grants. We would eventually like to be able to offer a number of these grants in each category, rather than just one a year. In order to do this, we will obviously need to increase the SAEM Research Fund. The Board of Directors, with input from the Financial Development Committee, chaired by Scott Syverud, will be exploring ways to increase funding, including whether there is a need for a formal development program.

We will be reaching out to the corporate world, and to private donors. As SAEM members, we encourage you to contribute to the SAEM Research Fund on an annual basis through the

(continued on page 3)

AACEM Elections Held in Atlanta

SAEM Election Results Announced

The Association of Academic Chairs of Emergency Medicine (AACEM) convened an all-day meeting and retreat on May 5 in Atlanta. The meeting was organized by Brian Gibler, MD, AACEM President. Annual elections were held during the AACEM Annual Business Meeting. Francis Counselman, MD, Eastern Virginia Medical School, was elected Presidentelect. Jerris Hedges, MD, Oregon Health Sciences University, was elected Secretary-treasurer. Dr. Gibler was succeeded as AACEM President by John Gallagher, MD, Montefiore Medical Center.

During the Annual Business Meeting in Atlanta Dr. Zink reported on the newly established election procedures which had been approved by the membership through amendments to the SAEM Constitution and Bylaws. Dr. Zink noted that these amendments allowed for the SAEM election to take place via mail ballot, rather than requiring members to be present at the Annual Business Meeting to vote. Dr. Zink reported that ballots for all elected positions were mailed to all active members and that ballots for the resident member of the Board were mailed to all resident members. Over 750 active member ballots and over 300 resident member ballots were returned to the SAEM office and the results were as follows:

Tales . . . “Moving On” Being members of the human race, there is grouping of persons with like relations called family that we all connect with in some fashion. The family focus for each of us varies and may entail relationships with grandparents, parents, siblings, spouses, children, grandchildren, uncles, aunts, cousins, nieces, nephews, and yes even pets and the greater SAEM family. “No society is so precious as that of one’s own family” (Thomas Jefferson 1789). My biggest family focus over the past quarter of a century has been all the above but primarily my wife, 2 sons 2 daughters, 2 dogs (Binky and Peanut) and 2 cats (Lion and Karma). Along the way there were turtles, hamsters, guinea pigs, rabbits, fish, frogs, etc. I think you get the picture.

As the SAEM president, you will have to put up with me from time to time as I tell tales from the crib (home) to accompany newsletters. Over the years, each of my children has had assigned chores around the house (take out garbage, wash dishes, clean pool). They have been encouraged to manage their time (rules such as no TV or telephone calls or games for a period of time after dinner so that home work could be completed). The dogs and cats also had to follow rules, especially as they relate to not leaving unwanted gifts inside the house, messing with the plants by kicking out dirt on the floor or destroying household structures. There were joyful moments brought by the animals such as the litters of kittens born in the girls’ bedroom closet, puppies born in the basement, etc. Assignment of chores and time management generally ended with good results. Sometimes, however, the well-meaning child can cause some headaches by performing unassigned chores.

As I completed my residency in Cincinnati years ago, I prepared to move my family to Pittsburgh. Fish that we had nurtured for a few years seemingly doubled in size overnight, and were floating belly up in the fish tank. Our mistake was leaving the fish tank and a box of laundry detergent mistaken for fish food in reach of one of our toddlers who fed the fish. I have learned to keep everything out of a toddler’s reach. I was sorry to lose the fish, but I had one less packing concern. We have not had much success with sustaining fish over the years, but dogs and cats (to my wife’s dismay) are proliferative and perpetual around our house. We no longer have toddlers but we certainly have a lot of precious experiences to remember.

Congratulations to graduating EM residents, fellows and to those taking on new jobs. Good luck with the move for all those facing the challenge this year. Don’t forget to forward your new address to the SAEM office.

Marcus Martin, MD SAEM President

President-elect: Roger Lewis, MD, PhD, Harbor-UCLA Board of Directors: Carey Chisholm, MD, Indiana University Glenn Hamilton, MD, Wright State University Debra Houry, MD, Denver Health Medical Center Nominating Committee: Leon Haley, MD, Emory University Jeff Kline, MD, Carolinas Medical Center Constitution and Bylaws Committee: Linda Spillane, MD, University of Rochester Because Dr. Lewis was the current SAEM Secretary/treasurer at the time of his election as President-elect, an unexpired term on the Board remained. Therefore, following the Annual Business Meeting, in compliance with the Constitution and Bylaws, Marcus Martin, MD, SAEM President, announced the appointment of current Board member, Don Yealy, MD, University of Pittsburgh, to serve as Secretary/Treasurer. Dr. Martin also appointed Felix Ankel, MD, Regions Hospital, to serve a one-year term on the Board of Directors to complete the complement of eleven members of the SAEM Board of Directors.

In addition to the announcement of election results, the annual SAEM awards were formally presented at the Annual Business Meeting: Leadership Award: Louis Binder, MD, MetroHealth Medical Center Academic Excellence Award: Emanuel Rivers, MD, Henry Ford Hospital Resident Research Year Awards: Roland Merchant, MD, Brown University, and Jason Haukoos, MD, HarborUCLA EMS Fellowship: Gina Wilson-Rameriz, MD, University of New Mexico Young Investigator Awards: David Wright, MD, Emory University, Robert O. Wright, MD, Brown University, and Terry Venden Hoek, MD, University of Chicago 2000 Annual Meeting Awards: Suzanne Schuh, MD, Emanuel Rivers, MD, Laurence Katz, MD, Xin-liang Ma, MD, PhD, David Wright, MD, D Matthew Sullivan, MD, Geoffrey Jackman, MD, Brigitte Baumann, MD, Joshua Rucker, BSc, and Valerie De Maio Dr. Zink presented his Presidential Address (see page 7 of this Newsletter) and introduced incoming President, Marcus Martin, MD, University of Virginia, who presented his first address to the membership during a special reception at the Jimmy Carter Center, which was sponsored by the Department of Emergency Medicine at Emory University.

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CORD Meets in Atlanta

Annual Meeting Presentation Awards Announced

Approximately 200 members attended the Council of Emergency Medicine Residency Directors (CORD) Meeting in Atlanta on May 7. Steve Hayden, MD, from the University of California, San Diego was elected President-elect, Susan Dufel, MD, from Hartford Hospital, was elected Secretary/Treasurer, and Mary Jo Wagner, MD, from Saginaw Cooperative Hospitals, Inc. was elected to the Board of Directors. The CORD Faculty Teaching Award was presented to James Ritchie, MD, from Portsmouth Naval Hospital. The CORD Resident Academic Achievement Award was presented to Andra Blomkalns, MD, from the University of Cincinnati and Kevin Merrell, MD, from Denver Health Medical Center. The next CORD meeting will be held during the ACEP Scientific Assembly in Chicago on October 14.

The SAEM Program Committee is pleased to announce the recipients of the Presentation Awards for the 2001 Annual Meeting. Recipients will be recognized during the Annual Business Meeting during the 2002 SAEM Annual Meeting in St. Louis. The awardees and their associated abstract citations (including title and coauthors) are listed below: FACULTY CLINICAL SCIENCE PRESENTATION Suzanne Schuh, MD, Hospital for Sick Children, Toronto Suzanne Schuh, Allan Coates, Rosemary Binnie, Tracey Allin, Cristina Goia, Mary Corey, Paul T Dick: Efficacy of Oral Dexamethasone in Outpatients with Acute Bronchiolitis. Acad Emerg Med 2001; 8:5:417

Update on Research Funding Programs (Continued) check off on your yearly dues form. Those members who are in a position to be planning the distribution of their estates and inheritance are encouraged to consider the SAEM Research Fund. An investment in the early stage of an EM investigator’s research career can reap enormous benefits down the line in research productivity and potential treatments for our emergency patients. Contributors can be assured that all donated money will go to directly to fund research.

SAEM has taken a step forward in becoming a significant force in research funding for emergency medicine. With the help of SAEM members and the community at large, we can reach our goal of providing many quality research training experiences for our young investigators.

FACULTY BASIC SCIENCE PRESENTATION Raymond Regan, MD, Thomas Jefferson Raymond F Regan, Yizheng Wang, Yaping Guo: Activation of Extracellular Regulated Kinases Potentiates Heme-mediated Oxidative Injury to Astrocytes. Acad Emerg Med 2001; 8:5: 510-511 YOUNG INVESTIGATOR PRESENTATION Eric W Dickson, MD, University of Massachusetts Eric W Dickson, David J Blehar, Robert J Tubbs, William A Porcaro, Robert E Carraway, Karin Przyklenk: Preconditioning Induction Trigger Evokes Cardioprotection via the Opiate Receptor. Acad Emerg Med 2001; 8:5: 560-561 BASIC SCIENCE FELLOW PRESENTATION Henry E Wang, MD, University of Pittsburgh Henry E Wang, James J Menegazzi, Christopher B Lightfoot, Clifton W Callaway, Kristofer C Fertig, Lawrence D Sherman: Effects of Biphasic vs. Monophasic Defibrillation on the Scaling Exponent and Defibrillation Outcome in a Swine Model of Prolonged Ventricular Fibrillation. Acad Emerg Med 2001; 8:5: 425

Jump-Starting Emergency Center Categorization — An Opportunity for Departments The importance of reviewing and categorizing Level One Emergency Centers has recently received increased attention (see March/April Newsletter) and was a topic of discussion at the AACEM meeting on May 5, 2001 and the May SAEM Annual Meeting. Many leaders in Emergency Medicine have agreed that it is crucial to have a number of EM programs apply for Level One categorization in the next year in order to have the process properly develop.

Two things that have been cited as deterrents for applying for Level One Emergency Center Categorization have been the complexity and time required to complete the application, and cost. The SAEM Board has addressed these potential problems by asking the EEC Committee to examine the current application process and suggest revisions that will make it simpler and less timeconsuming. Also, • The ECC application fee of $500 and associated expenses will be waived for any program that applies for ECC Level One prior to December 31, 2002 The SAEM Board is committed to the ECC process, and hopes that these changes will serve as a stimulus to academic emergency medicine programs. Please do not hesitate to contact the SAEM office if you have any questions, suggestions or comments about the ECC Level One process.

RESIDENT PRESENTATION Wende R Reenstra, PhD, Beth Israel Deaconess, Boston Wende R Reenstra, Aristidis Veves, Daniel Orlow, Jon A Buras: Decreased Proliferation and Cellular Signaling in Primary Dermal Fibroblasts Derived from Diabetics versus Non-diabetic Sibling Controls. Acad Emerg Med 2001; 8:5: 519 MEDICAL STUDENT PRESENTATION Bret Rogers, Thomas Jefferson University Bret Rogers, Yaping Guo, Raymond F Regan: Heme Oxygenase-2 Knockout Neurons are Less Vulnerable to Hemoglobin Toxicity. Acad Emerg Med 2001; 8:5: 510 Alex Limkakeng, University of Pennsylvania Alex Limkakeng, W Brian Gibler, Charles Pollack, James W Hoekstra, Brian Tiffany, Frank Sites, Frances S Shofer, Judd E Hollander: Combination of Goldman Risk and Troponin I for ED Chest Pain Patient Risk Stratification. Acad Emerg Med 2001; 8:5: 536

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Academic Emergency Medicine Annual Report Michelle H. Biros, MS, MD Editor-In–Chief Hennepin County Medical Center Minneapolis Jim Adams, MD Senior Associate Editor Northwestern Medical Center Chicago The editors of Academic Emergency Medicine are pleased to provide you with this journal report for 2000. This has been the seventh year of publication for the journal, and while the look, content, editors and contributors have changed over time, we remain committed to the production of a high quality spoke-piece for our academic and clinical specialty. We have benefited from your input, and welcome your questions, comments and suggestions; please feel free to contact any of the editors at any time.

In May 2000, the journal became available on line (www.aemj.org). From October 2000 to March 2001, our site was hit 37,725 times. The most frequently hit journal sections were Clinical Investigations (6100 hits), followed

by Brief Reports (2868), Clinical Practice (2849) and Basic Investigations (1802). We can also track on a monthly basis, who is accessing the website.

In addition to seeing the contents of the current month’s journal, the on line journal also provides abstracts of all articles published in AEM, and full text from 1999. Many additional special features make the on line journal very useful to authors and readers alike.

References listed in published articles can be accessed directly from our website. Other articles by the same author or articles of similar content are linked to published articles. By tracking the number of hits we receive, we are able to provide our readers with lists of the most frequently cited and most frequently read articles in any month, over the year, or since the beginning of the journal’s publication history. We have periodically provided this information in the journal, and will continue to do so both in the journal and in the SAEM Newsletter. We are also exploring links with funding agencies, research foundations, and other potential sources of research and educational support.

Based on the manuscript checklist provided at the time of manuscript submission, we are able to track “hot topics” in current emergency medicine research and education, as defined by the submitting authors. This tracking allows us to examine where we are with our specialty’s academic evolution and where we might as a journal foster ad-

ditional growth and development. The manuscript checklist is a vital step in our review process as well; the categories designated on this list by the submitting authors drives the assignment of the associate (decision) editors responsible for processing the manuscript, and the reviewers who will provide peer review. Careful consideration of these categories will speed the entire process, and we encourage our authors to carefully consider this when they submit their original works. We will continue the policy of providing only consensus reviews to the authors; this additional step in the review process reduces redundancy or contradiction in the manuscript review process. The consensus review has been popular with our authors, who often relate that the reviews are easy to understand and address. A copy of our consensus reviews are also usually supplied to the peer reviewers. Comparing their reviews with the overall assessment of the manuscript provides feedback and a learning tool for our reviewers.

Again this year, the journal has demonstrated continued tangible growth.

Our subscriptions have topped over 6000. Our impact factor, calculated only for the last 3 years, has increased from just over 1 in 1998 to a respectable 1.75 for 1999. From January 1 to Dec 31, 2000, we received 578 manuscripts. As of this writing, decisions have been made on 574 (a few revisions have not yet been received) with an overall acceptance rate of 39%. The average time to first decisions in 2000 was 35.4 days and for revisions, decisions were rendered in an average of 13.4 days The overall turn around time was 28.3 days. A large number of our manuscripts are submitted electronically (send to aem@saem.org); this speeds their in house review, their distribution to decision editors, and their delivery to peer reviewers. We also receive most of our peer reviews electronically; undoubtedly this has helped keep our turn around times very reasonable.

We believe our journal has responsibilities beyond the publication of excellent and relevant original reports of basic, clinical and educational advances. As a vehicle for the dissemination of thoughts and visions of emergency medicine academicians, educators and clinicians, we have the opportunity to call attention to special concerns of our practice. With this in mind, we convened a consensus conference in May 2000, on “Errors in Emergency Medicine,” with the purpose of critical education, provocative and thoughtful discussion, and creative development 4

of research and educational initiatives surrounding this important concept. Led

by Dr. Bob Wears, this conference was held in conjunction with the SAEM Annual Meeting, and attended by over 90 individuals with diverse backgrounds and from many countries. The proceedings of this conference, as well as a series of articles written in response to a call for papers on the topic, were published in the November issue of AEM. Because of its success, we have decided to continue to convene consensus conferences on topics of medical, socioeconomic and political significance for practitioners of emergency medicine. The 2001 AEM consensus conference is “The Unraveling Safety Net” and was held on May 9, 2001.

Our journal has been incredibly fortunate in the talent, enthusiasm and dedication demonstrated by our editorial board. In 2000, we added several new editors to complement our ranks.

We welcome Felix Ankel, Charlene Babcock Irvin, Catherine Marco and Marco Sivilotti to the editorial board. We are privileged to have them among us, and look forward to their contributions.

We also most sincerely thank Lou Binder, Dane Chapman, John Marx, Paul Pepe, and Andy Zechnich, long standing editors who rotated off the board in 2000.

We also offer our sincere thanks to our 233 peer reviewers. Without the generous commitment of these dedicated individuals, our journal’s quality would undoubtedly suffer. Our reviewers are listed in the December 2000 issue. Special thanks to Thomas Auble, Patrick Brunette, Lewis Goldfrank, Steven Green, and John Younger. Based on their consistently thorough, timely and supportive reviews, the editors have designated them as Outstanding Reviewers for 2000.

We hope our journal has continued to serve your needs, and that this report provides you with a glimpse of our workings. Your comments and ideas are very valuable to us, and we hope you continue to help direct our vision. It has been an honor to work with the editorial board, the reviewers, the authors and our readers in 2000. We look forward to another exciting year of continued growth and fruitful collaborations in 2001.

Visit AEM online at www.aemj.org (continued on next page)

Academic Emergency Medicine (Continued) HOT TOPICS, AEM 2000; Top 10 (This list is derived from the manuscript checklists of all articles submitted in 2000. The category designation is selected by the authors and drives assignment of the decision editors and peer reviewers. Authors may designate more than one topic category).

Topic

No. of manuscripts received, including this designation

No of manuscripts accepted with this designation

348 296 260 259 248 228 128 126 117 106

134 101 101 92 82 79 41 39 42 31

Cardiovascular Emergencies Educational Concepts Administration/ QI General Clinical E Med EMS General Pediatrics Injury Prevention Infectious disease Medical Imaging General Trauma

MOST FREQUENT USERS OF THE AEM WEBSITE DURING MARCH 2001 (based on frequency of individual institutional addresses accessing the website) McMasters University Welch Medical Library- JHU Duke University Library NIH Library/ Acquisitions Texas Medical Center University of Pittsburgh University of San Francisco University of Washington University of Michigan Yale University

MOST FREQUENTLY CITED, TOP 10 (to March 2001; calculated monthly) Rankings are based on hits received by articles archived on this site only.

1. JF Tucker, RA Collins, AJ Anderson, J Hauser, J Kalas, FS Apple Early diagnostic efficiency of cardiac troponin I and Troponin T for acute myocardial infarction Acad Emerg Med Jan 01, 1997 4: 13-21.

2. WD Rosamond, RA Gorton, AR Hinn, SM Hohenhaus, DL Morris Rapid response to stroke symptoms: the Delay in Accessing Stroke Healthcare (DASH) study Acad Emerg Med Jan 01, 1998 5: 45-51.

3. JE Hollander, SM Valentine, GX Brogan Academic associate program: integrating clinical emergency medicine research with undergraduate education Acad Emerg Med Mar 01, 1997 4: 225-230.

4. JE Hollander, RS Hoffman, P Gennis, P Fairweather, MJ DiSano, DA Schumb, JA Feldman, SS Fish, S Dyer, P Wax Prospective

multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group Acad Emerg Med Jul 01, 1994 1: 330-339.

5. Core Content for emergency medicine. Task Force on the Core Content for Emergency Medicine Revision Acad Emerg Med Jun 01, 1997 4: 628-642.

6. DJ Karras Statistical methodology: II. Reliability and variability assessment in study design, Part A Acad Emerg Med Jan 01, 1997 4: 64-71.

7. JW Hoekstra, WB Gibler, RC Levy, M Sayre, W Naber, A Chandra, R Kacich, R Magorien, R Walsh Emergency-department diagnosis of acute myocardial infarction and ischemia: a cost analysis of two diagnostic protocols Acad Emerg Med Mar 01, 1994 1: 103-110.

MOST FREQUENTLY READ (From AEM site hits only; recalculated) Full text HTML

PDF

449

126

196

771

581

103

0

684

394

23

261

678

330

29

292

651

300

24

295

619

327

18

274

619

312

16

276

604

320

8

264

592

296

31

260

587

255

18

287

560

3,564

396

2,405

6,365

Total Abstracts Accesses

Age of Article in days from 03/31/2001

8. BT Jolly, E Massarin, EC Pigman Color Doppler ultrasonography by emergency physicians for the diagnosis of acute deep venous thrombosis Acad Emerg Med Feb 01, 1997 4: 129-132.

9. SO Henderson, RJ Hoffner, JL Aragona, DE Groth, VI Esekogwu, D Chan Bedside emergency department ultrasonography plus radiography of the kidneys, ureters, and bladder vs intravenous pyelography in the evaluation of suspected ureteral colic Acad Emerg Med Jul 01, 1998 5: 666-671.

10. SW Burgher, TK Tandy, MR Dawdy Transvaginal ultrasonography by emergency physicians decreases patient time in the emergency department Acad Emerg Med Aug 01, 1998 5: 802-807.

Top 10 Articles October 2000 - March 2001

Article

182

Section: CLINICAL INVESTIGATIONS Amy C. Plint, Martin H. Osmond, Terry P. Klassen The Efficacy of Nebulized Racemic Epinephrine in Children with Acute Asthma: A Randomized, Double-blind Trial Oct 01, 2000 7: 1097-1103 151 Section: COMMENTARIES Michelle H. Biros, James G. Adams, Robert L. Wears Errors in EM: A Call to Action Nov 01, 2000 7: 1173-1174 121 Section: CLINICAL INVESTIGATIONS H. Bryant Nguyen, Emanuel P. Rivers, Suzanne Havstad, Bernhard Knoblich, Julie A. Ressler, Alexandria M. Muzzin, Michael C. Tomlanovich Critical Care in the ED: A Physiologic Assessment and Outcome Evaluation Dec 01, 2000 7: 1354-1361 90 Section: CLINICAL INVESTIGATIONS William J. Ruth, John H. Burton, Anthony J. Bock Intravenous Etomidate for Procedural Sedation in ED Patients Jan 01, 2001 8: 13-18 59 Section: CLINICAL INVESTIGATIONS Mary Chellis, James E. Olson, James Augustine, Glenn C. Hamilton Evaluation of Missed Diagnoses for Patients Admitted from the ED Feb 01, 2001 8: 125-130 59 Section: CLINICAL PRACTICE Robert W. Derlet, John R. Richards, Richard L. Kravitz Frequent Overcrowding in U.S. ED Feb 01, 2001 8: 151-155 90 Section: BASIC INVESTIGATIONS Christina L. Schenarts, John H. Burton, Richard R. Riker Adrenocortical Dysfunction Following Etomidate Induction in ED Patients Jan 01, 2001 8: 1-7 59 Section: BASIC INVESTIGATIONS Alan C. Heffner, Jeffrey A. Kline Role of the Peripheral Intravenous Catheter in False-positive D-dimer Testing Feb 01, 2001 8: 103-106 121 Section: CLINICAL INVESTIGATIONS Erik G. Laurin, John C. Sakles, Edward A. Panacek, Aaron A. Rantapaa, Jason Redd A Comparison of Succinylcholine and Rocuronium for Rapid-sequence Intubation of ED Patients Dec 01, 2000 7: 1362-1369 59 Section: CLINICAL PRACTICE Marc H. Gorelick, Chistopher Lee, Kathleen Cronan, Susanne Kost, Kathleen Palmer Pediatric Emergency Assessment Tool (PEAT): A Risk-adjustment Measure for Pediatric Emergency Patients Feb 01, 2001 8: 156-162 99.1 (avg age) Totals for Top 10 Articles October 2000 - March 2001

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Pediatric Emergency Medicine: Making SAEM a Comfortable Home Roger J. Lewis, MD, PhD Harbor-UCLA Medical Center SAEM Board of Directors Most medical care for pediatric medical and surgical emergencies occurs in our nation’s emergency departments, rather than in the offices of pediatricians.1 Studies on the preparedness of pediatricians’ offices to deal with emergencies have demonstrated, not surprisingly, that many are ill equipped and their staff ill prepared to treat true emergencies.2-4 With respect to capability for and experience with pediatric emergencies, however, emergency departments are themselves quite heterogenous.

They range from low-volume community departments, for which the presentation of a critically-ill child is unusual, to the emergency departments of specialized pediatric tertiary medical centers, in which many of our academic pediatric emergency medicine colleagues practice. The vast majority of children with emergencies, however, are treated in general emergency departments, rather than in dedicated pediatric emergency departments. Thus, there is a paradoxical contrast between the practice settings in which most of these patients receive care, and the practice settings in which most academic pediatric emergency medicine specialists practice.

This paradox is mirrored in our professional organizations. During my research career, almost serendipitously, I have the opportunity to interact with a number of outstanding academicians in the field of pediatric emergency medicine. While I interact with these colleagues in a variety of professional settings, I do not, in general, see them at the SAEM Annual Meeting. The majority of pediatric emergency medicine specialists are primarily trained in pediatrics and, for historical or cultural reasons, identify most closely with pediatric societies, for example, the American Academy of Pediatrics (AAP), the Ambulatory Pediatric Association (APA), the American Pediatric Society (APS), and the Society for Pediatric Research (SPR). To accommodate their interests, these organizations have developed specific emergency medicine chapters, sections, or interest groups, which in some cases are quite active.

Although I intend no disrespect of these organizations, I believe the current situation is unfortunate for the field of emergency medicine. In many ways, the interests of academic pediatric emergency medicine specialists more closely resemble those of the academic emergency physicians who form the bulk of SAEM’s active members, rather than those of academic pediatricians.

Furthermore, I believe many of the re-

search interests of our members and our colleagues in pediatric emergency medicine are quite similar. Lastly, the research methodologies used in our two fields, the barriers to research, and many cultural and political considerations are similar as well.

The lack of an effective and synergistic relationship between the academic emergency medicine community, as represented by SAEM, and the majority of academicians in pediatric emergency medicine has real consequences. Because we do not frequently work side by side on academic, clinical, and research tasks with our pediatric emergency medicine colleagues, neither group fully appreciates the broad and deep expertise that exists in the other. This mutual ignorance results in lost opportunities for scientific, administrative, and public health collaborations between pediatric and adult emergency medicine specialists. It also hampers our efforts to improve the quality of pediatric emergency care in emergency departments across the country, and to improve the quality of pediatric emergency medicine training within our emergency medicine residency training programs.

What, then, can be done to encourage the full participation of pediatric emergency medicine academicians within our Society? A number of years ago, the SAEM Program Committee decided to allow the presentation of abstracts at the SAEM Annual Meeting that had also been presented at national meetings held within 30 days prior to the SAEM Annual Meeting. This allowed for the presentation of abstracts that had been presented at the annual meeting of the pediatric academic societies (i.e., the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association), which is traditionally held just before the SAEM Annual Meeting. While this allowed pediatric emergency medicine research to be presented in both venues, it did not address the difficulty many faculty members face in traveling to two national meetings within a month’s time.

The SAEM leadership has worked to ensure the presence of pediatric emer-

gency medicine specialists on the Annual Meeting Program Committee and tried to encourage the activities of the SAEM Pediatric Interest Group. The current SAEM President has also initiated an outreach program aimed at pediatric emergency physicians. While the SAEM Board of Directors has considered other options for encouraging the involvement of pediatricians in our society, many have been uneasy at the prospect of singling out a single area of emergency medicine, because of the appearance of special treatment. For example, would it be appropriate to specifically encourage those with an interest in pediatric emergency medicine to attend our meeting, without making similar efforts towards those with an interest in geriatric emergencies?

Writing as an individual, it is my opinion that we have not found a good solution to these issues. I believe we have failed to engage a significant group of clinicians and academicians, whose area of interest falls squarely within the field of emergency medicine. I would like to encourage all SAEM members to reach out to our pediatric emergency medicine colleagues and make them welcome in our Society. Specific proposals for increasing the participation of pediatric emergency medicine academicians within our Society should be directed to the Chair of the Pediatric Emergency Medicine Interest Group, to the SAEM Board of Directors, or to the SAEM President. All can be reached via the national SAEM office.

References 1. Institute of Medicine, Committee on Pediatric Emergency Medical Services.

Durch JS, Lohr KN, eds. Institute of Medicine Report: Emergency Medical Services for Children. Washington, DC: National Academy Press;1993 2. Flores G, Weinstock DJ. The preparedness of pediatricians for emergencies in the office. Arch Pediatr Adolesc Med 1996;150:249-256.

3. Fuchs S, Jaffe DM, Christoffel KK. Pediatric emergencies in office practices: Prevalence and office preparedness.

Pediatrics 1989;83:931-939.

4. Heath BW, Coffet JS, Malone P, Courtney J. Pediatric office emergencies and emergency preparedness in a small rural state. Pediatrics 2000;106:1391-1396.

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 e-mail to saem@saem.org or call 517-485-5484.

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SAEM — State of the Society, 2001 Brian Zink, MD* SAEM Past President The calendar of the Society for Academic Emergency Medicine runs from May to May, and the Annual Meeting is also the annual time of transition. We have just announced the results of our elections and in a few minutes I will welcome our new President. But first I would like, as my final official duty, to give you an assessment of the State of the Society, and to share with you some observations and insights that I have gained while serving as President.

Last year in my opening address I quoted poetry and received a lot of blank stares. So, this year I will present the State of the Society in a format that is more familiar to academic emergency physicians — an ED patient presentation. Here goes: Chief Complaint(s): Not enough time.

Not enough money.

Present History: SAEM is a 12 year old academic medical organization whose members are emergency medicine faculty, residents, and medical students. Most members are experiencing levels of academic discomfort that have increased exponentially in the past five years. Most academic Emergency Departments (ED’s) have seen a 10 to 20% increase in patient volumes over a short period of time, along with hospital resource cutbacks and a national nursing shortage. Clinical demands have raised faculty and resident stress levels and threaten the quality of academic life. Academic ED’s are experiencing a number of symptoms, including congestion, obstipation, constipation, frequency, hesitancy, and urgency. The symptoms are made worse by something called HCFA, and there are no apparent relieving factors. Despite the maladies experienced in their clinical settings, some SAEM members are enjoying increased success as researchers and educators. Many are volunteering their time on SAEM committees, task forces and interest groups. This has helped the Society to achieve a great deal in the past year in the areas of research, faculty development and national affairs. SAEM is run out of an executive office where a strong tendency toward obsessive work behaviors has been noted. However, the members do not view this as a significant problem.

Past History: Since its formation by the merger of the University Association for Emergency Medicine and the Society of Teachers of Emergency Medicine in 1989, SAEM has grown and changed tremendously. The consistent crowning

achievement each year has been the Annual Meeting, which is the largest forum for presentation of emergency medicine research and educational programs in the world. The Society’s journal, Academic Emergency Medicine, has also grown considerably since its inception in 1995. About 6 years ago SAEM formally started Interest Groups, which are collections of members who have similar academic interests, and many of these have developed into active groups that have contributed significant scholarly work. SAEM has a slight inferiority complex that seems to be resolving, and its only other chronic condition is anemia in the researchfunding realm, which has been partially corrected in the past year.

Review of Systems: Unlike the average academic ED chart’s review of systems, which often says: “all 10 reviewed and negative”, the SAEM review of systems is a key component of the presentation. Our systems are the SAEM committees, task forces, and interest groups. I do not have the time to report on all of our “systems”, but will comment on those that were central to our focus areas of research, faculty development, national affairs, and some others that did great work this year.

First, research: our message for the year was that good research requires training, a mentor, focus, resources, time, and stable funding. The SAEM Board of Directors and the Research Committee helped to spread the word, and the Grants Committee, headed by Art Sanders, debuted this year and did an outstanding job of consolidating our existing grants and improving the efficiency and quality of grant review. It also helped to form the new Neuroscience Research Fellowship that is supported by AstraZeneca. We patterned this grant after our long-standing, very successful EMS Research Fellowship Grant, that has been funded for over a decade by Medtronic Physio-Control.

The Grants Committee, and other committees also participated in our dialogue about research, and this eventually lead to the Board’s decision this winter to change the Resident Research Year Grant to the SAEM Research Training Grant, which is a two year, $150,000 research fellowship grant. We also added the $150,000 Institutional Research Training Grant which provides funding to an EM program to train a research fellow for two years. In making this decision, we essentially put our money where are mouths are – if we are to advocate for strong research training for our residents and junior faculty, then we must offer grants that allow for two years of training and a 7

large amount of protected time. We also intentionally put a bit of pressure on the Society in forming these grants.

A bit of math will demonstrate that given our current reserves, we cannot fund at this level for more than a few years. Since we plan to further expand the SAEM Research Funding Program, we will need to increase fund-raising dramatically to meet our goals.

Part of our push in the research area this year was to highlight those SAEM members who have followed a successful path in their research careers, and to encourage the exchange of ideas and information and informal mentoring that will help our more junior investigators.

We have seen a great deal of this so far at the Annual Meeting. The maturation of our research programs could not have come at a more opportune time, as federal, corporate and foundation support for research is at an all time high. More and more EM investigators are developing to the point of being able to consistently compete for federal research grants. We are now sitting on study sections at the NIH, and forming the networks and collaborations that lead to sustainable research programs.

Our next focus area for the year was faculty development. The Faculty Development Committee under John Gallagher’s direction has done a great job putting together a faculty development website with a new Faculty Development Guide that will soon be available thought the SAEM website. As you have seen, this meeting is also full of faculty development discussions and presentations.

In the area of National Affairs we have made significant progress in the past year. Jim Hoekstra chaired the National Affairs Task Force, and was responsible for coordinating SAEM’s formal responses to a number of national issues including a response to the Medicare Payment Advisory Commission on how regulatory burdens affect ED patients and physicians, and a comment on the Prospective Payment System for Hospital Outpatient Services final rule, which related to observation care reimbursement, and other responses. We have also examined the big picture of how we should advocate for our emergency patients and our trainees at a national level. Currently we do not have the infrastructure to do this effectively.

Last fall, we visited the American College of Emergency Physicians Washington Office to discuss ways that we could collaborate on areas of mutual interest and importance. This has resulted in SAEM being a bit more in the loop, and able to respond quicker to situations that arise in Washington.

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The 2001 NRMP Match in Emergency Medicine Louis Binder, MD and Nicholas Jouriles, MD Case Western Reserve University/MetroHealth Medical Center/Cleveland Clinic EM Residency The results of the 2001 NRMP Match became final on March 22, 2001. Emergency Medicine residency programs offered a total of 1148 entry level positions (5.0% of total positions in all specialties). The following numbers (taken from the 2001 NRMP Data Book) include information from all programs that entered the 2001 Match:

EM positions/total NRMP positions

1999 22,584 11% 118 (103 PG1, 15 PG2) 1063 (912 PG1, 151 PG2) 4.7%

2000 22,722 11% 120 (104 PG1, 16 PG2) 1118 (971 PG1, 147 PG2) 4.9%

2001 22,878 11% 120 (106 PG1, 14 PG2) 1148 (1001 PG1, 147 PG2) 5.0%

# EM programs with PG1 vacancies # unmatched EM PG1 positions

11/103 (11%) 30/912 (3%)

2/104 (2%) 4/971 (0.4%)

3/106 (3%) 6/1001 (0.6%)

# EM programs with PG2 vacancies # unmatched EM PG2 positions

1/15 (7%) 2/151 (1%)

2/16 (12%) 3/147 (2%)

1/14 (7%) 3/147 (2%)

Total # EM programs with vacancies Total # unmatched EM positions

12/118 (10%) 32/1063 (3%)

4/120 (3%) 7/1118 (0.6%)

4/120 (3%) 9/1148 (0.8%)

Total # of NRMP positions Overall % of positions unfilled Number of EM programs listed Total PG1/PG2 entry positions

Applicant Pool Data Applicants who ranked only EM programs: 1999 US graduates 719 256 Independent applicants Total applicants 975

2000 818 294 1112

2001 825 279 1104

Applicants who ranked at least one EM program: US graduates 953 437 Independent applicants Total applicants 1390

1056 492 1548

1092 430 1522

54/818 (6.6%)

56/825 (6.8%)

Independent applicants applying 168/256 (66%) 185/294 (63%) only to EM programs who went unmatched

190/279 (68%)

US seniors applying only to EM Programs who went unmatched

28/719 (3.9%)

Breakdown of filled EM positions by type of applicant: PG1 EM positions Filled by US graduates Filled by independent applicants Total filled

1999 912 714 (78%) 168 (18%) 882 (97%)

2000 971 794 (82%) 172 (18%) 966 (99.5%)

2001 1001 825 (82%) 170 (17%) 995 (99.4%)

PG2 EM positions Filled by US graduates Filled by independent applicants Total filled

151444 41 125 (83%) 24 (16%) 149 (99%)

147 110 (75%) 34 (23%) 144 (98%)

Total EM positions Filled by US graduates Filled by independent applicants Total filled

1063444 41 839 (79%) 192 (18%) 1031 (97%)

1118 1148 904 (81%) 939 (82%) 206 (18%) 200 (17%) 1110 (99.3%) 1139 (99.2%)

147 114 (78%) 30 (20%) 144 (99%)

** For PG1 filled entry positions (995), 825 were filled by US seniors, 81 were filled

by US physicians, 53 by osteopathic physicians, 20 by US foreign medical graduates, 9 by international medical graduates, 3 by Canadian physicians, and 4

by Fifth Pathway graduates.

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From these data, several conclusions can be drawn: 1. After a reduction of 58 entry level positions (PG1 and PG2 entry, a 5% decrease) between 1998 and 1999 resulting from GME downsizing initiatives, Emergency Medicine experienced an increase of 55 entry level positions in the 2000 match (5% increase) and an additional increase of 30 entry level positions in the 2001 match (additional 2.7% increase). With the addition of no new Emergency Medicine residency programs in the last year, it appears that this growth has occurred due to the expansion of quotas in existing residency programs.

2. The overall demand for EM entry level positions (i.e. number of applicants) remained relatively flat from 2000, after raising 11 to 15% last year. US seniors within the EM applicant pool increased by 7 to 36 seniors (1 to 3% increase), but independent applicants within the pool decreased by 15 to 62 applicants (5 to 13% decrease). The number of applicants (1104 applicants ranked only EM programs, and 1522 applicants ranked at least one EM program, in competition for 1148 entry level spots) is the second highest ever within the match, compared with last yearâ&#x20AC;&#x2122;s numbers (1112 and 1548, respectively). The excess applicant demand over and above the size of the training base is 243 to 374 applicants (21 to 33% surplus), depending on how the parameters of the applicant pool are determined.

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Semi-Final CPC Competition Results

EMF/SAEM Medical Student Grant and Innovations in Medical Education Grant Recipients

On May 5, fifty Emergency Medicine Residency Programs competed in the Eleventh Annual Semi-Final CPC Competition. A resident from each participating program submitted a challenging unknown case for discussion by an attending from another residency program. The faculty discussant had 20 minutes to develop a differential diagnosis and explain the thought process leading to the final diagnosis.

Winning presenters and discussants were selected from each of five tracks and these individuals will represent those tracks at the national competition. The CPC finals will be held at the ACEP Scientific Assembly in Chicago on October 16. It is not necessary to register for the Scientific Assembly if you plan only to attend the CPC. The CPC Competition is sponsored by ACEP, CORD, EMRA, and SAEM. Congratulations to the 2001 winners!

Track A Best Presenter, Elaine Sapiro, MD, University of California, San Diego Best Discussant, Annie Sadosty, MD, Mayo Clinic Track B Best Presenter, Tricia Villanueva, MD, MCP-Hahnemann Best Discussant, Victoria Palmer-Smith, MD, Emory University Track C Best Presenter, Randy Goldstein, MD, Texas Tech University Best Discussant, Robert Baevsky, MD, Baystate Medical Center Track D Best Presenter, Michael Gisondi, MD, Stanford-Kaiser Best Discussant, Darren Braude, MD, University of New Mexico Track E Best Presenter, Marc Roy, MD, Baystate Medical Center Best Discussant, Mary Ryan, MD, Lincoln Medical and Mental Health

The Emergency Medicine Foundation and SAEM are pleased to announce the recipients of the 2001-2002 EMF/SAEM Medical Student and Innovations in Medical Education Grants. Each of the Medical Student Grant recipients will receive $2,400 and the Innovation in Medical Education Grant recipient will receive $5,000 in funding from EMF and SAEM. William Spivey Grant Applicant: Chaya G. Bhuvaneswar Institution: Stanford University Preceptor: H. Range Hutson, MD Project Title: Do Emergency Department Health Providers’ Diagnostic Criteria for Identifying Domestic Violence Presenting to the ED Match Those Criteria Identified by Domestic Violence Survivor Focus Groups? A Cross Sectional Study Applicant: Hamal Gada Institution: Hospital of the University of Pennsylvania Preceptor: Rober W. Neumar, MD, PhD Project Title: Proteolytic Cleavage of Calcium Regulatory Proteins in Primary Hippocampal Neurons Following Simulated Ischemia Applicant: Richard Ko Institution: Maricopa Medical Center Preceptor: Christopher Lipinski, MD Project Title: Laminin and its Effects on Mature Neuronal Viability Applicant: Allyson A. Kreshak Institution: Thomas Jefferson University Preceptor: Bernard L. Lopez, MD Project Title: The Value of Plasma L-arginine and Nitric Oxide Levels in Predicting the Severity of Acute Vasoocclusive Sickle Cell Crisis Applicant: Jonathan Li Institution: University of California, San Francisco Preceptor: James Quinn, MD Project Title: Patterns of Complementary and Alternative Medicine Use in ED Patients and Its Association with Health Care Utilization

NRMP Match (Continued) 3. A small increase in the supply of EM entry level positions, coupled with relatively flat demand for them, resulted in a nearly equivalent fill rate for EM programs (99.2%) in 2001 compared with 99.4% in 2000. This was the highest fill rate of any specialty in the 2001 Match. The very low number of unmatched postions (nine, or less than 1% of available positions) also reflects these supply and demand trends.

4. The proportions of EM positions filled by US seniors, US physicians, and international graduates remained stable in 2001 compared with 2000. There was a slight increase in the proportion of positions filled by US physicians, and a slight decrease in the percentage of positions filled by international graduates.

5. The unmatched rate for US seniors applying to EM programs remained relatively level (from 6.6% in 2000 to 6.8% in 2001), again reflecting stability of supply and demand trends. These data continue to support the notion that a very reasonable probability remains for most US seniors (93% probability) to match into an EM residency.

The unmatched rate for independent applicants has been in the 60-70% range for the past 3 years, suggesting significant difficulties for unsponsored applicants to compete successfully for an EM position.

Applicant: Anthony M. Napoli Institution: Providence Hospital Preceptor: David Milzman, MD Project Title: Effectiveness of Non-Invasive Ventilatory Support (Bi-Level Positive Airway Pressure) to Avoid Intubation in the ED: A Comparison of Hypercapnic vs.

Hypoxic Respiratory Failure Applicant: Lane McNeil Smith Institution: Virginia Commonwealth University Preceptor: Robert Wayne Barbee, PhD Project Title: In Vivo Analysis of Critical Oxygen Delivery in the Spontaneously Hypertensive Rat Innovations in Medical Education Validation of the Educational Intervention “GRIEV_ING” as a Tool to Improve Resident Death Notification Skills, Cherri D. Hobgood, MD, University of North Carolina at Chapel Hill

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First Annual Regional SAEM Research Meeting — Rochester, New York March 12-13, 2001 Sandra Schneider, MD University of Rochester

Dr. Sharon Humiston led the research on How to Write an Abstract. In the first half of the workshop individuals worked in groups to create an abstract from a sample standardized study. In the second part of the abstract, they scored each others work with a standardized abstract reviewer sheet.

Dr. Frank Zwemer taught a mini-business course in another workshop introducing the attendees to the principles of business as they relate to Emergency Medicine.

Finally, Dr. Linda Spillane led a workshop utilizing the Meti Patient Simulator. Participants were able to run a complicated patient whose course terminated in cardiac arrest and then view their work on videotape. Dr. Robert Schafermeyer led one team, and we are pleased to report that he is up-to-date on his ACLS protocols.

The dates of the Regional Meeting corresponded to the opening of the brand new Emergency Department at Strong Memorial Hospital. Participants were able to tour the Emergency Department twenty-four hours prior to its opening hopefully getting ideas for their own department renovations.

All of the participants felt that the first Annual New York State Regional SAEM Meeting was a huge success. Proceeds from this meeting will be transferred to New York University, who will host the second Annual Meeting next Spring. We wish to thank SAEM for its support of our endeavors to make the New York State Regional Meeting a success.

In one corner sat two scientists discussing their latest ideas regarding apoptosis and skin healing and in another, two clinicians planned a study on the effects of overcrowding. These encounters and many like them are the real reasons that regional research meetings, sponsored by SAEM, have been successful around the country.

Rochester was host to the first annual New York State Regional SAEM Research Meeting. New York State boasts 17 residencies and over 400 residents. This wealth of talent made possible the highly successful research meeting. There were over 90 participants from 14 different institutions attending the conference. There were 47 abstracts presented, 6 of these in the oral form.

The highlight of the conference was our keynote speakers. Dr. Brian Zink, President of SAEM, spoke on the future of research and education in emergency medicine. He was followed by Dr. Marcus Martin, President Elect of SAEM, who spoke on the value of diversity and cultural confidence in academic emergency medicine.

On the second day Dr. Robert Schafermeyer, President of the American College of Emergency Physicians spoke about the next five years of emergency medicine practice.

On the afternoon of the second day, attendees chose from 3 different workshops.

Meeting Wilderness Adventure Race Mary Jo Wagner, MD Saginaw Cooperative Hospitals, Inc. SAEM Program Committee The First Annual Medical Wilderness Adventure Race (Medwar) was held outside of Augusta, GA on April 29, 2001.

There were 21 3-4 member teams who participated in the EcoChallenge type race over a 6-10 hour period. Teams were composed of Emergency Medicine residents, faculty, attendings, nurses, physician assistants and EMS personnel.

The race was designed around completing medical challenges.

These included multiple extrication tasks, usually requiring the team to immobilize, then carry an injured team member, while struggling through mud and water and traversing over obstacles.

Another challenge required team members to triage and treat seven disaster patients secondary to a lightning storm. A thirtyquestion test on wilderness medicine had teammates debating questions on hypothermia, poisonous animals, and identifying the flora in an alligator’s mouth. A significant time penalty was given for incorrect answers to the quiz questions and if improper triaging was done, the team was sent on a diversionary route.

The physical portion of the challenge was varied. Running was a staple of the race. Other activities included canoeing and water crossing, rope climbing, and then there was more running. Teams were required to complete 5 legs in the race. Geologic coordinates were given, requiring the use of orienteering skills. The challenge was designed to run into the night, necessitating the use of headlamps and sharp night vision to complete the course.

The Emergency Medicine residents Shaun Adams, MD, Stephanie Gammons, MD, Roger Merk, MD and Daryl Steen, MD from the Saginaw Cooperative Hospitals Michigan State University Program crossed the finish line first in 6 hours and 8 minutes.

The second place team from Maryland completed the race in 7 hours 3 minutes. However, the first place team’s lead increased significantly when penalties were included for errors in the medical challenges. The Saginaw Cooperative Hospitals, Inc. team looks forward to defending their championship title next year and challenges more residency teams to join them.

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Academic Career Profile

This is part 3 of a series of interviews of experienced and accomplished researchers that focus on issues of interest to the young investigator. On behalf of the SAEM Research Committee, Dr. Craig Newgard interviewed Dr. Roger Lewis who shares how he began in research and advice for the young investigator.

What do you consider to be your highest research accomplishment?

How long did it take from the time you first had this goal, to the time you reached it?

Three accomplishments stand out in my mind. The first is a work in progress—creating a supportive environment for research fellows in our department. Regarding the length of time required to create this environment, we’re still working on it. Second, I am proud of my collaborative work with Dr. Marianne Gausche-Hill on her study of out-of-hospital bag-valve-mask ventilation versus intubation in critically ill children. Given the setting of the study, this undertaking presented major obstacles and required creative ideas, organization and tremendous effort to complete the study while maintaining a rigorous methodologic design. The study took approximately eight years from conception to completion. I should also point out that my role was quite small when compared to the principal investigator, Dr. Gausche-Hill. Last, I am proud of my role as Chair of the Data Monitoring Committee for an outof-hospital trial of a hemoglobin-based volume replacement product for adult patients with post-traumatic hemorrhagic shock. The trial was stopped prior to the first planned interim analysis when a higher than expected death rate in the treatment group could not be adequately explained by patient characteristics.

Although this decision led to the termination of development of this product by the sponsor, I believe these actions helped limit the risk to the critically-ill study subjects. The data monitoring committee made the recommendation to suspend enrollment only 24 days after the first evidence of a mortality imbalance was detected. This study was also the first large multicenter study conducted under the FDA’s waiver of consent regulations (21 CFR §50.24).

How would you rank these issues in order of importance for reaching your research goal: mentoring, seed money, protected time, collaborative support, personality, fellowship training, writing skills, luck, intelligence?

I would put them in the following order, starting with the most important: mentoring, protected time, writing skills, intelligence, fellowship training, personality, collaborative support, seed money, and luck.

Is there another more important factor that allowed you to reach your accomplishment? Can you elaborate on what you feel was the single most

important factor in your success?

I believe the most important single factor was training that allowed me to think “like a scientist.” I believe my doctoral training in biophysics and my research mentors assisted me, not only by helping me refine the skills necessary to excel in research, but also helped me gain the ability to explain scientific ideas clearly in both written and verbal formats.

How did you identify your mentor and what advice would you give a young researcher looking for a mentor? How important was mentoring to your accomplishment?

I approached my first mentor, Dr. Philip Hanawalt in the biology department at Stanford University, while a junior in college. I had absolutely no research experience but Dr. Hanawalt was willing to take a chance on me. Despite my lack of experience, this opportunity helped nurture a love of research and resulted in my first paper being published.

A second instrumental person in my career was Dr. Robert Pecora, a physical chemist with whom I performed my doctoral research while in medical school.

Dr. Pecora was always available, and provided me tremendous latitude to select and answer difficult scientific questions. He helped me to think rigorously. I believe the most important characteristics in a mentor are available time, a willingness to mentor, research resources and environment, strong research experience, the ability to help steer a mentee in the right direction while still fostering a sense of autonomy, providing the freedom to choose approaches to research problems, and the willingness to take risks on young mentees.

Has fellowship training become a necessity for a young researcher to become successful in EM research?

While it is possible for some investigators to achieve significant success without formal research training, such as that provided in a fellowship, I believe that the focused time dedicated to learning research fundamentals and career development will increase the long term productivity, likelihood of obtaining extramural funding, and career success of any investigator.

Where do you think the majority of funding for young investigators involved in EM research will come from in 10 years? Foundations, Industry, or Federal?

All three of these funding sources will provide important sources of EM research funding, even for young investigators. I believe that foundations, such 11

as the Emergency Medicine Foundation, provide and will continue to provide an important source of funding to support young investigators in EM. SAEM is also beginning to put programs together that provide substantial support for research training. Furthermore, as the NIH and other federal funding sources increasingly emphasize the importance of clinical research, and especially clinical research training, these funding sources will become increasingly important. The percentage of NIH and AHRQ fellowship training grants that are funded is very high, often close to 50%.

Where have you derived most of your research funding?

My research funding has come largely as a result of collaborative projects with other researchers, from federal sources, foundations, and to a lesser extent from industry. By focusing on the design and analysis of clinical studies, I have built many partnerships with other researchers and have served as a coinvestigator on many funded projects.

What is the biggest challenge to the EM researcher to obtaining funding, compared to researchers in other fields? How did you deal with this challenge?

One of the biggest challenges to the EM researcher is overcoming the tendency to believe that residency alone provides adequate preparation for a research career. It is clear that mentorship, formal research training, and establishing a track record in undertaking and completing projects are all critical in obtaining funding. In addition, EM investigators must avoid the idea that being a generalist, as in clinical practice, also works well in research. A clear research focus and demonstrated productivity in a specific area are also necessary to become a competitive candidate for funding.

If you had a time machine, what decision would you change, or what would you have done differently about your research career?

While completing my PhD in biophysics I took a number of courses in theoretical physics. I now wish that I would have taken additional courses in mathematical statistics and epidemiology instead.

What should SAEM be doing to help young researchers?

I believe SAEM should: increase funding available for fellowship training and ensure that these fellowships provide a sufficient duration and depth of training; and ensure that the research of young investigators has an appropriate venue for presentation and publication through our Annual Meeting and the Society’s journal.

Filming of Patients in Academic Emergency Departments The following report is the result of the first SAEM Ethics Consultation request. Due to the general interest of the topic, and with the permission of the individual who requested the consult, the consultation report is published below for the benefit of the membership. Please contact SAEM with any consultation requests.

Catherine A. Marco, MD and Gregory L. Larkin, MD, MSPH, for the SAEM Ethics Committee Consultation from the SAEM Ethics Committee Questions: 1. When is filming of ED patients in academic emergency departments appropriate?

2. What conditions should be met to enable commercial ventures involving the filming of ED patients?

Use of Recorded Images for Medical Records A longstanding tradition exists of producing and maintaining medical records and documentation of medical care delivered to patients, in all medical settings, including the emergency department. In recent years, the paper documentation of medical records has expanded to, in some settings, include photographs and videos. There is little debate that these venues are appropriate when used for documentation in the confidential medical record, as these services are clearly provided for the best interest of the patient.

Recorded Images for Educational Purposes Debate arises when other uses are proposed for various additional uses of the medical record (including photographs and video). Use of patient photographs and video for educational purposes is rapidly expanding.1,2,3 Although consent is not always obtained prior to taking the photos, standard practice is to obtain consent from the patient, or surrogate, prior to the dissemination of these modalities. There are several logical justifications for the use of filming of patient encounters for educational purposes: 1. There is a benefit to the medical community, and to society, by improving the quality of care. There is a clear educational benefit of multimedia educational presentations4-8 and of retrospective video quality analysis.2,3 2. The proposed audience includes health care professionals, who routinely encounter such settings.

3. Film records are not publicly available.

Recorded Images for Commercial Purposes Filming of patients for commercial purposes (such as television programs or movies) clearly presents unique moral questions. Although some argue

that there is educational value to society,9 the primary motivations for such filming are public education, entertainment, and financial benefit to proprietors. The clear alternative to filming of patients is the simulation of events, which can be based on true incidents.

Numerous ethical arguments against the use of recorded images of ED patients for commercial purposes exist, including: 1. Many patients are unable to consent prior to recording, due to medical condition.

2. Patients who are technically able to consent may feel coercion whether overt or camouflaged, in part due to the inherent vulnerability of their position as a patient. 10 Rawlsian conceptions of justice mandate that the most vulnerable should accure benefits first when societal burdens and benefits are apportioned.11 3. Confidentiality and privacy of patients and health care providers are severely invaded.

4. Film crews may interfere with patient care, both physically and subliminally. The presence of commercial, nonmedical staff in the ED may pose a significant distraction, and conflict of interest for already overburdened and stressed health care providers.

5. Both the Code of Conduct for SAEM12 and the Code of Ethics for ACEP13 put the interests of patients above all else. Filming patients without any tangible patient-centered benefit clearly violates both the letter and the spirit of these Codes.

There may conceivably, be some circumstance in which the the commercial use of recorded images of ED patients could be justified in limited circumstances. To be justifiable, these circumstances arise rarely, but could occur when benefit to patients is clearly demonstrated. Review by a multidisciplinary ethics committee or an institutional review board may be of value to ascertain that such conditions of patient-centered benefit are in force.

When the appropriate use of images are deemed to be helpful, significant community and patient advocate representation should be invoked prior to project initiation. Although not directly applicable to this question, the FDA Waiver of Consent guidelines for emergency research14 may provide a useful model. Although these guidelines were specifically designed to facilitate the conducting of emergency research in situations where obtaining traditional 12

written informed consent is not feasible, they provide a model for obtaining proactive input from the institution and community prior to initiation of a project in which informed consent is not feasible. The feasibility of obtaining agreement from an overwhelming majority depends in large measure on the wording of the question. (For example, “You wouldn’t mind if we took a few pictures, would you?” versus “Would it be okay with you if the television crew were to videotape you after a car accident, as you lie unconscious, naked, and bloody, on a stretcher, surrounded by strangers in the ER?”).

Summary 1. Filming of ED patients for medical records is acceptable, provided routine confidentiality of records is maintained.

2. Filming of ED patients for peer review and professional educational purposes is acceptable, provided informed consent is obtained when possible, and patient confidentiality is maintained.

3. The SAEM Ethics Committee discourages the commercial use of images of ED patients in academic emergency departments.

4. Commercial filming should only be considered in rare cases, where benefit to patients and society can be clearly demonstrated, and where overwhelming support of the Emergency Department staff, the institution and the community is demonstrated.

5. If permitted, fastidious attention should be paid to patient confidentiality and voluntary informed consent, and strict limitations should be enforced to prevent adverse effects on patient care.

References 1. Brooks AJ, Phipson M, Potgieter A et al: Education of the trauma team: video evaluation of compliance with universal barrier precautions in resuscitation. Eur J Surg 1999; 165:1125-8.

2. Ellis DG, Lerner EB, Jehle DV et al: A multi-state survey of videotaping practices for major trauma resuscitations. J Emerg Med 1999; 17:597-604.

3. Olsen JC, Gurr DE and Hughes M: Video analysis of emergency medicine residents performing rapid-sequence intubations. J Emerg Med 2000; 18:469-72.

4. Herxhaumer A, McPherson A, Miller R et al: Database of patients’ experiences (DIPEx): a multimedia approach to sharing experiences and information.

Lancet 2000; 355:1540-3.

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Report on Western Regional Meeting March 17-18, 2110 A. Antoine Kazzi, MD University of California, Irvine Program Chair, 4th Annual SAEM Western Regional Research Forum “This was a terrific meeting.” “The opportunities for young faculty development and for networking were great!”

These were the kind of words that summarize the feedback we received following the Fourth Annual SAEM Western Regional Research Forum that was held on March 17-18, 2001, at the Hyatt Newporter, in Newport Beach.

Co-sponsored by the EM program at the University of California, the 2001 meeting brought together nearly 40 panelists, speakers and moderators, as well as 137 participants. Perhaps the most remarkable achievement this year for the Western SAEM Regional Planning Committee was that it succeeded in involving and representing all 19 Emergency Medicine residency programs in the Western USA. For the first time in 4 years, they were all there!

Four separate sessions of abstract presentations (oral and poster) were held. Young faculty, residents and students presented over 60 abstracts to their peers, learning the skills necessary in that process. Moderators included Drs. Deirdre Anglin, Amiram Shneiderman, Sean Henderson, Deana Baudonnet, Jerris Hedges, Jeffrey Succhard, Judith Brillman, John Sakles, Robert Buckley. Deborah Diercks, Greg Guldner, Stephen Hayden, Tareg Bey, Carin Olson, Mitesh Patel, Rob Rodriguez, Michael J. Lambert, and Chris Lipinski.

The didactic sessions related to junior faculty and resident development, and to the skills needed to pursue academic careers. The topics included: ● The Evolution from EM Residency to Subspecialty Fellowship Training: Impact on Academic EM (Dr. V. Markovchick) ● From Data Collection to Publication: Issues in Authorship and Peer Review (Dr. D. Schriger) ● Faculty Development and Protected Time: Rules of the Road (Drs. D. Gus and M. Langdorf) ● Introduction to Statistics: How to make it stick! (Dr. R. Lewis, our SAEM president-elect) ● Joining a Multi-Center Trial: What’s in It for Me? (Dr. J. Hoffman, G. Hendey and J. Krawczyk) ● Authorship: Issues of Credit, Ownership and Intellectual Integrity (Drs. J. Hedges and T. Schmidt) ● Ultrasound Credentialing in EM: an Overview (M. Lambert and C. Fox) An outstanding turnout was noted for the “SAEM Western Regional Medical

Student Forum.” Over 50 students attended the exceptional 3-hour session that was moderated by Dr. Wendy Coates and Dr. Barbara Blasko. This was an opportunity for medical students interested in EM as a career to listen to superb presentations by renowned educators such as Drs. Gus Garmel, Lori Weichenthal, Wendy Coates and Stephen McLaughlin.

One student commented: “First, the SAEM conference in Newport Beach was a very educational opportunity to learn more about the current issues surrounding academic Emergency Medicine and was a chance to see some intriguing presentations of research in the field. On Sunday, the Medical Student Forum had an amazing collection of speakers who covered all the aspects of the residency application process, which will help all attendees approach this future period with a structured plan. The turnout of medical students was quite impressive, and this was probably the best 5 hours of presentations and Q & A that any medical student could have asked for.”

Recipients of Visual Diagnosis Contest Announced During the 2001 Annual Meeting in Atlanta a Visual Diagnosis Contest was open to all residents and medical students in attendance. The following winners are to be congratulated on their excellent diagnostic skills:

Perhaps the most unusual session was “Medical Jeopardy — With a Research Twist,” which concluded the 2day meeting. Moderated by Drs. Lisa Chan and Bill Mallon, teams from New Mexico, the Navy program in San Diego and UC Irvine competed ferociously.

The Navy program valiantly won and took no prisoners. Actually the humor, competitive collegiality and teamwork were an outstanding way to end the meeting, which we hope will be repeated.

I wish to take this opportunity to thank SAEM for leading us in this direction, and giving us financial and human resources, insight and regional opportunity to invest time and effort in developing our residents and young faculty.

In particular, I must acknowledge Dr. Deirdre Anglin, Dr. Jerris Hedges and my partner Dr. Mark Langdorf for their outstanding guidance and support. Last but not least, I wish to thank all our speakers and the moderators for their time and commitment, which was the basic ingredient that allowed this meeting to be a success. Thank you.

Filming of Patients in Academic Emergency Departments (Continued) 5.

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Medical Student Winners: Cory J. Pitre, LSU/Charity Hospital and Wame Waggenspack, LSU/New Orleans Resident Winner: Chris Fee, MD, Highland Hospital The medical student winners will receive a free Annual Meeting registration to the 2002 Annual Meeting. The resident winner will receive a textbook and a free Annual Meeting registration to the 2002 Annual Meeting.

The Program Committee is already making plans for next year’s contest and members are encouraged to submit potential cases and photos.

Please refer to the Call for Photographs that will be published in the next issue of the SAEM Newsletter.

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Hovenga EJ: Using multimedia to enhance a flexible learning program: lessons learned. Proc AMIA Symp 1999; 530-4.

Xie ZZ, Chen JJ, Scamell RW et al; An interactive multimedia training system for advanced cardiac life support.

Comput Methods Programs Biomed 1999; 60:117-31.

Clark LJ, Watson J, Cobbe SM et al: CPR 98: a practical multimedia computer-based guide to cardiopulmonary resuscitation for medical students. Resuscitation 2000; 44:109-17.

McGee JB, Neill J, Goldman L et al: Using multimedia virtual patients to enhance the clinical curriculum for medical students. Medinfo 1998; 9 Pt 2: 732-5.

Iserson KV: Film: exposing the emergency department. Ann Emerg Med 2001; 37:220-221.

Geiderman JM: Fame, Rights, and Videotape. Ann Emerg Med 2001; 37:217-19.

Rawls J: A Theory of Justice: Revised Edition. Belknap Publishers, 1999.

Larkin GL: A Code of Conduct for Academic Emergency Medicine. Acad Emerg Med 6:45, 1999.

American College of Emergency Physicians: Code of ethics for emergency physicians. Ann Emerg Med 30:365-72, 1997.

21 CFR 50.24 and 45 CFR 46.101(i).

SAEM Response to the GAO About EMTALA The following is the text of a letter sent to the General Accounting Office on February 28, 2001, in response to the GAO Study questions. This text is also posted on the SAEM web site at www.saem.org.

Jim Hoekstra, MD Chair, SAEM National Affairs Task Force Ohio State University The General Accounting Office (GAO) has initiated a study of the impact of EMTALA on the practice of emergency medicine. The following are the SAEM responses to the GAO Study questions. SAEM represents over 5000 academic emergency physicians working in the nation’s teaching hospitals.

EMTALA’s effects are felt more in academic emergency departments than anywhere else. These hospitals provide the majority of the uncompensated emergency care in this country. As such, they represent the true medical safety net. Academic emergency departments are also the teaching centers that train our health-care providers of the future. As such, any negative effects of EMTALA on teaching hospital EDs will have negative repercussions throughout the health-care industry.

EMTALA was initially passed by Congress as part of the 1985 federal budget and became effective August 1, 1986. Its purpose was to protect uninsured patients presenting to a hospital’s emergency department (ED) from being “dumped”, i.e. transferred to another, generally public, facility without evaluation and stabilization because of inability to pay. This law is commonly referred to as EMTALA, for the Emergency Medical Treatment and Labor Act. SAEM endorses the concepts of EMTALA as it was originally written. It is important that all patients presenting to the ED for care are examined and treated without bias toward ability to pay. It is also important that patients are not transferred from one hospital ED to another based on their inability to pay.

Unquestionably the greatest expansion of the scope of EMTALA occurred in 1998, which extended EMTALA obligations to any individual who “comes to the ED”, which now also includes hospital owned and operated ambulances, even if the ambulance is not on hospital grounds. The 1998 guidelines also make it clear that anyone who “arrives at a hospital . . . and requests emergency care” is entitled to a Medical Screening Exam (MSE) even if they are not technically in the hospital. Hospital premises also include the “parking lot, sidewalk and driveway of the hospital”.

The 1998 guidelines also state that EMTALA applies to “a hospital-owned facility which is non-contiguous or offcampus, and operates under the hospi-

tal’s Medicare provider number.” This was the first indication that HCFA intended to apply EMTALA requirements to hospital facilities, such as urgent care centers or satellite clinics, that are non-contiguous with that hospital’s ED. According to current HCFA regulations, therefore, if a patient “requesting emergency care” comes to a satellite center of a hospital, the facility must “screen and stabilize the patient to the best of its ability or execute an appropriate transfer, if necessary.” Compliance with EMTALA therefore requires these facilities either to develop a method of identifying any patient requesting “emergency care” among their clientele (as opposed to those needing only “walk in,” “urgent” or “fast track” care), or to medically screen all patients who present. The new legal liabilities, and their associated administrative and clinical costs, created by this section of the EMTALA guidelines may not have been anticipated by HCFA but are clearly being felt by hospitals all around the country.

1. In your opinion, how, if at all, has the scope of EMTALA expanded since its enactment?

The definitions that were provided in the original EMTALA legislation have expanded significantly. Unfortunately, the expansion has increased costs of ED care as well as the liability to ED physicians and hospitals.

The concept of “comes to the hospital” has expanded significantly the difficulties faced in the ED with identification of patients in need of care. It has expanded to the ED lobby, where nurses and techs are now expected to identify and screen patients for critical illness. It has expanded to the local area around an ED entrance, and it has expanded to EMS services. How can a diverted ambulance be considered a case that “came to the hospital?” How can an ED provide EMS to an area 250 yards (let alone 250 feet) beyond the confines of the hospital? There are no mechanisms to provide such care, and no way that EDs can police these areas. We are, however, liable for incidents that occur within these confines.

The review of all transfers and the L&D practices of a hospital by the local Medicare/Medicaid provider because one service or one practitioner is charged with an EMTALA violation is unnecessarily punitive and expensive.

These inquisitions and paper work marathons have taken countless nurses and physicians away from what they should be doing - i.e., providing patient care.

The EMTALA law has provided trial 14

lawyers to sue outside of the traditional malpractice environment.

Rather than having to prove harm, duty to serve, negligence and cause/effect, the trial lawyer must only show failure to follow someone’s interpretation of the EMTALA regulation. It has also allowed lawyers to circumvent state tort reform laws, abrogating the state’s right to protect its hospitals and physicians and save money for actually providing medical services to its citizens rather than spending that money on defense of suits or indemnity payments. This is a huge problem, especially given the vagueness of EMTALA legislation.

2. What impact has EMTALA had on hospitals and emergency departments? What impact has EMTALA had on physicians serving emergency departments?

Emergency physicians have a moral obligation to take care of any patient that presents to our ED for care. Unfortunately, private physician’s clinics and state and county agencies know this, and often send their patients to the ED for their health care needs, regardless as to whether or not there is a medical emergency. Emergency departments (especially teaching hospital emergency departments) provide a very high percentage of uncompensated care due to EMTALA mandates. Patients with true medical emergencies are often forced to wait for their care due to the overcrowding of EDs with misplaced uncompensated primary care.

The concept of providing a screening exam and stabilization to all patients who present to the ED is essentially an unfunded mandate. Unfortunately, only EDs are under this mandate. Any officebased physician can screen his/her patients for ability to pay. EDs cannot.

3. What impact has EMTALA had on the delivery of emergency services? How, if at all, has the delivery of emergency services changed since enactment of EMTALA? While hospitals and practitioners are more cautious about transferring patients, they are also somewhat concerned about doing all that might conceivably be considered necessary (after the fact) in a medical work up because of the additional liability threat produced by EMTALA. It has made getting a specialty consultation, or arranging a transport of a critically ill patient more difficult. (continued on next page)

Response to EMTALA (Continued) 4. What, if any, administrative problems have physicians serving emergency departments encountered in complying with EMTALA? See all of above items. In addition to the average practicing physician having to fill out transfer forms and provide more “stabilization” testing than before EMTALA, most hospitals have dedicated staff to police EMTALA compliance and reduce a given hospital’s liability to EMTALA reviews or fines.

Educational programs regarding EMTALA, paperwork, transfer forms, routing and investigation of complaints, etc, all cost nurses, administrators, and physicians time and money.

5. What, if any, financial problems have physicians serving emergency departments encountered in complying with EMTALA? The most significant financial problem due to EMTALA has to do with increased uncompensated care, which is elaborated above in question 2. This has resulted in the reduction of services available in the ED, reduction of staffing in the ED, and inability of EDs to keep up with increased patient volume demands. ED physicians are expected to provide medical screening exams to all patients without screening for ability to pay. As such, EMTALA has subjected emergency physicians, who often bill separately from the hospital, to a very high percentage of uncompensated care, with no mechanism to recoup their financial losses.

Meeting regulatory requirements (especially in conjunction with the punitive review process) takes the practitioner and her/his nursing staff away from patient care. The result is increased administrative time, which costs money.

Patients are unhappy with the additional charges brought about by the defensive practices resulting from EMTALA aversion, although many of them are hidden costs.

6. What are some reasons for the shortage of on-call physicians available to hospital emergency rooms?

Fear of litigation from EMTALA, fear of monetary penalties up to $50,000 outside of malpractice coverage, and potential exclusion from Medicare and Medicaid is a major concern of on-call physicians. As such, it is becoming more and more difficult to recruit and retain on-call physicians. The ED physician often becomes the safety net, and more often than not, transfer of patients to tertiary care hospitals occurs, adding to the costs of medical care.

7. Has managed care affected the provision of care in emergency departments? If yes, how?

Managed care clinics have told their patients to come to the ED when they are understaffed or when a problem occurs after hours. The managed care clinics then retrospectively decide what services to pay for. The EMTALA law leaves plenty of room for the managed care clinic to decide what represents an emergency after the fact. Managed care has not been successful in keeping patients out of EDs. On the contrary, patients cannot see their primary care providers as soon as they prefer in most managed care plans, so they come to the ED for their episodic or urgent care needs. Managed care plans have only been successful in limiting payments to ED physicians, who are mandated by EMTALA to provide screening exams and stabilization prior to discharge. In addition, non-payment of on-call physicians for after-hours or emergency care of managed care patients by managed care entities is one of the big reasons physicians decline to participate in on-call systems.

hours care. Hence the managed care organizations will argue that the ED visit was unnecessary after the fact and refuse to pay for all but the retrospectively documented major case while taking none of the liability for sorting out the serious from the mundane.

Mental health organizations and services are often provided purely on the basis of the patient’s insurance plan.

As such, psychiatric patients are often transferred from site to site purely on the basis of financial reasons. This is a “pseudo-violation” of EMTALA, even though it is an almost universal practice.

8. Has EMTALA affected the utilization of the emergency room? If yes, in what way?

EMTALA has had an increase on the use of the ED. The patient who cannot pay often comes or is sent to the ED preferentially because they know the ED must provide service, without regard to payment. In addition, what must be done when the patient is seen in the ED has been raised to a higher level by the EMTALA legal threat. The lack of primary care in most communities when patients need it (e.g., after hours so that the employee can maintain her/his job) is also increasing the use of the ED.

11. Recommendations for regions, states, and/or hospitals to consider in our fieldwork? a). Some of the definitions provided

by EMTALA need to be seriously reconsidered. The original purpose of EMTALA was to assure appropriate transfers to assure that they were not based on financial status. The expansion of EMTALA beyond its original purpose, as outlined above, should be reconsidered. b). Review of Managed Care Organization policies and actual practices.

The MCOs should be taken to task demonstrate that their patients have access to emergency care without retrospective review, and that they should provide reasonable after-hours primary care access. c). If the federal government is going to mandate ED care for all patients, and expose ED physicians to increased liability, paperwork, and reviews, it should COMPENSATE emergency physicians for it. The increased costs of ED care due to EMTALA are real, and should be considered in reimbursement schemes. These costs include on-call costs, standby costs, paperwork costs, and the cost of increasingly complex evaluations that EMTALA mandates.

9. Have any state laws complicated hospitals’ or physicians’ compliance with EMTALA? Examples.

While a good concept, the prudent layperson law of many states does not prohibit abuse of the ED by managed care clinics. It is the unavailability of primary care (including outright referrals from the managed care clinics to the ED) that drives patients to the ED. The managed care organizations do not really want to stop this practice (in fact their clinics encourage it), they just don’t want to pay the premium for after-

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10. Are you aware of regional differences in enforcement of EMTALA? Yes, the recent GAO report supported considerable variance in the different Medicare regions. District courts have decided differently with regard to burden of proof for whether or not care was denied without bias or whether or not the patient was appropriately stabilized prior to discharge. This adds to the EMTALA confusion, and the ED fears of liability.

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

Edited by the SAEM GME Committee

THE ACGME CORE COMPETENCIES: IMPLICATIONS FOR EMERGENCY MEDICINE TRAINING Gary Katz, MD, RRC-EM Mike Beeson, MD, MBA, from the SAEM GME Committee

The next two, interpersonal skills and professionalism, also have direct application to Emergency Medicine. In fact, it has been suggested since 1910, and perhaps before, that they apply to all fields of medical study. In his report, Abraham Flexner noted that among the more subtle skills are insight and sympathy, particularly in multi-cultural encounters.

In February of 1999 the ACGME endorsed the concept that professional development be evaluated in competency rather than strict exposure to a defined curriculum. There are six competencies that are considered to encompass the practice of medicine. These are: 1. Patient care 2. Medical knowledge 3. Interpersonal skills and communication 4. Professionalism 5. Practice-based learning and improvement 6. Systems-based practice

In Emergency Medicine we see patients from a wide spectrum of socioeconomic and cultural environments.

This requires the emergency physician to develop broad listening skills as well as sensitivity to ethnic, cultural, and gender issues in the creation of therapeutic relationships. The training of an emergency physician must therefore incorporate these competencies.

Suggested instruments of testing include OSCE, standardized patients, portfolios, and global evaluations.

Since then, there has been extensive debate as to how medical educators can attest to competency and which instruments should be used to assess them.

The fifth competency, practice-based learning, is the career long process of self-assessment and quality improvement. The skills needed to accomplish this pursuit of extended knowledge must be taught early in medical education and reinforced during residency. The skills for this can be roughly imagined as the utilization of peer review, introspection, emerging technologies, and other modalities to recognize oneâ&#x20AC;&#x2122;s own limitations of knowledge and proficiency. Residencies may use chart and literature review, project portfolios, and procedure logs.

Our professional organizations have examined this concept with varying levels of success. Currently, the ACGME and American Board of Medical Specialties (ABMS) are sponsoring a joint endeavor, with leaders from ABEM, RRC-EM, CORD, and EMRA, to define how these competencies apply to Emergency Medicine.

Furthermore, they will outline suggested tools that will allow for standard and reliable evaluation of residency training and maintenance of certification. It is expected that this project will accomplish its goals over the course of this next year.

Systems-based practice may well be the newest concept in medical education. Todayâ&#x20AC;&#x2122;s physician must have a strong understanding of the economic, political, and social pressures of the modern practice of medicine. The physician must demonstrate the practice of Emergency Medicine within the larger health care system and be able to apply this knowledge to deliver cost-effective care while maintaining advocacy for the emergency department patient. Educators can use OSCE, a global ratings scale, project portfolios, and chart stimulation recall to assess progress in this modern arena.

In the meantime, in what capacity might we consider these competencies? What is the application to Emergency Medicine? What tools currently exist that might become essential assets in assessing the presence of ability rather than the absence of problems?

The applications of the first two competencies are rather obvious. No one would argue that a strong fund of knowledge and the practice of patient care do not belong in Emergency Medicine. Essential skills associated with these competencies include obtaining complaint relevant H & Pâ&#x20AC;&#x2122;s, counseling patients and families, multi-tasking and team management, and selection of diagnostic studies and therapeutic interventions. For some time educators have been using assessment tools including standardized patients, objective structured clinical evaluation (OSCE), patient satisfaction queries, and live recordings to evaluate caring and respectful behavior that leads to a thorough and successful patient examination. Tests of medical knowledge often use similar modalities and, often, incorporate chart stimulated recall or oral examination, chart review, and model simulation for procedures.

Encompassing all of emergency medicine within six core competencies is an enormous task. To some the assumption of increased paperwork is an ominous sign for our efforts to effectively manage our schedules and keep a proper balance between educating and grading. Certainly, just as these competencies encourage lifelong learning, so should the learner encounter these assessment instruments throughout the entirety of medical education. When incorporated as such, one can visualize how the testing modalities overlap and how their use will allow for the teacher attestations to truly signify a standard of proficiency and competence in emergency medicine.

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MOONLIGHTING AND THE EMERGENCY MEDICINE RESIDENT Carey D Chisholm, MD, University of Indiana

Moonlighting places our specialty at risk. If we truly believe that EM is a unique specialty requiring a cognitive and technical skill set obtained through completion of an accredited postgraduate training program, it becomes difficult to rationalize how one can engage in this practice without having developed those cognitive and technical skill sets. By engaging in the independent practice of EM before training is completed perpetuates the myth that “anyone can work in the ED”.

Moonlighting violates the intent of ACGME mandates limiting resident work hours. Those of us in the academic community have applauded efforts by the ACGME and the RRC-EM to limit the number of hours residents can be required to work in their programs.

These were instituted to firstly and most importantly protect our patients from mistakes made through mental and physical fatigue. They are also part of the cornerstone of resident wellness. This time was developed to promote quality personal and family interactions, allow a more balanced life to include non-medical interests, and to increase the opportunity for the resident to explore non-clinical components of their residency training environment. Spending these hours engaged in the clinical practice of EM may lessen personal and family growth, and limit potential contributions you make to your training program.

Moonlighting Position Statement Links: SAEM: http://www.saem.org/newsltr/1999/position.htm CORD: http://www.cordem.org/moonlig.htm AAEM: http://www.aaem.org/ (see position statement section) AAMC debt management strategies & financial planning: http://www.aamc.org/about/gsa/md2/phase2/start.htm http://www.aamc.org/stuapps/finaid/layman/strat3qs.htm http://www.aamc.org/about/gsa/md2/md2_sec_iv.htm http://www.aamc.org/about/gsa/md2/phase3/md2_sec_iiib htm Articles of interest: 1. Hedges JR, Chisholm CD: Building a Profession.

Academic Emergency Med 2001 8: 386-388.

2. Kazzi AA and the SAEM-CORD-AAEM Writing Group: AAEM, CORD, and SAEM Reach a Landmark Position: Consensus Recommendations to the Federation of State Medical Boards (FSMB) for Revisions to the FSMB May 1998 Policy Statement on Physician Licensure. Academic Emergency Med 2001 8: 393-394.

3. Keim S, Chisholm C: Moonlighting and Emergency Medicine: Raising the Standard. Academic Emergency Med. 7(8):927-8, 2000 Aug 4. Chisholm CD. The moonlighting paradox. American Journal of Emergency Medicine. 18(2):224-6, 2000 Mar. 5. Berlin L. Liability of the moonlighting resident. American Journal of Roentgenology. 171(3):565-7, 1998 Sep. 6. Kellermann AL. Moonlighting. Annals of Emergency Medicine. 26(1):83-4, 1995 Jul. 7. Frumkin K. “What’s in a name?,” “Moonlighting for fun and profit”: reflections on the state of emergency medicine—a goal for 2000 and beyond. Annals of Emergency Medicine. 21(7):862-4, 1992 Jul.

EM residents are eligible to gain full unrestricted licensure in their state after 1 or 2 years of postgraduate training. With this comes the ability to engage in extracurricular activities for financial gain (“moonlighting”).

While the pressures to engage in moonlighting activities may be great, and the immediate financial rewards large, the EM resident should consider several of the downsides and consequences of moonlighting prior to jumping into this activity.

Moonlighting places ED patients at potential risk.

This is particularly true if you choose to work in a setting involving autonomous practice. In such a situation, there is no one available to offer a second opinion or assist you with a difficult intubation or interpretation of a imaging study. Your may not feel empowered to fully advocate for your patient when a private attending recommends a course that may not be optimal for that patient. Finally, there is no “safety net” for that patient in situations in which you lack experience with a disease or injury and do not realize this (how often do you go through an entire ED shift and have NO changes in your approach to patient care?). Are you ready to care for a 3 day old in shock? Perform a delivery and care for both mother and infant for 30 minutes? Serve as the only provider for 4 MVA victims who arrive simultaneously in your ED? Do you understand EMTALA and how it applies to medical staff responsibilities and patient transfer? As a professional, placing patient interest above your own is required. Engaging in the independent practice of EM before you are fully trained could be viewed as placing your own interests above those of your patients.

Moonlighting places the EM resident at risk. The additional commuting involved has resulted in automobile accidents for the resident (fatigue and distance = risk).

Experience in California has demonstrated that practitioners with under 3 years of postgraduate experience are disproportionately represented in adverse medical licensing actions. With the creation of the National Practitioners Data Bank {http://www.npdb-hipdb.com/} malpractice judgments must be reported. This has the potential to prolong or complicate your future applications for medical privileges. Unfamiliarity with EMTALA and the need to transfer the patient to tertiary facilities may place you at risk for civil penalties for violations (these are not covered by your malpractice insurance). What arrangements have been made for your malpractice insurance coverage? Will you be responsible for purchasing tail coverage for a claims-made policy? Have you made appropriate arrangements for tax withholding or will you be subject to an unforeseen payment come tax time? Are you being taken advantage of financially in this employment (while it is unrealistic to expect the same salary as established members of the group, how much “overhead” is being removed)? Finally, inexperience also may mean that your conflict resolution skills are relatively underdeveloped, increasing the chance of a violent encounter with a patient or family member.

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Council of Academic Societies Spring Meeting David Sklar, MD SAEM Rep to AAMC/CAS University of New Mexico The Council of Academic Societies held its spring meeting in San Antonio, Texas, March 22-25, 2001. The Council includes ninety-one member societies fifteen basic science societies, seventytwo clinical societies and four interdisciplinary societies. The purpose of the meeting is to bring issues of importance from medical faculty to the attention of the leadership of the Association of American Medical Colleges and to foster collaboration and information exchange between the member societies.

The theme of this meeting was information technology and how it could be incorporated into clinical, education and research activities of academic medical faculty. Of particular relevance to emergency medicine is the development of virtual reality programs and simulators to provide experience in procedural performance and care of critically ill simulated patients. In an environment of increasing scrutiny concerning medical error, simulators and virtual reality may be able to offer necessary experi-

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Send updated information to saem@saem.org

ence to students who may not get as much opportunity to learn by doing as in previous years.

The meeting also offered an opportunity to discuss issues of concern to the members. The issue of overcrowding of emergency departments, diverting of ambulances and nursing shortages received long and emotional requests for prioritization as an area of critical importance. Not only did emergency medicine representatives address this issue, but surgeons, internists and pediatricians also described concerns and the need for concerted effort.

The recent resident match results were discussed informally and the popularity of emergency medicine as compared with family medicine remarked upon. Although I hesitate to draw any conclusion from the match, I can say that it was watched closely and influences the perception of the leaders of

the AAMC about the specialties. The violent oscillations of Anesthesiology over the past five years based upon work force projections and income projections is an example of how outside forces can cause major changes in the medical studentsâ&#x20AC;&#x2122; sentiments concerning the desirability of a specialty. I hope the present ED overcrowding and divert crisis does not adversely affect student sentiment in a similar manner.

Finally, there were several discussions concerning non-physician health providers, particularly in anesthesia and psychiatry. However, physician assistants and nurse practitioners are increasingly appearing in emergency departments sometimes practicing independently. From the discussions, I would suggest that emergency medicine begin to define the role of nurse practitioners and physician assistants in the ED before someone else does it for us.

ABEM Philosophy of Combined Training Programs and Review Process At the SAEM Annual Meeting, the ABEM report included a discussion of combined training programs in Emergency Medicine and other primary specialties. This information came out of the ABEM Board meeting on February 2, 2001. Currently, the Board has approved Emergency Medicine combined training programs with Pediatrics, Internal Medicine, and Internal Medicine/Critical Care Medicine. It clarified that proposals for new combined training options should support an established career path that a significant number of individuals have already pursued, rather than seek to establish a new career path to attract individuals. The Board identified several areas of information that are important to have in place when considering a proposed combined training program. Institutions interested in starting a combined training program should contact ABEM. INFORMATION REQUIRED FOR PROPOSED COMBINED TRAINING PROGRAMS 1. What is the name of the specialty to be combined with EM training?

2. What is the origin of the request to consider a combined training program?

3. What are the basic objectives of a combined training program in EM and the other specialty?

4. How would a combined training option in EM and the other specialty improve patient care?

5. How many institutions have accredited programs in both specialties?

6. Include a written commitment from at least six training programs that support the proposed combined program.

7. What is the anticipated career path of graduates of such a combined program?

In addition, would there be a reasonable demand for the graduates of such a program?

8. How many practicing physicians are currently dual-boarded in EM and the other specialty?

9. Include statements from physicians who have pursued this career path.

10. Include a template of a proposed curriculum clearly showing and describing the overlap that is possible between the two specialties.

11. How would the combined program be funded?

12. How would diplomates certified through the combined program recertify or maintain certification in both specialty areas?

13. Include a letter of endorsement from the director or other appropriate individual of the residency program of the specialty with which the combined program would be developed.

14. Has there been contact with the other specialty board? If so, what was the response?

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President’s Message (Continued) Many thanks are in order to Mary Ann, Patty and the SAEM family staff “supreme team” (Jennifer, Sonya, Sylvia and Jean). Also, thanks to Mary Ann’s husband, Frank, for all the uncompensated work he does for SAEM. Thanks to the SAEM Board of Directors for their vote of confidence in me. I especially thank the Program Committee for putting together another great Annual Meeting. I thank all committee, task force and interest groups and I thank each and every member of the SAEM family for your support and diligent work.

The pre-meeting day of activities such as the CPC, Chief Resident Forum, committee, task force and interest group orientation dinner, academic chairs retreat, the opening plenary paper session and the banquet in its new format on the first day, (attended by well over 400 people) to the poster sessions, paper presentations, didactics, the keynote speech, committee and task force and interest group meetings, and the President’s reception/banquet held at the Jimmy Carter Presidential Center (hosted by the Emory University Department of Emergency Medicine), and many other affiliated activities were all first rate. The last day of the meeting continued with outstanding presentations. There was also a very informative Academic Emergency Medicine consensus conference on the unraveling of the safety net held on the last day.

Those who attended the Annual Meeting recognized that the traditional slide trays that have in the past fueled the Imago Obscura award are now becoming extinct. Technical support for computer presentations went well.

During my term as SAEM presidentelect, I was responsible for appointing the chairs and members of the various task forces and committees. I also was responsible (with the Board’s approval) for putting together the objectives. The committees and task forces have gotten off to a great start. The committee and task force objectives are printed in this issue of the Newsletter.

The SAEM family obviously has a lot of work to do this year. In this message, I will not mention all but I will mention some of the chores. We will evaluate the new election process, which appears quite successful. We will provide consults to requesting emergency medicine divisions and departments based on requests. There has been renewed, although cautious, interests in emergency care center categorization.

Twenty academic departments have expressed interest and many have made recommendations for members of their departments to participate in the ECC categorization committee. The

ECC committee is charged with reviewing the ECC application for possible streamlining. There was much debate during the meeting on the question of “why do it and what are the rewards?” Although there has been inertia in the past year regarding the ECC, some departments have expressed interest and some departments have indicated that they are in the process of applying.

We will develop a teaching module for residents interested in academic careers and we will develop a fellowship catalogue similar to the residency catalogue. We will also develop a teaching module for emergency medicine residency programs on ethics and professionalism. The Faculty Development Academic Handbook has many chapters already completed but we have identified more chapters that need to be written. It is our goal to have the handbook completed within the next year. We will develop the mission and goals and a business plan and mechanism for fund raising for the SAEM Research Fund. This research fund was formerly called FAEM. Grant applications for the multiple SAEM grants will be reviewed and we will assess the need and development for future new grants. We will monitor HCFA regulations, GME funding and the EMTALA regulations. We will organize an emergency medicine program at the AAMC annual meeting. We will solicit and review nominations for the elected positions of our organization, the Young Investigator Awards and the Academic Excellence and Leadership Awards.

We will develop a teaching module on patient safety and develop a report that discusses the issues of how to study, monitor, analyze, report and act on adverse events, near misses and errors.

We will develop a teaching module for residents explaining the healthy people 2010 objectives.

SAEM has not before had a specific public relations plan. This year we intend to lay the groundwork for public relations plans. Our public relations efforts will highlight SAEM’s research and education activities and also will serve as the watchdog for national activities related to research and education that may affect emergency medicine. We will publish a series of articles that highlight the various NIH Institutes, grant programs and training programs applicable to emergency medicine. We will mentor junior researchers by providing quick reviews and comments on federal grants prior to submission. We will implement the 2001-2002 salary survey and we will continue to develop and revise the virtual advisor project for undergraduates. A plan will be developed 19

to implement the standardized emergency medicine undergraduate curriculum and we will continue to assess the potential for an emergency medicine shelf examination for undergraduates.

This past year, SAEM issued a position statement on diversity. The followup to that position statement has been the development of the Under Represented Member Research/Mentoring Task Force. The goal of this task force is to provide mentoring to under represented members of SAEM and to address cultural competency issues through the development of teaching cases (training modules), monographs and various forms of research. Overtime, we hope to obtain a significant organizational grant. A major question to be answered is “can cultural competency help to reduce health care disparities”?

The SAEM board has a new initiative for this year — “projecting SAEM for the year 2010”. We will obtain information from other academic organizations and various sources and we will develop strategies and plans for 2010 goals.

We will look at the SAEM finances, staff, the SAEM office building, communication modalities, fund raising plans and staffing needs necessary to implement PR and national affairs tracking. We have a lot of work ahead of us and I look forward to leading the organization and having some fun along the way. It is my pleasure to work with the SAEM family now and hopefully for years to come.

After the meeting was over, I was happy to get back home to family; wife and children (two who had just finished their college exams), and my 2 dogs and 2 cats; who were all very glad to see me and I was very happy to see them. Just as my kids are relieved to have completed their college exams for this year, I was relieved having completed the Annual Meeting. College grades don’t arrive until later in the summer. As far as the Annual Meeting, I give the Program Committee and all who contributed an A+.

Future SAEM Annual Meetings May 19-22, 2002 Adam’s Mark Hotel St. Louis, MO May 29-June 1, 2003 Marriott Copley Place Boston, MA

Annual Meeting Highlights 2001-2002 SAEM Board of Directors: (L-R in back) Roger Lewis, MD, PhD, Brian Zink, MD, Donald Yealy, MD, Jim Adams, MD, and Glenn Hamilton, MD. (L-R in front) Susan Stern, MD, Judd Hollander, MD, Carey Chisholm, MD, Marcus Martin, MD, and Debra Houry, MD.

Brian Zink (R) is pictured with Dr. Louis Binder, the recipient of the 2001 SAEM Leadership Award.

Emanuel Rivers, MD, the recipient of the 2001 SAEM Academic Excellence Award is congratulated by Brian Zink and Marcus Martin. (L-R) Dr. Zink, Dr. Rivers, and Dr. Martin.

Jerris Hedges, MD, MS, was the speaker at the Annual Meeting Banquet. Dr. Hedges shared his personal, historical perspective on building a research career ala “Forrest Gump.” He spoke on the question, “Do we have a destiny or do we just float around on a breeze?” Dr. Hedges (L) is pictured with Brian Zink.

(L-R) Robert O. Wright, MD, MPH, Terry Vanden Hoek, MD, and David Wright, MD, the 2001 recipients of the Young Investigator Award were presented with their awards at the Annual Meeting Business Meeting in Atlanta.

The recipients of the 2000 Annual Meeting Best Presentations awards were recognized during the Annual Business Meeting.

(L-R in back) Xin-liang Ma, MD, PhD, D Matthew Sullivan, MD, Suzanne Schuh, MD, and Emanuel Rivers, MD. (L-R in front) Valerie De Maio, David Wright, MD, and Laurence Katz, MD. Not pictured: Geoffrey Jackman, MD, Brigitte Baumann, MD, and Joshua Rucker.

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Dr. Brian Gibler, AACEM outgoing President (R) is presented with a plaque in appreciation of his services to AACEM by Dr. John Gallagher, AACEM incoming President.

Dr. William Foege, the Annual Meeting Keynote Speaker is pictured with (L-R) Art Kellermann, MD, Ellen Weber, MD, Dr. Foege, Brian Zink, MD, and Marcus Martin, MD.

2001-2002 AACEM Executive Committee (L-R) Jerris Hedges, MD, John Gallagher, MD, Brian Gibler, MD, and Frank Counselman, MD.

Dr. Brian Zink (R) presents the Resident Research Year Grant award to one of the recipients, Roland Merchant, MD.

Dr. Terry Kowalenko, the National Coordinator for the Semi-Final CPC Competition is pictured with the winners of the Competition and the Coordinators: (L-R in back) Frank McGeorge, MD, Robert Baevsky, MD, Marc Roy, MD, Darren Braude, MD, Steve Baxter, MD, Annie Sadosty, MD, Victoria Palmer-Smith, MD, Doug McGee, DO. (L-R in front) Dr. Kowalenko, Shawna Perry, MD, Michael Gisondi, MD, Randy Goldstein, MD, Mary Ryan, MD, Tricia Villanueva, MD, Elaine Sapiro, MD, and Kevin Rodgers, MD. 21

Dr. Zink (L) is pictured with Gina Wilson-Rameriz, MD, the 2001-2002 Medtronic Physio Control EMS Fellow and Robert Niskanen from the Medtronic Physio Control Corporation.

SAEM 2001-2002 Committee/Task Force Objectives Constitution and Bylaws Committee Chair: Kate Heilpern, MD, Emory University Email: kheilpe@emory.edu 1. Review the Constitution and Bylaws to ensure accuracy in regards to the Society’s activities and propose needed amendments to the Board for approval.

2. Evaluate the new election process and provide a report to the Board and membership.

Graduate Medical Education Committee Chair: Michael Beeson, MD, Akron City Hospital Email: beesonm@summa-health.org 1. Complete the development of a teaching module for a rotation for residents interested in an academic career.

2. Develop a “Fellowship Catalog” which provides expanded, structured information on fellowships and other postgraduate opportunities (MPH, MBA, PhD) and include articles on topics such as the potential benefit, curriculum requirements, why it is important to obtain postgraduate training, and likely career impact.

3. Maintain and update the Resident Section of the web site.

Consultation Service Task Force Chair: Louis Binder, MD, MetroHealth Medical Center Email: lsbinder688@pol.net 1. Provide consultation services as requested by institutions.

2. Collect data from the survey of academic chairs and recipients of consults from the past three years and develop a report to the Board.

Grants Committee Chair: Jim V. Quinn, MD, University of California, San Francisco Email: quinnj@medicine.ucsf.edu 1. Coordinate the grant application reviews (working with expert reviewers from committees, task forces and interest groups) and recommend recipients to the Board for the following grants: a. Medical Student Interest Group b. Scholarly Sabbatical c. Research Training d. Institutional Research Training e. EMF/SAEM Innovations in Emergency Medicine Education f. EMS Research Fellowship g. EMF/SAEM Medical Student h. Neuroscience Fellowship 2. Assess the need and development of future new grants including Bridge Grants and an MD/PhD Grant.

3. Develop a database to track grant recipients for possible follow-up, possibly using the NRSA appraoch to assess career trajectories.

Emergency Care Center Categorization Committee Chair: Andrew Sama, MD, North Shore University Hospital Email: asama@nshs.edu 1. Promote Emergency Care Center Categorization through advertisements, Newsletter articles, and letters to institutions and chairs.

2. Coordinate the review and approval of ECC categorization applications.

3. Review the ECC application and process and recommend proposed changes to the Board.

Ethics Committee Chair: Catherine Marco, MD, St. Vincent Mercy Medical Center Email: cmarco2@aol.com 1. Develop 3 articles on ethical issues or in response to questions submitted by SAEM members for publication in the SAEM Newsletter.

2. Develop 2-3 ethical case studies for submission to Academic Emergency Medicine.

3. Continue educational efforts for ethics related subjects, including didactic session proposals for consideration at the Annual Meeting, regional meetings, and other forums.

4. Promote and coordinate the Ethics Consulting Service.

5. Develop a teaching module for emergency medicine residency programs on ethics and professionalism and submit to the Board for approval.

6. Develop guidelines for filming of ED patients in academic emergency departments.

National Affairs Committee Chair: James Hoekstra, MD, Ohio State University Email: hoekstra.1@osu.edu 1. Represent SAEM at the AAMC and AMA and submit periodic reports, positions papers and articles of the organizations’ activities and meetings to the Board and for publication in the SAEM Newsletter.

2. Monitor HCFA regulations, GME funding, EMTALA regulations and other issues pertinent to academic emergency medicine and develop Newsletter articles and position statements as needed for submission to the Board.

3. Develop a proposal and organize an emergency medicine program at the AAMC Annual Meeting for submission to the Board.

4. Continue a liaison relationship with the other national emergency medicine organizations to work together on common issues.

5. Encourage involvement of academic emergency physicians in the political process.

6. Develop a didactic proposal to inform SAEM members of the governmental affairs positions and initiatives of interest to academic emergency physicians for submission to the Program Committee for consideration at the Annual Meeting.

Faculty Development Committee Chair: John Gallagher, MD, Montefiore Medical Center Email: jgallagh@montefiore.org 1. Complete the Academic Handbook.

2. Develop educational didactic proposals and submit to the Program Committee for consideration of presentation at the Annual Meeting.

3. Continue to develop and update the Faculty Development section of the SAEM web site.

4. Develop a Newsletter article on examples of what constitutes excellence and scholarship for promotion and tenure for clinician educators.

Financial Development Committee Chair: Scott Syverud, MD, University of Virginia Email: sas3k@virginia.edu 1. Establish Research/Academic Development mission and goals with a business plan to include estate planning and other means of endowment.

2. Develop a mechanism for fund-raising efforts directed towards corporate and private support and endowment, including the development of policies for applying for corporate and private contributions.

3. Provide continued oversight of SAEM investments.

Nominating Committee Chair: Roger Lewis, MD, PhD Email: roger@emedharbor.edu 1. Develop a slate of nominees for the elected positions on the Board of Directors, Nominating Committee, and Constitution and Bylaws Committee and submit to the Board for approval.

2. Solicit and review nominations for the Young Investigator Award and recommend recipients to the Board.

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Committee/Task Force Objectives (Continued) 3. Solicit and review nominations for the Academic Excellence and Leadership Awards and recommend recipients to the Board.

4. Continue efforts to increase membership involvement and diversity within SAEM. 5. Develop criteria for a possible SAEM Humanitarian Award.

6. Identify organizations that SAEM should interact with in regards to exchanging information about the organizations’ and SAEM’s Annual Meetings.

Salary Survey Task Force Chair: Steve Kristal, MD, Henry Ford Hospital Email: skristal@earthlink.net 1. Develop survey instrument for 2001-2002 Salary Survey of faculty at emergency medicine residency programs and submit to the Board for approval.

2. Implement the 2001-2002 Salary Survey, collate and analyze the results, and submit the resultant manuscript to the Board for approval, and publication in Academic Emergency Medicine.

Patient Safety Task Force Chair: Robert Wears, MD, University of Florida, Jacksonville Email: wears@ufl.edu 1. Continue the development of a teaching module on patient safety.

2. Develop an Annual Meeting didactic proposal for submission to the Program Committee for consideration at the Annual Meeting.

3. Prepare a Newsletter article on research opportunities related to patient safety.

4. Develop a report that discusses the issues of how to study, monitor, analyze, report, and act on adverse events, near misses, and errors.

5. Collaborate with other professional societies and disciplines on patient safety as needed.

Undergraduate Committee Co-Chair: Stephen Thomas, MD, Massachusetts General Hospital Email: thomas.stephen@mgh.harvard.edu Co-Chair: Wendy Coates, MD, Harbor-UCLA Medical Center Email: coates@emedharbor.edu 1. Review, revise and update the Medical Student Section of the SAEM web site and develop strategies to ensure that SAEM is more identifiable to medical students.

2. Solicit and review articles and announcements of interest to medical students interested in a career in emergency medicine, with an emphasis on academic emergency medicine, for publication on the Medical Student Section of the web site.

3. Continue development and revision of the Virtual Advisor project.

4. Work with the Medical Student Educators Interest Group to develop a Medical Student Educators’ Section on the SAEM web site, including resources such as medical student rotation information, emergency medicine interest groups, affiliated residencies, departmental status, etc.

5. Develop an implementation plan of the standardized emergency medicine undergraduate curriculum previously developed by SAEM. 6. Continue to assess the potential for an emergency medicine shelf exam.

Program Committee Chair: Ellen Weber, MD, University of California, San Francisco Email: weber@itsa.ucsf.edu 1. Develop and coordinate 2002 Annual Meeting including a work plan, timeline, budget, and publicity.

2. Provide continuous review of the Annual Meeting goals and objectives as they relate to the Society’s long range plan and mission and make recommendations to the Board.

3. Publicize the Annual Meeting to other national organizations and meetings to encourage the cross-disciplinary exchange of science.

Public Health Task Force Chair: Carlos Camargo, MD, Massachusetts General Hospital Email: ccamargo@partners.org 1. Develop a teaching module directed towards residents to explain HP2010 and its objectives.

2. Develop an action plan to address four HP2010 objectives (observational research, interventions, networking with other medical specialties/public health departments, grants) and present to the Board for approval.

3. Continue to participate in HP2010 national meetings and disseminate information to the SAEM membership through Newsletter articles.

Under Represented Member Research Mentoring Task Force Chair: Glenn Hamilton, MD, Wright State University Email: glenn.hamilton@wright.edu This task force will provide mentoring to under-represented members of SAEM and will address cultural competency issues, including whether cultural competency reduces racial and ethnic health disparities.

1. Provide research mentoring predominantly, but not exclusively, to under represented minority emergency medicine residents as defined by the AAMC (African American, Mainland Puerto Rican, Native American, and Mexican American): a. Develop a teaching module on cultural competency b. Develop and implement research proposals regarding cultural competency 2. Develop a monograph to encourage under represented minority medical students to consider emergency medicine as a specialty.

3. Suggest research proposal for future mentoring initiatives for submission to the Board.

Public Relations Committee Chair: Marcus Martin, MD, University of Virginia Email: mlm8n@virginia.edu 1. Develop and implement public relations plans for SAEM. Research Committee Chair: Mark Angelos, MD, Ohio State University Email: angelos.1@osu.edu 1. Develop research didactic proposals, including sessions focusing on the NIH and other sources of federal funding, for submission to the Program Committee for consideration of presentation at the Annual Meeting.

2. Publish articles in the SAEM Newsletter highlighting EM researchers receiving NIH and other large grants.

3. Publish a series of SAEM Newsletter articles that highlight various NIH institutes, grant programs, and training programs applicable to emergency medicine.

4. Develop a program by which the Research Committee can provide mentorship for junior researchers by providing quick review and comments on federal grants prior to submission.

5. Continue to develop Researcher Career Profiles for publication in the Newsletter with the goal of publishing 2-3 articles.

Board Initiative-Projecting SAEM in 2010 The Board of Directors plans to survey other medical organizations to compare with SAEM and develop goals for SAEM in 2010.

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State of the Society (Continued) So, I think we did well in our focus areas in the past year. And for those committee and task force chairs and members who were not in the “focus areas”, I appreciate the fact that you did not whine about it, but did some incredibly good work. Just to cite a couple of these, Felix Ankel chaired the Undergraduate Education Committee, which has done a great job over the past few years. One of the innovative projects from this Committee is a web-based Virtual Advisor program for medical students. You can check this out at the Innovations in Emergency Medicine Education Exhibit, along with the new Faculty Development Website. The Virtual Advisor program should be especially valuable to medical students who are at medical schools without strong EM programs. I encourage faculty members to sign up to be Virtual Advisors.

Another success story has been the Patient Safety Task Force, chaired by Bob Wear, which was formed last spring in response to the national attention directed at patient safety and medical error. The Task Force got off to a great start with the Consensus Conference that was sponsored by AEM and SAEM last spring. The proceedings from that conference were published in the November 2000 edition of AEM, and are being highly referenced and mentioned in national discussions on patient safety.

Bob and his task force have been traveling extensively in the past year, representing SAEM at national patient safety meetings and forums.

I would also like to acknowledge the significant systems changes that occurred in our organization as a result of the C&B amendments that were developed by Sue Fish and the Constitution and Bylaws (C&B) Committee. As you know, the amendments were put to the members for vote in February, and we overwhelmingly voted to change our elections to a mail ballot, and to allow resident members to vote for the resident member of the Board of Directors.

The results of our first mail ballot election have just been announced, and we are pleased that 5 times as many SAEM members voted in the election this year as compared with our previous method that limiting voting to those present at the business meeting. As part of the C&B amendment changes, resident members were able to vote for the first time this year for the resident member of the Board of Directors.

Finally in our review, the most obvious evidence of our success is all around us these 5 days in the proceedings of a fantastic Annual Meeting that is the result of the tireless work of Ellen Weber and the Program Committee.

Well, that’s a long review of systems, and if I were presenting this case to the

average academic emergency attending physician, he or she would have that glazed over look in the eyes, and be thinking about a ski trip to Vail last January. So, let’s move on: Family and Social History: In our case, this is far from “noncontributory.”

SAEM interacts with lots of other organizations that begin with “A”. We attempt to foster productive, harmonious relationships with ACEP, AAEM, AACEM, ABEM, AAMC, and AMA. We also collaborate with CORD, EMRA, and the RRC in areas that relate to resident education and research.

Physical Exam: SAEM vital signs are not only stable, in fact they are increasing. SAEM has 5,500 members, 2,150 who are active members, 2,751 resident and medical student members, and 360 associate members. Finances are in the black.

Head(quarters): The SAEM Headquarters are in Lansing, MI, in a beautiful old gray house that has wonderful woodworking, high ceilings, and boasts the oldest bathroom in Lansing. Many members are surprised to learn that the Executive Director, Assistant Director, and a full time staff of 3 other people run, out of this old house — SAEM, the journal AEM, CORD, and AACEM. In all, this is an amazing enterprise — efficient, lean, but also innovative, responsive, and very attentive to members’ needs.

Heart: The heart of the Society is its members, and while there are bouts of tachycardia, especially around abstract submission time, and an occasional murmur of discontent, the heartbeat is strong, and regular and not failing.

Neurological: The neurological circuitry of SAEM has become its website.

This site is one of the finest available for an academic organization, and has developed considerably in the past year. Almost all of the important SAEM functions are now web-based, including membership registration, abstract submission, and meeting registration. The site is also a major repository of information on EM research opportunities, career development, and medical student and resident information.

Assessment and Plan: In summary, this is a 12-year-old academic medical organization. In somewhat of a medical paradox, the basic elements of the Society, the members, are somewhat infirm, but the Society as a whole is healthy. This makes one a bit nervous that the problems that are endemic to academic medicine will eventually affect SAEM. The Society is ready to make a leap to becoming a significant source of funding for EM research 24

training, but this will require a large increase in our research endowment and formal development efforts. We are ready to increase our presence in national affairs and advocacy, but this may require additional resources and time. We are determined to offer more support to EM faculty to develop their careers. We want to continue to lead in medical student and resident education.

But to keep to this plan will require more, rather than less of our members.

The pressures of clinical workload, departmental finances, and increased scrutiny of our medical practices are eroding some of things that we have regarded as fundamental. On the medical school side this is manifested as a decrease in the time and attention that faculty devote to medical student education. Presumably, the reason that we are in academic medicine, and employed by or affiliated with medical schools, is that we value educating the next generation of physicians. But because medical student teaching activity is not usually rewarded monetarily, and because other crises may be treated as a higher priority, this fundamental part of our mission as academic physicians is threatened.

The same thing is happening in our emergency medicine residency programs. Burgeoning patient volumes, reduced clinical resources, and burdensome federal regulations create a black hole with a mighty gravitational field that pulls our educational and research missions out of our normal orbits. I’m pretty sure that our residents nowadays do not have the same depth of faculty interaction, even in the form of basic conversations, that I enjoyed as a resident. All of that discretionary time seems to be sucked up by the black hole. The thing that disturbs me most about this is that the way in which we use our voluntary or discretionary time indicates where our values lie, and this sends a message to our trainees. How can we impart the values and show the rewards of teaching, and scientific inquiry to those people who will follow us if we seem to ignore or give poor effort in those areas? How will we attract bright, and talented people to academic emergency medicine if the adjective used to describe EM faculty is “frenzied” rather than “fun”? It seems unconscionable to ask, but at this time, when the demands on us individually and as departments is greatest, we must rededicate ourselves to our central and fundamental values as academicians. We must find the time to teach and investigate, and feel and show the joy that comes from these endeavors. Churchill said, “I like a man

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State of the Society (Continued) who grins when he fights.” I hope that can be our approach.

What strategies can we use to fight what Kenneth Ludmerer calls “the second revolution” of American health care? This revolution places market strategies and cost containment in a higher plane than the training of our medical students and residents, and the care of the poor and underserved in society. Our initial response in academic medicine was a corporate one — to compete with each other for patients and health care markets — to improve our efficiency and bottom line. It can be argued that this approach has been unsuccessful, especially as it relates to medical education. We may now have a health care system that is leaner and doesn’t spend at quite the rate as previously, but as we all have seen, discontent is rampant in our patients, medical personnel, faculty, medical students and resident physicians. Seeing this, perhaps the best strategy at this moment, as we combat the industry and government forces that have wounded academic medicine, need not be too aggressive. As Napoleon noted, you should “never interrupt your enemy when he is making a mistake.”

I have written in the past year on advocacy, and reiterate now, that our position in Emergency Medicine is very familiar to most of the American public.

People pay attention when we speak.

Our words can be simple: that high quality emergency care must be available to all people, that the training of quality physicians to provide emergency care cannot be further compromised, and that the scientific exploration that will lead to improved care for future emergency patients must be supported.

Note that our most effective and influential position is to advocate for our patients, our residents, and our students, and not for ourselves. Although we work hard and have lots of stressors, this hardly makes us unique in the American workforce, and with our generous incomes, we will not evoke much sympathy if our advocacy is only for emergency physicians. Jordan Cohen, the President of AAMC said in an address last June: “the key to valuing the profession is to profess its values.”

We can feel secure that the basic values of teaching, scientific investigation, and providing care to all who need it, whenever they need it, are beyond reproach, and resonate with the American public. We do not all need to have a mastery of complex political and legislative processes to be effective advocates — we merely need to be able to illustrate and share our values.

I am very hopeful that a few years from now we may be translating the lessons we have learned from our

hardships into improved, more efficient emergency patient care, and innovative teaching and research. Perhaps my middle name is Pollyanna, but I hope you will all be there with me, grinning, and fighting.

As would be expected, the problems that academic emergency physicians are encountering in their individual situations are transferred to some extent to our academic society. The erosion of discretionary time means that fewer people are able to commit to SAEM projects or work that take significant effort. So, even though our membership numbers are going up, I believe the number of people who are doing the work of the Society is decreasing.

There are a number of problems with this. First, as a national and international society, we want to represent ideas and activity from members of a diverse and varied background. If one or two people do all the work on a particular project we risk having a product that is not representative of our Society as a whole. Another concerning thing is that if SAEM work becomes the domain of a few energetic, well-meaning true believers, who will keep advancing our mission when these individuals (some may call us zealots) grow old, or weary, or retire? I am concerned that many of our junior members are not able to find the time to have meaningful participation in the Society. This is our loss, and also their loss. And we have the same problem at the other end of the experience spectrum. It never seemed possible, but now we have senior members who have wisdom and insights to share with SAEM, but who find little time to do

so. I would challenge these members to bring your skills and leadership back into SAEM so that we have some elders to mentor us and keep us on course.

Why give your precious time and effort to SAEM? That is a question that each of us has to answer individually.

For me, it may sound corny, but it has always been the simplicity of the organization. I find myself refreshed and restored again and again by the basic beauty of our mission. And like many of you, I find a very nice fit between my values and the SAEM mission: to improve patient care by advancing research and education in emergency medicine. There are not a lot of things in professional life that remain pure, but the SAEM mission, and the way its members and staff have pursued that mission over the past 12 years is as about as pure as it gets.

In closing, I would like to say thank you to the Society for the outstanding experience it has been for me to serve as your President in the past year.

Many people ask me if I am tired, and ready for a break, and to some extent I am. But after spending a year traveling and interacting with SAEM faculty, residents, medical students, and our SAEM staff, I am left with such a positive feel for the future of academic emergency medicine, that I leave more rejuvenated than tired. And on that note, I would like to present to you our new SAEM President, Dr. Marcus Martin.

*From the 2001 SAEM President’s Address presented at the SAEM Annual Meeting, May 7th, 2001, Atlanta, GA.

11th Annual Midwest Regional SAEM Research Forum September 15, 2001 St. Louis, Missouri Hyatt Regency Hotel Union Station Keynote Speaker: Jerris R. Hedges, MD, MS “Ten Things You Should Do in 2001” The Program Committee is now accepting abstracts for oral and poster presentation at the 11th Annual Midwest Regional Research Forum to be held in St. Louis on September 15, 2001. The deadline for abstract submission is Saturday, June 30, 2001.

For meeting information and hotel reservations, contact Linda Barth or Michael Mullins, MD, at the Division of Emergency Medicine, Washington University, Campus Box 8072, 660 S. Euclid Ave, St. Louis, MO 63110-8072. Phone: 314-362-8971. Fax: 314362-0478. E-mail: barthl@msnotes.wustl.edu or mullinsm@msnotes.wustl.edu.

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SAEM 2001-2002 Committees and Task Forces Consultation Service Task Force Chair: Louis S. Binder, MD, MetroHealth Medical Center Wallace Carter, MD, NYU/Bellevue Hospital Center James Holliman, MD, Penn State Geisinger Health System Liudvikas Jagminas, MD, Rhode Island Hospital Kathleen Ann Neacy, MD, Regions Hospital Dan Pallin, MD, Mount Sinai School of Medicine Robert Shesser, MD, MPH, George Washington University Allan B. Wolfson, MD, University of Pittsburgh Ethics Committee Jean T. Abbott, MD, University of Colorado Eric N. Bryant, MD Michelle Grant Ervin, MD, MHPE, Howard University Neal Flomenbaum, MD, New York Hospital Joel M. Geiderman, MD, Cedars-Sinai Medical Center Gregory Luke Larkin, MD, University of Pittsburgh Chair: Catherine A. Marco, MD, St. Vincent Mercy Medical Center Mary Patricia McKay, MD, Allegheny General Hospital Patricia P. Nouhan, MD, St. John Hospital and Medical Center Philip N. Salen, MD, St. Luke’s Hospital Stacy N. Weisberg, MD, State Univ. of New York, Syracuse Faculty Development Committee William G. Barsan, MD, University of Michigan Howard A. Blumstein, MD, Wake Forest University Kathleen Brown, MD, State University of New York, Syracuse Gregory P. Conners, MD, University of Rochester Deborah B. Diercks, MD, University of California, Davis David Esses, MD, Montefiore Medical Center John T. Finnell, MD, Regions Hospital Chair: E. John Gallagher, MD, Montefiore Medical Center J. Lee Garvey, MD, Carolinas Medical Center Kristin E. Harkin, MD, Jacobi Medical Center Sean O. Henderson, MD, University of Southern California Jennifer Krawczyk, MD, University of California, Irvine Gloria Kuhn, DO, PhD, Medical College of Virginia Douglas W. Lowery, III MD, Emory University Michael S. Lyons, MD, University of Cincinnati Debra G. Perina, MD, University of Virginia S. Scott Polsky, MD, Summa Health System Georges Ramalanjaona, MD DSc, Newark Beth Israel Gail S. Rudnitsky, MD, MCP Hahnemann University Latha Ganti Stead, MD, Jacobi/Montefiore Financial Development Committee Steven C. Dronen, MD, University of Michigan Judd E. Hollander, MD, University of Pennsylvania Roger J. Lewis, MD PhD, Harbor-UCLA Medical Center Joseph A. Salomone, III MD, Truman Medical Center Arthur B. Sanders, MD, University of Arizona Chair: Scott A. Syverud, MD, University of Virginia Jill D. Teplensky, PhD, Thomas Jefferson University Brian J. Zink, MD, University of Michigan Frank L. Zwemer, Jr, MD, University of Rochester Graduate Medical Education Committee Joel M. Bartfield, MD, Albany Medical Center Chair: Michael S. Beeson, MD, Akron City Hospital Steven H. Bowman, MD, Cook County Hospital Charles K. Brown, MD, The Brody School of Medicine Douglas Brunette, MD, Hennepin County Medical Center Mike Burg, MD, University Medical Center Mark W. Fourre, MD, Maine Medical Center Sheryl L. Heron, MD, MPH, Emory University David S. Howes, MD, University of Chicago

Steven A. McLaughlin, MD, University of New Mexico Usamah Mossallam, MD, Henry Ford Hospital N. Heramba Prasad, MD, State University of New York Sandra Sallustio, MD, PhD, Mount Sinai Medical Center James Scott, MD, George Washington University Patricia Dighton Short, MD, Indiana University Malini Kishen Singh, MD Rebecca Smith-Coggins, MD, Stanford University Joseph Adrian Tyndall, MD, Brooklyn Hospital Center Anthony J. Weekes, MD, St. Luke’s-Roosevelt Hospital Beth Whelchel, University of Virginia Keith Wilkinson, MD, William Beaumont Hospital Wendie Williams, MD, Howard University Hospital Bradley N. Younggren, MD Grants Committee Charles B. Cairns, MD, University of Colorado Theodore R. Delbridge, MD, MPH, University of Pittsburgh John Eric Duldner, Jr, MD, Akron General Medical Center Jason Scott Haukoos, MD, Harbor-UCLA Joseph LaMantia, MD, North Shore University Hospital Chair: Jim Quinn, MD, University of California, San Diego Marc S. Rosenthal, PhD, DO, Regions Hospital Arthur B. Sanders, MD, University of Arizona Federico E. Vaca, MD, University of California, Irvine John G. Younger, MS, MD, University of Michigan National Affairs Task Force Jill Grant, University of Virginia Azita Hamedani, MD, Brigham and Women’s Hospital J. Brian Hancock, MD, Timberline Emergency Physicians, P.C. Mark C. Henry, MD, State Univ. of New York, Stony Brook Chair: James W. Hoekstra, MD, Ohio State University Kenneth V. Iserson, MD, MBA, University of Arizona Amin Antoine Kazzi, MD, University of California, Irvine John A. Marx, MD, Carolinas Medical Center William Frank Peacock, IV, MD, Cleveland Clinic David P. Sklar, MD, University of New Mexico Vincent P. Verdile, MD, Albany Medical College Peter Viccellio, MD, State Univ. of New York, Stony Brook Patient Safety Task Force Scott D. Berns, MD, Rhode Island Hospital Robert A. Bitterman, MD, JD, Carolinas Medical Center Karen Cosby, MD Patrick G Croskerry, MD, PhD, Dartmouth General Hospital Cliff Erickson, MD, Albany Medical Center Jonathan Fisher, MD, Brigham and Women’s Hospital Richard J. Hamilton, MD, MCP, Hahnemann University Stephen Hargarten, MD, MPH, Medical College of Wisconsin Gregory D. Jay, MD, PhD, Rhode Island Hospital Ingrid T. Labat, MD, Howard University Nadine R. Levick, MD, Johns Hopkins University William D. O’Riordan, MD Shawna Perry, MD, University of Florida Howard L. Peters, Jr, MD, Howard University Stephen Schenkel, MD, University of Michigan Marc J. Shapiro, MD, Rhode Island Hospital John Dennis Vinen, MD, Royal North Shore Hospital Chair: Robert L. Wears, MD, MS, University of Florida Health Science Center

(continued on next page)

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Committees and Task Forces (Continued) Program Committee Chris Barton, MD, San Francisco General Hospital William J. Brady, MD, University of Virginia Dane M. Chapman, MD, PhD, Washington University Norman C. Christopher, MD, Children’s Hospital Medical Center/Akron Cathy Custalow, MD, PhD, University of Virgina Brian Euerle, MD, University of Maryland John J. Flaherty, MD, Evanston Hospital Leonard R. Friedland, MD, Temple University Diane Gorgas, MD, Ohio State University David A. Guss, MD, University of California, San Diego Sheldon Jacobson, MD, Mount Sinai Medical Center James B. Jones, MD, PharmD, Methodist Hospital of Indiana John J. Kelly, DO, Albert Einstein Medical Center Todd M. Larabee, MD, Washington Hospital Center David C. Lee, MD, North Shore University Hospital John S. Leung, MD, Northwestern University Bernard L. Lopez, MD, Thomas Jefferson University William J. Meggs, MD, PhD, East Carolina University Lewis Nelson, MD Emanuel P. Rivers, MD, MPH, Henry Ford Hospital Adam J. Singer, MD, State Univ. of New York, Stony Brook Terry L. Vanden Hoek, MD, University of Chicago Gary M. Vilke, MD, University of California, San Diego Mary Jo Wagner, MD, Saginaw Cooperative Hospitals Chair: Ellen J. Weber, MD, University of California, San Francisco

Roland Clayton Merchant, MD, Mt. Sinai Medical Center David P. Milzman, MD, Providence Hospital James R. Miner, MD, Hennepin County Medical Center Craig D. Newgard, Harbor-UCLA Medical Center James E. Olson, PhD, Wright State University Richard Eric Rothman, MD, PhD, Johns Hopkins Hospital Ian Gilmour Stiell, MD, MSc, Ottawa Civic Hospital Anne Tintinalli, MD, State University of New York, Brooklyn T. Paul Tran, MD Kevin R. Ward, MD, Medical College of Virginia Robert O. Wright, MD, MPH, Rhode Island Hospital Undergraduate Committee Winifred Agard, MD, University of Rochester Adrienne Birnbaum, MD, Jacobi Medical Center Kerry B. Broderick, MD, Denver Health Medical Center Judy Jean Chapman, RN, EMT, Vanderbilt University Co-Chair: Wendy C. Coates, MD, Harbor-UCLA Jamie Collings, MD, Northwestern Memorial Hospital Adam D. Corrado, Chicago Medical School Gus Garmel, MD, Kaiser Permanente Medical Center Cherri Hobgood, MD, University of North Carolina Heather N. Hollowell, University of Pittsburgh Tamara Howard, MD, Howard University Jennifer L. Isenhour, MD, Vanderbilt University Donald J. Kosiak, Jr, University of North Dakota Robert R. Leschke, MD, Froedtert Hospital East Lisa R. Maercks, MD, Christiana Care Health System David Edwin Manthey, MD, Wake Forest University Moss H. Mendelson, MD, Eastern Virginia Medical School Tamas R. Peredy, MD, Maine Medical Center Cory J. Pitre, Louisiana State University Annie Tewel Sadosty, MD, Mayo Clinic Lawrence R. Schwartz, MD, Wayne State University Kevin Terrell, Wishard Memorial Hospital Raffi Terzian, MD, MPH, University of Pennsylvania Co-Chair: Stephen H. Thomas, MD, Massachusetts General Hospital Michael C. Wadman, MD, University of Nebraska

Public Health Task Force Brent R. Asplin, MD, Regions Hospital Bruce Becker, MD, MPH, Rhode Island Hospital Dominic A. Borgialli, DO, MPH, Michigan State University Chair: Carlos A. Camargo, Jr, MD, DrPH, Massachusetts General Hospital Meta Carroll, MD, Children’s Memorial Hospital Linda C. Degutis, DrPH, Yale University Lowell W. Gerson, PhD, Northeastern Ohio Universities Peggy E. Goodman, MD, East Carolina University Kyle Gunnerson, MD, Henry Ford Hospital Dave A. Holson, MD, Harlem Hospital Center Charlene Babcock Irvin, MD, St. John Hospital and Medical Center Terry Kowalenko, MD, Sinai-Grace Hospital Michael H. LeWitt, MD, MPH Robert A. Lowe, MD, MPH, Oregon Health Sciences University Daniel A. Pollock, MD, Centers for Disease Control and Prevention Lynne D. Richardson, MD, Mt. Sinai Medical Center Peter Wyer, MD, New York Presbyterian Medical Center

Under-Represented Member Research Mentoring Task Force Kumar Alagappan, MD, Long Island Jewish Medical Center Louis S. Binder, MD, MetroHealth Medical Center Michelle H. Biros, MS, MD, Hennepin County Medical Center Michelle Grant Ervin, MD, MHPE, Howard University Miguel C. Fernandez, MD, University of Texas Juan A. Gonzalez-Sanchez, MD, Universidad de Puerto Rico Chair: Glenn C. Hamilton, MD, Wright State University Fred P. Harchelroad, Jr, MD, Allegheny General Hospital Jerris R. Hedges, MD, MS, Oregon Health Sciences University Thea James, MD, Boston Medical Center Norm Kalbfleisch, MD, Oregon Health Sciences University Gabor D. Kelen, MD, FRCP(C), Johns Hopkins University Arthur L. Kellermann, MD, MPH, Emory University Louis J. Ling, MD, Hennepin County Medical Center James Niemann, MD, Harbor-UCLA Medical Center Shawna Perry, MD, University of Florida Lynne D. Richardson, MD, Mt. Sinai Medical Center Emanuel P. Rivers, MD, MPH, Henry Ford Hospital Arthur B. Sanders, MD, University of Arizona Sandra M. Schneider, MD, University of Rochester David P. Sklar, MD, University of New Mexico David O. Wright, MD, St. Mary’s Hospital

Research Committee Chair: Mark G. Angelos, MD, Ohio State University Robert N. Bilkovski, MD, Christ Hospital and Medical Center Gerard X. Brogan, Jr, MD, North Shore University Hospital Clifton Callaway, MD, PhD, University of Pittsburgh Robert T. Gerhardt, MD, MPH, Brooke Army Medical Center Gary B. Green, MD, MPH, Johns Hopkins Hospital Walter L. Green, MD Charles J. Havel, Jr, MD, Medical College of Wisconsin Alan E. Jones, MD, Carolinas Medical Center Jeffrey A. Kline, MD, Carolinas Medical Center Peter L. Lane, MD, Albert Einstein Medical Center Frank Lovecchio, DO, Good Samaritan Regional Poison Center

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

FACULTY POSITIONS ILLINOIS, Chicago: Cook County Hospital seeks an energetic BC/BP residency trained emergency physician for a full-time academic position.

Attendings enjoy protected time and limited nights/WE in order to pursue research and academic pursuits. Our faculty development program allows attendings to gain depth in clinical areas of interest. The ED sees 120,000 adult patients per year and is staffed by 26 full time attendings and 54 emergency medicine residents. We have active emergency ultrasound program. A new state of the art Cook County Hospital will open in August 2002 with a greatly expanded ED, trauma unit and OBS unit. For more information contact: Jeffrey Schaider, MD, Associate Chairman, Department of Emergency Medicine, 1900 West Polk St, Chicago, IL 60612; telephone 312-633-5451; FAX 312-633-8189; e-mail jschaider@ccbh.org

UNIVERSITY OF ARIZONA: Department of Emergency Medicine is seeking candidates for a full-time faculty position. Candidates may be at the Assistant, Associate or Professor level of Clinical Emergency Medicine and committed to excellence in clinical care, teaching and research. The successful candidate will be an attending in the University Medical Center Emergency Department, which is a regional referral center caring for over 60,000 sick and injured children and adults. Interested individuals should send their CV’s and letter of intent to: Samuel M. Keim, MD, Faculty Search Committee Chair, PO Box 245057, Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ 85724-5057.

MARYLAND: New emergency medicine opportunity available for summer 2001 at growing community hospital in suburban Maryland facility. BC/BP emergency medicine specialists interested in full-time opportunity with small democratic group with excellent benefits and compensation can forward C.V. to Medical Matrix at Fax (301) 498-6576 or e-mail to medmatrix@aol.com.

MICHIGAN – Ann Arbor: Academic EM position available in Ann Arbor at 78,000 annual visit trauma center: ED, Adult and Pediatric ambulatory care centers, on site helicopter ambulance service, chest pain observation unit. Approved EM Residency sponsored by St. Joseph Mercy Hospital and the University of Michigan. BC/BE EM physicians with two years clinical experience. Excellent remuneration plus faculty stipend, paid malpractice insurance, relocation allowance, profit sharing, cafeteria-style benefits package, 401(k), long term disability, flexible scheduling, referral bonuses, and more. To learn more, contact Nancy Ely at 800-466-3764, ext.337, via e-mail - nely@epmgpc.com, or visit us at www.epmgpc.com.

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO: Academic: Faculty position available for residency-trained, board eligible or certified emergency physician with previous teaching experience and commitment to academic career. Mix of clinical, research, educational and administrative responsibilities available. High acuity university ED with EM residents and diverse mix of community and tertiary care patients, serving one of the top-rated medical centers in the U.S. Please send your CV and description of interests to Michael Callaham, MD; Box 0208, University of California, San Francisco CA 94143-0208 (email mlc@itsa. ucsf.edu). The University of California is an equal opportunity employer.

VANDERBILT UNIVERSITY: The Department of Emergency Medicine has an unexpected opening for a clinician-educator at the Instructor or Assistant Professor level. Please consider joining our successful department. We have 1st and 4th year student rotations, a Level 1 Trauma center, contiguous Pediatric and Adult ED’s and have all the other components of a well established program. Great benefits, great city. Please reply to Corey M. Slovis, MD, Chairman, Department of Emergency Medicine, Vanderbilt University, 703 Oxford House, Nashville, TN 37232-4700. Email: corey.slovis@mcmail.vanderbilt.edu

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

Head, Department of Emergency Medicine The College of Medicine at the University of Arizona seeks a Head of Emergency Medicine to lead the unitÕs patient care, research, and educational programs. Emergency Medicine, currently a division in the Department of Surgery, will become an independent academic department in the College of Medicine July 1, 2001. Candidates must be board certified in emergency medicine and have experience in resident/medical student teaching, documented research productivity, and proven administrative skills. Clinical and teaching site is at University Medical Center in Tucson, which is a regional referral center and level-I trauma center caring for over 60,000 patients a year. Academic qualifications are full professor or academic credentials commensurate with full professor.

Send personal statement, CV, and contact information for 3 references to: William A. Grana, M.D. Chair, Emergency Medicine Dept Head Search Committee Professor and Head, Department of Orthopaedic Surgery P.O. Box 245064 Tucson, AZ 85724-5064 fax: (520) 626-2668 email: asv@email.arizona.edu

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VANDERBILT UNIVERSITY: Research Position — The Department of Emergency Medicine at Vanderbilt University is seeking a researchoriented faculty member for a tenure track position. This position will be customized to meet a junior or senior level faculty member’s training and experience. This exciting position is based in the Department of Emergency Medicine in collaboration with The Vanderbilt Center for Health Services Research. The individual to be recruited will have completed training in an Emergency Medicine Residency Program. He or she should have a strong interest, or record, in an academic career and a desire to focus on outcomes research. If appropriate, the selected investigator will be allowed sufficient non-clinical time to complete the Vanderbilt MPH program during his or her two years. This position will have up to 80% protected time and start-up funding. Secretarial, research nurse, and statistical support will be provided, along with a premium discretionary research package. Appointments will be commensurate with the individuals level of achievement. Excellent salary and benefits in a great community. Please reply to Corey M. Slovis, MD, Chairman, Department of Emergency Medicine, Vanderbilt University, Room 703, Oxford House, Nashville, TN 37232-4700, Email: corey.slovis@mcmail.vanderbilt.edu

The Division of Emergency Medicine at Michigan State University (MSU) in cooperation with the MSU Emergency Medicine Residency Program in Lansing, Michigan and Ingham Regional Medical Center invites applications for an immediate opening for a tenure-track faculty position in cardiovascular health service research. We are seeking a faculty member to assist the residency faculty in establishing a successful cardiovascular theme of emergency medicine research. The successful candidate will provide leadership in the development of a research program involving Emergency Medicine residents and faculty in the cardiovascular disease area. Duties will include facilitating collaborative research efforts between the specialty of emergency medicine and other medical specialties, directing and administering studies, grant preparation, and mentoring of clinical faculty in research.

Specific requirements for the position are: 1) PhD degree in epidemiology or related discipline with formal training in cardiovascular health services research, 2) minimum of five years’ experience in scientific medical research, 3) demonstrated ability to publish in peer-reviewed journals, 4) demonstrated ability to obtain peer-reviewed, external grant funding.

Salary depends on faculty rank and experience. Michigan State University is an affirmative action equal opportunity employer.

Applicants should submit a letter of interest and curriculum vitae to: Earl J. Reisdorff, MD, Chairperson - Search Committee, Director of Medical Education Office, Ingham Regional Medical Center, 401 W. Greenlawn Avenue, Lansing, MI 48910.

APPLICATION DUE DATE: JULY 1, 2001

RESIDENCY DIRECTOR

Chairman, Emergency Medicine Southeastern Pennsylvania

BELLEVUE HOSPITAL NEW YORK UNIVERSITY MEDICAL CENTER

Chairman, Department of Emergency Medicine is sought for a 480-bed, not-for-profit, teaching hospital in an attractive suburb of Philadelphia. Serving a regional population of 600,000, the medical center’s programs include a burn treatment center and the county’s only adult Level II trauma center. Over 600 medical students rotate through the medical center from one of the area’s leading medical colleges. The medical center also supports several highly respected residency programs. The Chairman of the Department of Emergency Medicine will be responsible for all administrative and clinical aspects of this busy department which manages 47,000 visits, including 1,300 trauma patients, a year. He/she will develop initiatives which will provide the organization with a sustained strategic advantage in the delivery of the highest quality emergency care services to the community. The successful candidate for this position will be Board Certified and residency trained in Emergency Medicine, possess a track record of successful leadership in a complex environment, and be a demonstrated builder of both programs and collaborative relationships. For additional information, please contact:

NEW YORK, NEW YORK We are seeking an inspired, creative leader with demonstrated administrative experience to enhance the growth and development of our residency training program.

The residency program is based at Bellevue Hospital Center, New York University Medical Center, and New York University School of Medicine.

The active emergency departments at both sites offer a broad exposure to all aspects of Emergency Medicine.

The residency consists of 14 residents per year in a four-year program.

Qualified candidates must have completed Emergency Medicine Residency Training with extensive experience in an academic training program. The successful candidate will join a large faculty committed to education, research and exceptional care at America’s oldest public hospital and one of America’s oldest medical schools.

The academic and administrative support will permit the candidate to prosper in a demanding and stimulating environment.

Inquiries should be accompanied by a Curriculum Vitae and addressed to: Lewis Goldfrank, MD, Director Emergency Medicine Bellevue Hospital Center 27th Street and First Avenue New York, New York 10016 Tel: (212) 562-3346 Fax: (212) 562-3001 e-mail: goldfl03@popmail.med.nyu.edu

Esther Collet, Vice President & Senior Associate The Diversified Search Companies 2005 Market Street, Suite 3300, Philadelphia, PA 19103.

Telephone: 215-656-3579 or Email: ecollet@divsearch.com.

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Faculty Development Fellowship

FACULTY POSITION

The Wright State University School of Medicine, Department of Emergency Medicine is pleased to offer a newly developed Faculty Development Fellowship beginning July 1, 2001. Starting dates are flexible. Although we recognize that it is late in the recruitment season, we hope you will contact us if you have an interest in pursuing careers in academic emergency medicine.

We have been working on developing this one-year fellowship for several years and are pleased that we have secured all of the support elements.

The Fellowship consists of an 18-20 hour per week clinical commitment at one of our several practice sites (ranging from 27,000 to 100,000 patient visits). There are planned instructional sessions in organizing one’s faculty development, curriculum design, research project planning, grantsmanship, writing and publishing in the medical literature, use of media, international emergency medicine and several other topics. Each of these is tied to the expertise of a specific faculty member and written materials.

Additionally, there is a portion of the program which can be tailored to suit the needs of the candidate relative to their own faculty development.

Stipend is $50,000 plus generous benefits and travel support. We are currently accepting applications which would include a CV, letter of interest and two letters of reference until the two available positions are filled.

If you have an interest in academic emergency medicine and believe a year of focused training in the skills necessary to succeed in the profession would benefit your career, then please contact: Glenn C. Hamilton, MD, MSM Department of Emergency Medicine 3525 Southern Blvd. • Kettering, OH 45429 Phone: (937) 296-7839 • Fax: (937) 296-4287 email: glenn.hamilton@wright.edu

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

Residency training and BC in EM required.

Duke University Medical Center Emergency Department is a Level I Trauma Center in Durham, North Carolina, with an annual volume of 65,000 patient visits. Competitive salary and benefits. Faculty at all academic levels are invited to apply.

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

CALL FOR ABSTRACTS 2002 Annual Meeting May 19-22 — St. Louis, Missouri The Program Committee is accepting abstracts for review for oral and poster presentation at the 2002 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obstetrics/gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The deadline for submission of abstracts is Tuesday, January 8, 2002 at 3:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instructions will be available on the SAEM web site at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Only reports of original research may be submitted. The data must not have been published in manuscript or abstract form or presented at a national medical scientific meeting prior to the 2002 SAEM Annual Meeting. Original abstracts presented at other national meetings within 30 days prior to the 2002 Annual Meeting will be considered.

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

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

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SAEM Research Grants for 2002 The following is a summary of the research grants that will be funded by SAEM in academic year 2002.

Further information and application materials can be obtained via the SAEM website at www.saem.org.

SAEM Research Training Grant (formerly known as the Resident Research Year Award) This grant provides financial support of $75,000 per year for two years of formal, full-time research training for emergency medicine fellows, resident physicians, or junior faculty. The trainee must have a concentrated, mentored program in specific research methods and concepts, and complete a research project. Deadline for applications is November 1, 2001.

SAEM Institutional Research Training Grant This grant is currently under development, but SAEM expects to call for applications in the summer of 2001 for a start date of July 2002. The grant will provide financial support of $75,000 per year for two years for an academic emergency medicine program to train a research fellow. The sponsoring program must demonstrate an excellent research training environment with a qualified mentor and specific area of research emphasis. The training for the fellow may include a formal research education program or advanced degree. It is expected that the fellow who is selected by the applying program will dedicate full time effort to research, and will complete a research project. The ultimate goal of this grant is to help establish a departmental culture in emergency medicine programs that will continue to support advanced research training for emergency medicine residency graduates. Tentative deadline is November 1, 2001.

SAEM Scholarly Sabbatical Grant This grant provides funding of $10,000 per month for a maximum of six months to help emergency medicine faculty at the level of assistant professor or higher obtain release time to develop skills that will advance their academic careers. The ultimate goal of the grant is to increase the number of independent career researchers who may further advance research and education in emergency medicine. The grant may be used to learn unique research or educational methods or procedures which require day-to day, in-depth training under the direct supervision of a knowledgeable mentor, or to develop a knowledge base that can be shared with the faculty memberâ&#x20AC;&#x2122;s department to further research and education.

Deadline for applications is November 1, 2001.

SAEM Emergency Medical Services Research Fellowship This grant is sponsored by Medtronic Physio-Control. It provides $50,000 for a one year fellowship for emergency medicine residency graduates in EMS at an approved fellowship training site. The fellow must have an in-depth training experience in EMS with an emphasis on research concepts and methods. The grant process involves a review and approval of emergency medicine training sites as well as individual applications from potential fellows. Deadline for applications is November 1, 2001.

SAEM Neuroscience Research Fellowship This grant is sponsored by AstraZeneca. It provides one year of funding at $50,000 for an emergency medicine resident, graduate, or junior faculty member to obtain a mentored research training experience in cerebrovascular emergencies. The research training may be in basic science research, clinical research, or a combination of both, and the mentor need not be an emergency medicine faculty member. Completion of a research project is required, but the emphasis of the fellowship is on the acquisition of research skills. Deadline for applications is November 1, 2001.

EMF/SAEM Medical Student Research Grants This grant is co-sponsored by the Emergency Medicine Foundation and SAEM. It provides up to $2400 over 3 months for a medical student or resident to encourage research in emergency medicine. More than one grant is awarded each year.

The trainee must have a qualified research mentor and a specific research project proposal. The final deadline for the 2002 grants has not been announced, but will likely be in January 2002.

EMF/SAEM Innovations in Medical Education Grant This grant is co-sponsored by the Emergency Medicine Foundation and SAEM. It provides up to $5,000 to support projects that use novel techniques, programs, or products to improve emergency medicine education. The final deadline for the 2002 grants has not been announced, but will likely be in January 2002.

SAEM Medical Student Interest Group Grants These grants provide funding of $500 each to help support the educational or research activities of emergency medicine medical student organizations at U.S. medical schools. Established or developing interest groups, clubs, or other medical student organizations are eligible to apply. It is not necessary for the medical school to have an emergency medicine training program for the student group to apply. The application deadline is September 1, 2001.

The above descriptions may be subject to modification by the Board of Directors and Grants Committee. Please check the SAEM website, or call the SAEM office at (517) 485-5484 for grant instructions, application materials, and confirmation of deadlines.

Final grant applications and announcements are expected to be posted on the SAEM web site

by July 1, 2001.

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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 Marcus Martin, MD President Roger Lewis, MD, PhD President-Elect Donald Yealy, MD Secretary-Treasurer Brian Zink, MD Past President James Adams, MD Carey Chisholm, MD Glenn Hamilton, MD Judd Hollander, MD Debra Houry, MD, MPH Susan Stern, 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.

CALL FOR DIDACTIC PROPOSALS 2002 Annual Meeting May 19-22, 2002 — St. Louis, Missouri The Program Committee is soliciting proposals for didactic sessions for the 2002 Annual Meeting. Didactic sessions should emphasize issues of research, education, clinical advances in Emergency Medicine, and faculty development. Didactics may be aimed at medical students, residents, junior faculty and/or senior faculty.

The format may be a lecture, panel discussion, or workshop. The Program Committee will also review proposals for pre- or post-day workshops, or multiple sessions during the Annual Meeting aimed at in-depth instruction in a specific discipline. Didactic proposals should support the mission of SAEM and should fall into one of the following categories: • • • •

Education (education methodology, improving the quality of education, enhancing teaching skills) Research (research methodology, improving the quality of research) Career Development State-of-the-Art (presentation of cutting-edge basic science or clinical research that has important implications for further investigation or the future practice of emergency medicine) • Health Care Policy and National Affairs Note that State of the Art sessions are not a review of the literature of a summary of clinical practice. All submitters are asked to briefly explain how the session meets the SAEM mission.

The deadline for submission is August 30, 2001.

To submit a proposal, complete a Didactic Submission Form, which will be posted on the SAEM web site at www.saem.org. All proposals must be submitted electronically. For additional questions or information, contact the Program Committee/Didactic Subcommittee through the SAEM office at saem@saem.org or 517-485-5484.