November-December 2000

NEWSLETTER

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

Newsletter of the Society for Academic Emergency Medicine November-December 2000 Volume XII, Number 6

PRESIDENT’S MESSAGE SAEM and the Corporate World SAEM is an academic, professional organization that has a myriad of interactions and relationships with individuals at all levels of training, and with other national emergency medicine and non-emergency medicine organizations. For SAEM, the activities, communications, and boundaries that develop in these individual and inter-organizational Brian Zink, MD relationships are usually fairly clear, and center around whether the interaction is in keeping with our mission — to improve patient care by advancing research and education in emergency medicine. Most individuals and organizations with whom we partner have objectives that are similar to our own, and it is relatively easy to collaborate on activities or projects. When SAEM interactions extend to the corporate world, the picture is less clear. At least part of the mission of businesses and corporations is to to make a profit. A profit motive does not necessarily set the missions of the corporate world and SAEM at odds. As a fiscally responsible organization, we also seek to generate revenue to help fund grants, awards, and the Annual Meeting and other Society activities. However, if a corporate profit motive leads SAEM to compromise academic freedom, injects bias, or promotes an unacceptable conflict of interest, our members and our emergency patients are not well served. Over the past few years, the SAEM Board of Directors has attempted to create a consistent position on our interactions with industry. This has resulted in a Policy on Commercial Support, and related policies on co-sponsorship of meetings and satellite meetings. (See the SAEM website for these policies.) Some members have regarded the SAEM position to be prudish and too restrictive, others have decried the fact that any association with commercial entities is permitted. Somewhere in the middle of these viewpoints rests our rationale, and in the following paragraphs I will attempt to explain why I think we are where we should be.

In a 1999 article in JAMA, Pellegrino and Relman delivered a fairly scathing assessment of professional medical associations, stating: “Too many have already become corporatized entities in pursuit of profit to finance bulky administrative staffs or to lobby for the protection of privileges and benefit of their members.”(1) Not many people would accuse SAEM, with its 5 person administrative staff for a membership of 5,000, and it’s strong research, education, and public health focus, of being too corporatized. As part of our nonprofit status, we are not permitted to lobby. We do take

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Password Required to Receive AEM Online Academic Emergency Medicine (AEM) has been available online since mid-May. Beginning November 15, SAEM members must use a password to access their online subscription. All SAEM members are entitled to a receive a free subscription of both the print copy and online version of AEM. To activate your subscription go to the website: <www. aemj.org>. Click on the subscriptions button. Click on the link “activate your member subscription.” Enter your membership number (which is printed above your name on the mailing label of this Newsletter) and click the submit button. You will then be asked to select a user name and password. If you need assistance or do not have a member number, send an e-mail to saem@saem.org or call 517-485-5484.

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

Please send manuscripts electronically to aem@saem.org or by mail to: Academic Emergency Medicine, Special Issue, 901 North Washington Ave., Lansing, MI 48906.

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

The Grant application and criteria will be posted on the SAEM web site at www.saem.org by December 10. The deadline for the submission of completed applications will be February 15, 2001, with announcement of the recipient by March 15. The funding will be for the period from July 1, 2001 to June 30, 2002. Contact SAEM at saem@saem.org for questions or further information.

SAEM Representatives Visit ACEP Washington Office Brian Zink, MD SAEM President University of Michigan James Hoekstra, MD Chair, SAEM National Affairs Task Force Ohio State University On September 15 we traveled to Washington, DC to visit the Washington Office of the American College of Emergency Physicians (ACEP). The purpose of the trip was to improve SAEM’s understanding of the Washington ACEP Office’s involvement in national affairs as they relate to academic emergency medicine, and to explore how SAEM and ACEP can collaborate on issues of common interest in national and governmental affairs.

During the two-day visit we met with the ACEP President, Michael Rapp, MD, and ACEP President-elect, Robert Schafermeyer, MD, to discuss issues of concern for academic emergency medicine. Mr. Gordon Wheeler, the Washington ACEP Office Director, reviewed the organizational structure and methods that are used to advance ACEP’s positions in the regulatory and legislative branches of the federal government.

We met with Ann LaBelle, Director, Congressional Affairs, Michelle Fried, Director, Federal Affairs, Debbie Campbell, Political Action Manager, and Laura Gore, Public Relations Manager. These meetings provided information and insights as to how the Health Care Finance Administration (HCFA) and Congress function, and the strategies used to promote improved care for emergency patients, and a healthy workplace and secure career for emergency physicians. Major issues in academic emergency medicine that relate to HCFA and current legislation, such as the Balanced Budget Act Refinement proposals, Graduate Medical Education Provisions, the practice expense component of the Physician Payment System, the proposed Patient Protection Act of 2000, the HCFA medical history caveat for emergency care, and payment codes for observation units were reviewed. SAEM priorities were outlined in relation to national affairs, including the plight of the medically uninsured, patient safety, federal funding for emergency medicine research, ED overcrowding, the financial stresses facing academic

medical centers and GME funding.

The visit to the Washington ACEP Office was enlightening, and we were impressed by the broad-based experience, knowledge, and activities of Mr. Wheeler and the Directors and Managers in the office. The next step is to define how SAEM and ACEP can work together to influence governmental policy and legislation when we seek to advance common issues in academic emergency medicine. Dr. Hoekstra is representing SAEM on the ACEP Governmental Affairs Committee.

2000-2001 Committee/Task Force Interest Forms are due January 15, 2001. The form is on the web site at www.saem.org.

Nominations Sought for SAEM Elected Positions Deadline: January 1, 2001

Nominations are sought for the SAEM elections which will be held during the Annual Business Meeting on May 8 in Atlanta. The Nominating Committee will select a slate of nominees based on the following criteria: previous service to SAEM, leadership potential, interpersonal skills, and the ability to advance the broad interests of the membership and academic emergency medicine.

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

The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more than one nominee for each position. Nominations may be submitted by the candidate or any SAEM member. Nominations should include a copy of the candidate’s curriculum vita and a cover letter describing the candidate’s qualifications and previous SAEM activities. Nominations may also be made from the floor in San Francisco. Nominations are sought for the following positions: President-elect — The President-elect serves one year as President-elect followed by one year as President and one year as Past President. Candidates are usually current members of the Board of Directors.

Board of Directors — Two members will be elected to three year terms on the Board of Directors. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces and are often currently serving as committee or task force chairs.

Resident Board Member — The resident member is elected to a one year term and is a full voting member of the Board of Directors. Candidates must be a resident during the entire term on the Board (May 2001-May 2002). Candidates should demonstrate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of support from the candidate’s residency director.

Nominating Committee — Two members will be elected to two year terms on the Nominating Committee. The Nominating Committee is charged with selecting the recipients of the Young Investigator Award, the Academic Excellence Award, and the Leadership Award, as well as developing the slate of nominees for the elected positions within the Society. Candidates should have considerable experience and leadership on SAEM committees and task forces.

Constitution and Bylaws Committee — One member will be elected to a three year position on the Constitution and Bylaws Committee. The final year will be served as the chair of the Committee. The Committee is charged with reviewing the Constitution and Bylaws and making recommendations to the Board for any proposed amendments to be considered by the membership. Candidates should have considerable experience and leadership on SAEM committees and task forces.

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Call for Nominations Deadline: January 1, 2001

Nominations are sought for the Hal Jayne Academic Excellence Award and the Leadership Award. These awards will be presented during the SAEM Annual Business Meeting on May 8 in Atlanta. Nominations for honorary membership for those who have made exceptional contributions to emergency medicine are also sought.

The Nominating Committee wishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or any SAEM member. Nominations should include a copy of the candidate’s CV and a cover letter describing his/her qualifications. The awards and criteria are described below:

Leadership Award The Leadership Award is presented to a member of SAEM who has demonstrated exceptional leadership in academic emergency medicine.

Candidates will be evaluated on their leadership contributions including: 1. Emergency medicine organizations and publications.

2. Emergency medicine academic productivity.

3. Growth of academic emergency medicine.

Academic Excellence Award The Hal Jayne Academic Excellence Award is presented to a member of SAEM who has made outstanding contributions to emergency medicine through research, education, and scholarly accomplishments.

Candidates will be evaluated on their accomplishments in emergency medicine, including: 1. Teaching A. Didactic/Bedside B. Development of new techniques of instruction or instructional materials C. Scholarly works D. Presentations E. Recognition or awards by students, residents, or peers 2. Research and Scholarly Accomplishments A. Original research in peer-reviewed journals B. Other research publications (e.g., review articles, book chapters, editorials) C. Research support generated through grants and contracts D. Peer-reviewed research presentations E. Honors and awards

Medical Student Interest Group Grant Recipients Selected SAEM is pleased to announce the recipients of the Medical Student Interest Group Grants. Fifteen proposals were received and reviewed by a committee of peers involved in medical student education. The criteria used included: the merit of the proposal, the qualifications of the perceptor and the instituional support including the budget justification. The Board of Directors approved the selections and the funding of $500 each for the following six recipients: Case Western Reserve University Christian Chisholm Halloran, class of 2003, and the faculty advisor, Mary Stewart, MD, project proposes a major lecture primarily for medical students reviewing lessons from on a local disaster where one person was killed and 75 persons injured. They also propose a medical student lead community education project on seat belts, child safety seats, bike helmets and smoke detectors.

Moorehouse School of Medicine Saira Najma Rahman, class of 2001, and Sudha Reddy, MPH, class of 2001, and the faculty advisor Douglas Ander, MD, proposal was a request for funding for a newly formed interest group to start a mentorship program and a series of invited lectures and interactive seminars involving Moorehouse, Emory and CDC and the Carter Center. The topics will include public health interventions in emergency medicine, the role of the emergency medicine in primary care, international emergency medicine, diversity with emergency medicine and potential careers within the specialty.

Louisiana State University Ashley E Booth, class of 2001, and the faculty advisor, Peter DeBlieux, MD, proposed to involve medical students to train 1200 ninth-grade students in 29 high schools in BLS-skills at the heartsaver level. The medical students also hope to have an influence with teens by stressing healthy living, smoking cesssation and accident and violence prevention.

Georgetown University Dave A Callaway, class of 2001, and the faculty advisors, David Milzman, MD, Eric Glasser, MD, and Emergency Medicine Resident E. Reed Smith, MD, propose to implement a core curriculum of important first aid topics, the BSL/FA course to 160 first year students. Students will receive comprehensive syllabus with lecture notes, diagrams and procedural techniques taught by Emergency Medicine Interest Group students and Emergency Medcine Residents. The Dean has promised matching funds to support the effort.

University of Arkansas Michael Wagner, and Jim Coghill, class of 2002, and the faculty advisor, Martin Carey, MD, propose a hands-on skills workshop, lectures and ED observations. A website dedicated to Emergency Medicine Interest Groups will be designed as a networking communication tool to keep students appraised of latest events and information.

University of New England College of Osteopathic Medicine Jason Cohen, and the faculty advisor, Neal Cross, PhD, proposal is very unique in that they will use “fresh” cadavers for the introduction and practice of emergency medicine skills. The skills to be taught include intubation, chest tubes, central lines, needle thoractomies, wound closure and surgical airway approaches.

The Medical Student Interest Group grants were developed to recognize and assist the development of medical student interest groups for medical students interested in a career in emergency medicine. Applications must focus on educational activities or projects related to undergraduate education in emergency medicine and funds may be used for supplies, consultation and seed money to support activities such as skill laboratories, lectures, or workshops. The deadline for submission of applications for the next grant cycle will be August 15, 2001.

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Protection of Human Subjects — New Developments John A. Marx, MD SAEM National Affairs Task Force Carolinas Medical Center In May, Department of Health and Human Services (HHS) Secretary Donna Shalala announced several new initiatives to strengthen protection of human research subjects in clinical trials. The announcement was incited by the tragic death of a student at the University of Pennsylvania in a genetransfer trial funded by the National Institutes of Health (NIH) and the resulting loss of the public’s confidence in the protection of human research subjects.

The most widely published and feverishly implemented initiative was announced on June 5, 2000. This requires that all research institutions develop and implement a formal program of education on the protection of human subjects. The education has to be completed by all investigators and other personnel involved in human subject research who receive funding from the NIH or the Federal Drug Agency (FDA) and becomes effective October 1, 2000. This is a condition of the NIH grant award process and of the Office for Human Research Protections (OHRP) assurance process. Although no specific guidelines were issued, each institution must document that training in the ethical conduct of clinical research has been completed prior to issuance of an award. The documentation has to be in the form of a letter listing key personnel and the title of the education program as well as a onesentence description of the program, signed by the principal investigator and an institutional official. Many institutions in response have developed web-based tutorials and have voluntarily applied this policy to all personnel involved in human subject research regardless of funding source.

HHS is also developing legislation to enable the FDA to levy civil monetary penalties of up to $250,000 per investigator and up to $1 million per research institution for violations of informed consent and other research practices. The current tools available to the FDA include issuing warning letters or imposing regulatory sanctions that require a halt in research until problems are corrected.

This practice has received much media attention and has resulted to date in the temporary suspension of seven institutions from federally funded research. Additional measures include strengthening the informed consent process, improving monitoring and oversight, and ensuring that researchers understand and comply with federal conflict of interest regulations. Further, the OHRP issued guidance allowing grant applicants to

postpone IRB review until after completion of the initial phase of NIH peer review but before final funding approval.

This had been an enormous drain on IRB resources and considering fewer than half of all applications submitted to the NIH are actually funded, comes as welcome relief.

On June 8, 2000, the Human Research Subject Protections Act of 2000 bill was introduced. The key provision of this bill is the proposal that the Common Rule (45 CFR 46), which protects human subject research conducted by HHS and 16 other federal agencies, be applied to all human subjects research independent of setting and funding source. In addition, the bill requires that all IRBs must be accredited by a nonprofit, private entity, effective two years after enactment. This new legislation was endorsed by over 300 academic, scientific, and patient groups including the AAMC and the Coalition for American Trauma Care.

On the heels of the release of these initiatives came the announcement that in order to “elevate its stature and effectiveness”, the Office for Protection from Research Risks (OPRR) of the NIH would be replaced by the Office for Human Research Protections (OHRP) and be located at the Department of Health and Human Services. As part of NIH, the OPRR was required to oversee the research of the same organization from which it derived its authority, which made for an awkward situation and the perception of conflict of interest. OHRP is headed up by Edward Koski, PhD, MD, former director of human research affairs at Partners HealthCare System, Inc. in Boston.

After taking over as director in September, one of his first acts was to support the establishment of uniform standards for the accreditation of institutional review boards.

In addition, the NIH has required recipients of National Research Service Award research training grants to complete a program of instruction in the responsible conduct of research. The Office of Research Integrity and the Public Health Service (PHS) research agencies are proposing to expand this requirement from trainees to all persons conducting research with PHS support.

This decision was based on the Department’s commitment to ensure that all PHS-supported researchers receive basic instruction in the key elements of responsible research and are familiar with basic regulatory requirements, Although only applicable to PHS-supported research, it is recommended that this proposed program be implemented for all personnel involved in research at the institution and eventually replace the NIH policy. The program covers ten core instructional areas from data acquisition to human subjects and conflict of interest. It was proposed that each institution receiving PHS funding starting October 1, 2000 must certify that they will establish such a program

by June 1, 2001 and that it will be implemented by October 1, 2002. The final implementation policy is expected to be issued in November 2000.

In September, the AAMC released a “Proclamation and Pledge of Academic, Scientific, and Patient Health Organizations” to “reaffirm their commitment to the safe and ethical pursuit of the new knowledge necessary for the development of treatment and cures” and a commitment “to the protection and preservation of the rights and welfare of all the individuals who volunteer to participate in human subjects research.”

As of the end of September, over 400 organizations and institutions have endorsed this proclamation.

As we reflect on the last few years, IRBs continue to face the challenge of keeping up with these regulatory burdens but with limited resources. IRBs are inundated with paperwork and spend an enormous amount of time on review responsibilities that can be argued to be of little protective value.

Although the Office of Inspector General conducted an evaluation of Institutional Review Boards and made several recommendations to reduce some of the regulatory burden, few have been implemented to date and in fact the burden has continued to grow. The new initiatives are laudable. But, so long as the underlying workload pressures continue without a concomitant increase in flexibility and resources, IRBs will be hard-pressed to enact these new responsibilities in the manner proposed and intended.

Future SAEM Annual Meetings May 6-9, 2001 • Atlanta Hilton and Towers Atlanta, GA May 19-22, 2002 • Adam’s Mark Hotel — St. Louis, MO May 29-June 1, 2003 • Marriott Copley Place — Boston, MA 4

2000-2001 Interest Group Reports The September/October Newsletter included many interest group reports and three additional reports are included below. Interest groups were developed to allow members to participate with other SAEM members in areas of mutual interest.

Currently there are approximately 25 interest groups. All interest groups are asked to meet at the SAEM Annual Meeting and the chairs were asked to develop objectives for the 2000-2001 academic years, as well as provide a narrative report on their meetings in San Francisco. The full text of the reports can be found on the SAEM web site at: www. saem.org/inform/intgrps.htm All SAEM members are invited to participate in the interest groups. Contact the SAEM office at saem@saem.org or call 517-485-5484 to become a member of an interest group. Dues are $25 per year per interest group. For information on specific interest groups, please feel free to contact the interest group chairs listed below. For general information on interest groups or how to develop an interest group, please review the Interest Group Orientation Guidelines on the SAEM web site at: www. saem.org/inform/igorient.htm. The SAEM Board recently approved the development of list-servs for interest groups that request a list-serv and have at least 20 members.

Neurologic Emergencies Dexter Morris, MD, Chair: dmorris@med.unc.edu Objectives 1. Complete development and dissemination of a model Neurologic Emergencies Curriculum 2. Provide a “Teach the Teachers” symposium at the 2001 SAEM Annual Meeting 3. Pursue the development of a Neurologic Emergencies Research Fellowship or Grant 4. Continue discussions about joint research projects and data base.

Pediatric Jill Baren, MD, Chair: jbaren@mail.med.upenn.edu Objectives 1. Define the scope of pediatric emergency medicine education within emergency medicine residencies. This objective began with a survey to EM program directors several years ago and culminated with the publication of results this past summer in Academic Emergency Medicine.

2. Provide awareness of the activities of other organizations focused on the emergency care of children such as the federal emergency medical services for children program, American Academy of Pediatrics section on emergency medicine, and Ambulatory Pediatric Association. This is accomplished throughout the year on an ongoing basis through a group email list as well as hearing summary reports at the annual meeting by members who also belong to other organizations.

3. Provide information about research funding opportunities in pediatric emergency members. This objective is ongoing but has been partially completed by the inclusion of interested members on the EMSC research listserv maintained by the EMSC National Resource Center.

4. Provide a forum for networking during the annual meeting especially for PEM fellows and for residents considering a PEM fellowship. This objective will be met at the 2001 annual meeting by planning a luncheon session and discussion and we will work in conjunction with EMRA to encourage interested residents to attend.

5. Educate the general membership of SAEM on important issues in pediatric emergency medicine or in new developments in EMSC research. This objective includes developing and submitting at least 2 didactic proposal submissions to the Program Committee each year, as well as serving as a resource to the Program Committee for abstract review.

Trauma Michael Gibbs, MD, Chair: mgibbs@carolinas.org Objectives 1. Develop a Trauma Interest Group e-mail list-server to improve communication between members.

2. Establish a Trauma Interest Group Website to update SAEM members about Trauma Interest Group activities and to share research ideas, interesting cases, important articles, digital images, and a listing of trauma-related meetings. The website will be developed, organized and administered by the Group Chair, with guidance from SAEM. 3. Establish an Emergency Medicine Trauma Research Network to develop new research ideas, and facilitate collaboration and multicenter trials. Information regarding this Network would be shared on the Trauma Interest Group Website.

4. Facilitate future submissions of SAEM State-Of-The-Art proposals.

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Call For Nominations Young Investigator Award Deadline: December 15, 2000 Again this May, SAEM will recognize a few young investigators who have demonstrated promise and distinction in their emergency medicine research careers. The purpose of the award is to recognize and encourage emergency physicians/scientists of junior academic rank who have a demonstrated commitment to research as evidenced by academic achievement and qualifications. The criteria for the award includes: 1. Specialty training and certification in emergency medicine or pediatric emergency medicine.

2. Evidence of significant research collaboration with a senior clinical investigator/scientist. This may be in the setting of a collaborative research effort or a formal mentortrainee relationship.

3. Academic accomplishments which may include: a. postgraduate training/education: research fellowship, master’s program, doctoral program, etc. b. publications: abstracts, papers, review articles, chapters, case reports, etc. c. research grant awards d. presentations at national research meetings e. research awards/recognition The deadline for the submission of nominations is December 15, 2000.

Nominations should include the candidate’s CV and a cover letter summarizing why the candidate merits consideration for this award. Candidates can nominate themselves or any SAEM member can nominate a deserving young investigator. Candidates may not be senior faculty (associate or full professor) nor be more than seven years beyond residency training at the time of application.

The core mission of SAEM is to advance teaching and research in our specialty. This recognition may assist the career advancement of the successful nominees. We also hope the successful candidates will serve as role models and inspirations to us all. Your efforts to identify and nominate deserving candidates will help advance the mission of our Society.

Error in the Emergency Department: A Different Perspective Marc J. Shapiro, MD SAEM Patient Safety Task Force Brown University

“Just another drunk” A 45- year- old male was brought into the ED from the police station because he became less responsive while in custody. Earlier in the evening he had been involved in a single car crash and was arrested for driving while intoxicated. No additional history was available. His initial vital signs were HR-110, RR-12, T-97ºF, BP 130/70. The initial triage evaluation concluded that his altered mental status was a result of alcohol intoxication, and he was directed to the detoxification area of the emergency department. Further nursing evaluation revealed a GCS of 11 and raised the concern for a head injury. The resident physician quickly retriaged the patient to the trauma room and performed endotracheal intubation using Rapid Sequence Induction (RSI).

A subsequent head CT was unremarkable, and the patient was returned to the trauma room. Shortly after his return to the trauma room, the laboratory notified the ED that the patient had a critical glucose of 24 mg/dl. The patient then received D50 and returned to a normal mental status.

Is this an error? The traditional approach to this incident would have been to discuss it at Morbidity and Mortality where the focus would be on the individual physician’s error(s) and review of existing protocols. In this case, no serious morbidity occurred, and many may have been tempted to gloss over it on the grounds of “no harm, no foul.” However, this patient was certainly at increased risk for serious harm, so examination of this “near miss” provides a free lesson on problems in the care system to those willing to invest the time in studying it.

On the surface, this case does represent a simple violation of the standard “unconscious patient protocol”. However, it also represents an example of a cognitive bias (anchoring bias), a probable teamwork failure, and most notably, a system breakdown. Medical professionals need to move away from placing blame on individuals to thinking from a systems perspective. Systems changes aimed at preventing future error patterns, making visible those errors that cannot be prevented, and ‘buffering’ or protecting patients from the consequences of errors that slip through are at the heart of patient safety efforts.

Bias. Emergency physician training has devoted minimal attention to cognitive behaviors despite an established literature on medical decision-making.1,2

Most of us do not desire to be cognitive psychologists, but understanding the basics of reasoning strategies, cognitive biases, and forcing strategies may help prevent many medical errors. The cognitive bias most notable in this case is “anchoring bias”, the tendency to be unduly persuaded by features encountered early in the presentation of illness, thereby committing to a premature diagnosis. Once the mental “anchor” has been placed, new information that would tend to refute the current assessment is ignored or explained away, and information tending to reinforce the initial assessment is accepted at face value. This process is not a conscious one – subjects are not willfully ignoring conflicting information, but simply failing to perceive it.

deviations). Cross-monitoring is not naturally part of physicians’ culture, but could have caught the mental lapse that led to this error. The third team behavior involves advocacy and situational leadership, such as speaking out when mental models diverge, questioning a course of action, or suggesting a course of action different than that being planned. Had any team member asserted themselves and suggested the “unconscious protocol” be followed prior to Rapid Sequence Induction and head CT the course would have been different. Social pressures make it difficult for lower ranking members of teams to engage in this behavior, even when members are on the best of terms, so explicit efforts are needed to elicit advocacy and assertion.

Teamwork. Good teamwork is a powerful general tool for preventing errors and reducing their impact. The Med Teams project has developed a standard curriculum for error manangement and prevention, which leverages rudimentary teamwork skills that many emergency physicians possess (http://teams.drc. com). Three specific teamwork behaviors may have prevented the error in this case. If caregivers were accustomed to maintaining a shared “mental model”, that required that a specific plan be articulated, it would have prevented an assumption that the blood glucose had been previously been evaluated. A second behavior shown by highly trained teams is cross-monitoring of each other’s actions. This can occur explicitly (asking for and receiving confirmation of critical information) or implicitly (observing co-workers and questioning apparent

Systems Change. Since this event, ED nurses now routinely follow a standing protocol to obtain a fingerstick blood sugar on all patients triaged to the detoxification area with an altered mental status. In addition, RSI procedures for unconsciousness or altered mental status have been modified from those for respiratory distress by including the unconscious protocol as a component.

References 1. Kassirer, JP. And Kopelman, RI. Learning Clinical Reasoning. 1991: Baltimore: Williams and Wilkins.

2. Tversky,A. and Kahneman, D. Belief in the law of small numbers. In Judgment under Uncertainty: Heuristics and Biases . Kahneman, D. Slovic, P. and Tversky, A. (Eds.).

1982; New York: Cambridge University Press.

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

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

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Academic Announcements Jerris R. Hedges, MD, MS, Professor and Chairman of Emergency Medicine, Oregon Health Sciences University, has been elected to membership to the Institute of Medicine (IOM). Members of the Institute of Medicine are elected by the incumbent membership on the basis of professional achievement, and demonstrated interest, concern and involvement with problems and critical issues that affect the health of the public. The Institute conducts studies of specific problems, such as the recent report on medical errors in hospital settings. The Institute is a division of the National Academy of Sciences.

Craig D. Newgard, MD, a research fellow in the Department of Emergency Medicine at Harbor-UCLA Medical Center, has been awarded a two-year Indi-

vidual National Research Service Award (NRSA) from the Agency for Healthcare Research and Quality (AHRQ). This fellowship-training grant will support Dr. Newgard during his pursuit of a Masters of Public Health Degree at the UCLA School of Public Health, and for the duration of his research training.

Janet M. Williams, MD, will serve as the co-investigator of a 1.4 million dollar grant from the Agency for Health Care Research and Quality entitled, “The Rural ED as Access Point for Teen Smoking Interventions.” This 4-year collaborative effort includes the Department of Emergency Medicine, the Center for Rural Emergency Medicine, and the Prevention Research Center at West Virginia University. Dr. Kim Horn, EdD is the principal investigator.

For the first time, two Best Presenter recipients were selected during the CPC Finals Competition, which was held on October 22 during the ACEP Scientific Assembly. Best Resident Presenters are (L) Andrew Barton, MD, from Baystate Medical Center, and (R) Tricia Villanueva, MD, from Hahnemann University. Kathleen Jobe, MD, from the University of Washington, was selected as the Best Discussant.

Errors in Medicine: The Emergency Medicine Response James Hoekstra, MD Chair, National Affairs Task Force Ohio State University On October, 28, 2000, at the Association of American Medical Colleges (AAMC) Meeting in Chicago, SAEM sponsored an educational program entitled “Errors in Medicine: The Emergency Medicine Response.” Jim Adams and Bob Wears presented some of their work and ideas resulting from the Academic Emergency Medicine (AEM) sponsored consensus conference on errors in emergency medicine. The results of that conference were published in the November issue of AEM. Paul Griner, MD, from the AAMC, was kind enough to attend the program, and provided some valuable input regarding the process of error identification and mounting an appropriate response. The program was well received, both by the audience, as well as Dr. Griner and the AAMC. It was clear from our discussions with Dr. Griner that emergency medicine is well ahead of other medical specialties in dealing with this issue. The question is, will we as a specialty take advantage of it?

When the Institute of Medicine (IOM) report on medical errors was published earlier this year, it was followed by a public outcry for action to reduce medical errors. The high prevalence of medical errors sited in the report is not, however, a new issue. There have been a number of reports in the literature in the past decade citing high error rates in medications prescribed and the route and frequency by which medicines are given. These medical errors were found to be mostly preventable and often initiated by physicians. The IOM report simply brought the problem into the public

light. We can argue about the methodology used in the IOM report, or we can point to the fact that they analyzed data from 1985, but the fact remains that organized medicine has a problem with high medical error rates, and now the public is demanding solutions.

In emergency medicine, the problem of medical errors is even more acute.

We work in a high volume, high stress, high variety setting, where the potential for errors is enormous. Emergency physicians tend to “shoot from the hip” and make snap decisions based on minimal information. We work in a relative vacuum, where follow-up information is sketchy, and feedback on our errors may not be available to change our practices. It’s no surprise that the IOM report found that the highest prevalence of medical errors was present in the ED. The survey used for the IOM report was “old data” from an era when EDs were not staffed by board certified, residency trained EM physicians, and 24 hour coverage was lacking. As such, we can say that the times have changed, and we’ve improved. Unfortunately, if we take that stance, we are essentially denying a problem that we all know exists. We may miss the opportunity and momentum to change the way we are thinking about medical errors, and to act proactively to identify potential errors and correct them before they occur. Worse yet, we may be missing a golden opportunity for research funding in an area that the public wants to see funded.

Jim Adams and Bob Wears reported on the results of the AEM Consensus Conference on Errors in Emergency Medicine. They recommended a systems approach to medical errors in the 7

ED. If a potential error can be identified, a system can be modified or put in place to avoid that error. By systems, they were not talking about simply designing forms or more paperwork to deal with the issue, but actually redesigning processes to maximize efficiencies and eliminate inefficiencies, coordinate activities as a team, and facilitate the adoption of specific behaviors to optimize outcomes. The ED must be systematically reengineered along lines that stress simplicity, consistency, ease and automaticity in order to decrease errors.

There was a lot of lively discussion at the conference, mostly centering on the appropriate “next steps” that are needed to take advantage of our momentum in dealing with medical errors.

The audience had a number of suggestions regarding future steps in the error identification and systems-building approach. There was consensus that strict definitions are needed for medical errors. In order to fix a problem, we need to correctly identify the problem in such a way that there is uniformity in our definitions. Once we have uniform definitions, we can begin to work on systems approaches to attack the problems. The audience stressed that this is a fertile area for new investigators who are interested in outcomes research. It should be easy for each of us in our own EDs to identify a potential error, define it, and design an approach to solve it. If we can do so in a way that benefits all of emergency medicine, the results of our efforts should be fundable and publishable. Academic emergency medicine should be leading the way on this effort, and striking while the iron is hot.

ETHICS CORNER

“Does Pain Medication Impair Ability to Give Informed Consent?”

Catherine A. Marco, MD SAEM Ethics Committee St. Vincent Mercy Medical Center Editor’s Note: This is the first in a series of columns regarding ethical issues, written by members of the SAEM Ethics Committee. These columns are provided as an educational service, and are not intended to serve as position statements or otherwise reflect policies or positions of SAEM. Readers are invited to submit ethical questions or cases to: saem@saem.org Question: A 37 year-old male was being evaluated for right flank pain. He received 5 milligrams of morphine sulfate intravenously. Shortly thereafter, the decision was made to perform an intravenous pyelogram to evaluate possible nephrolithiasis. Is it still possible to obtain informed consent, after narcotic administration?

Introduction We routinely administer mind-altering pharmaceutical agents, such as narcotics or benzodiazepines, in the practice of Emergency Medicine. Often patients will subsequently require diagnostic or therapeutic interventions, for which informed consent from the patient is desired. Can informed consent truly be obtained after the administration of such medications? The short answer is: yes.

Elements of Informed Consent Informed consent , a term coined in 1957, defines the roles of physician and patient in medical decision-making.

Ideally, informed consent is comprised of the following elements: 1. Patient capacity. The patient must be capable of understanding and participating in the decision making process.

2. Delivery of information. The physician has a duty to deliver appropriate information regarding the proposed intervention, including risks, benefits, and expected outcome.

3. Voluntary participation. The patient should not be coerced in any way, but should voluntarily agree to the proposed intervention.

Case Discussion Numerous clinical, organic, psychological, sociological, and pharmaceutical factors can affect a patient’s ability to comprehend and participate in the informed consent process. Some examples of factors which may impair patient capacity include: pain, anxiety, delirium, age, mental capacity, language or cultural barriers, alcohol or drug intoxication, administration of mind-altering pharmaceutical agents, and a multitude

of others. There is no particular condition which in all cases either guarantees or negates appropriate patient capacity to participate in the informed consent process.

Whenever informed consent is obtained, assessment of patient capacity is an essential step in the process.

Regardless of the clinical scenario, the physician must assess the patient’s ability to comprehend clinical information, understand alternatives, and weigh risks and benefits.

In some cases, pain may be a stronger deterrent to ability to consent than pain control with narcotics or other agents. In others, adequate pain control may create confusion or somnolence sufficient to impair appropriate mental capacity.

Conclusions Whenever informed consent is obtained, the physician has the duty to assess decision-making capacity, and ensure that the patient is able to comprehend information, understand alternatives to the proposed intervention, and weigh risks and benefits. Narcotic administration may affect a patient’s capacity to provide informed consent.

While a patient who has received narcotics or other agents is not automatically unable to participate in the informed consent process, the effect of these medications on the individual patient’s decision-making capacity must be strongly considered.

References Borak J, Veilleux S: Informed consent in emergency settings. Ann Emerg Med 13:731-35, 1984.

Braddock CH, Edwards KA, Hasenberg NM et al: Informed decision making in outpatient practice. JAMA 1999; 282:2313-2320.

Drane J: Competency to give an informed consent: a model for making clinical assessments. JAMA 252:92527, 1984.

Kaufman DM, Zun L: A quantifiable, brief mental status examination for emergency patients. J Emerg Med 13:449-56, 1995.

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Moskop JC: Informed consent in the emergency department. Emerg Med Clin N America 17:327-40, 1999.

Smithline HA, Mader TJ and Crenshaw BJ: Do patients with acute medical conditions have the capacity to give informed consent for emergency medicine research? Acad Emerg Med 1999; 6:776-780.

Medtronic PhysioControl to Support EMS Research Fellowship Deadline: December 15, 2000 SAEM is pleased to announce that Medtronic Physio-Control Corporation will sponsor the 12th Annual EMS Research Fellowship. Medtronic Physio-Control provides $50,000 each year to fund an EMS Fellow, so the funding for the 20012002 fellowship means that $600,000 have been dedicated to support the fellowship. All funds are used to directly sponsor the fellowship.

The application materials for individuals wishing to apply for the EMS Fellowship commencing July 1, 2001, can be found on the SAEM web site at <www.saem.org> or from the SAEM office. The application, including personal statement and letters of reference, must be received

by SAEM by December 15, 2000.

Institutions interested in applying for consideration as a EMS Fellowship training site can also find application materials at www.saem.org or from the SAEM office. Additionally, previously approved institutions whose programs have undergone significant changes must apply for renewal. All materials must be received

by SAEM by December 15, 2000.

Notification to both prospective fellows and institutions will be made

by January, 2001. The selected EMS Fellow will then have a brief period to officially designate his/her fellowship site.

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

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

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

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

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

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

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

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

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

Deadline: March 5, 2001

EMF is accepting applications for its annual grants. Funding is for research done within the academic year of July 1, 2001 through June 30, 2002 unless otherwise specified. To request an application, contact EMF, P.O. Box 619911, Dallas, Texas 75261-9977 or call (972) 550-0911 ext. 3340. The following is a description of the awards and application deadlines: Riggs Family/EMF Health Policy Research Grant Between $25,000 and $50,000 for research projects in health policy or health services research topics. Applicants may apply for up to $50,000 of the funds, for a one- or two-year period.

The grants are awarded to researchers in the health policy or health services area, who have the experience to conduct research on critical health policy issues in emergency medicine.

Deadline: January 8, 2001 EMF/FERNE Neurological Emergencies Grant A maximum of $50,000. This grant is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE). The goal is to fund research based towards acute disorders of the neurological system, such as the identification and treament of diseases and injury to the brain, spinal cord and nerves.

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

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

Deadline: February 12, 2001

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

Deadline: March 19, 2001

CPC Finals Competition judges are pictured with the National CPC Coordinator, Terry Kowalenko. (L-R) Doug McGee, Kevin Rodgers, Judith Brillman, Glenn Tokarski, and Dr. Kowalenko.

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

Edited by the SAEM GME Committee

THE CLINICAL DIRECTOR OF AN ACADEMIC EMERGENCY DEPARTMENT Frank Zwemer, MD University of Rochester

services, or hospital administration. As a general statement, the “daily stuff” takes 1-2 hours/day.

As much as academic Emergency Medicine has a three-part mission of education, research, and clinical care, it is the clinical operation that is generally most visible (and of course, most exciting for national television audiences). Running the operation takes a significant effort, and in most academic ED’s, that role falls primarily to the Clinical Director (CD).

The CD is also the major liaison between the ED and the other hospital departments. The CD represents the ED for clinical issues, and will sit on interdepartmental committees. The intensity of inter-departmental activity depends on the general state of affairs, or more likely, the “crisis of the week.” Radiology and Lab are frequently the focus, as are the inpatient services or specific units (ie, ICU’s).

The full responsibilities of the CD depend on the organizational structure of the hospital and ED. In some settings, the CD has supervisory authority over both the physician staff, as well as the nursing and administrative staff. More commonly, the CD supervises the physicians, and has a limited advisory role for the other ED staff. This distinction is more than casual, as supervisory authority usually provides the ability to carry out a plan.

As a generality, the effectiveness of the CD is related to direct presence in and around the ED. While a manager can choose to be formal or informal in style, there is no replacement for simply being around and available. Presence sets a tone and expectation for others. Being specific about a daily routine, an effective CD is present on a daily basis (expect 5 of 7 days). There is also the matter of clinical time. Although quite individualized by institution, the CD will generally staff in the ED 10-20 hours/week.

As much as clinical care is centered at the bedside, the singularly most important role of the CD is to provide the physicians to be at the bedside-and leads directly to the issue of physician scheduling. The structure of the schedule is the key to the professional and personal satisfaction of faculty and residents. Think about your own experience with no-shows on the schedule (gasp-not here!), or problems with scheduling vacations, or getting that needed evening or weekend off. Maintaining control of the scheduling process is a core requirement for success of the CD. Being able to maintain control is a function of complexity of the schedule (number of institutions, number of shifts/day, etc.), adequate bodies to fill the schedule (keeping in mind the entire academic year as the scheduling period, not just an individual month or week), and being able to project and plan for the “predictable crises” (extended medical leaves, change in professional plans, etc.).

Academic performance is required as well, and is of course the reason that any of us choose an academic career. Resident conferences (presenting and attending) have a weekly demand, as well as the other residency-related activities. The publication requirements for faculty vary with institutional standards, but in general one can expect to be working on a variety of projects with the goal of approximately two publications/year. Collaboration is the key to success.

Planning to become the CD in an academic center can take one in various directions. A prerequisite to managing a department’s care is clinical competence, and importantly clinical confidence. Generally gaining this experience involves 2-3 years working beyond residency, and it is beneficial to have worked in a variety of settings (community and academic). Gaining the managerial skills can take place in an informal process (eg, the most common way of learning it as you go), in directed classes (ie, medical director training session, either proprietary or from other national organizations), or even in formal degree programs (master degrees). A very appropriate and practical route is by being an Assistant CD, and learning by that route.

The actual clinical activities of the ED are those that we all know and do. The CD’s role with ED clinical care ranges from establishing intra-ED treatment plans and protocols (ie, what ED staff is present for major trauma patients, which patients can go to Radiology off a monitor, how a point-of-care testing plan is going to be used), to selecting equipment for care, to dealing with the usual day-to-day issues. Routinely there are matters of “missed findings” (Radiology and Laboratory call-backs) that need follow-up and documentation.

And then there is always the matter of comments and complaints from the various ED “customers,” whether they would be patients, or consultants, or inpatient

From a personal perspective, I see myself as being a lucky person, being able to work as a clinician, as a manager, and as a scholar. Successfully combining the demands of CD administrative requirements, the clinical load, and academic productivity is a challenge.

Doing the job well is tremendously satisfying.

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NOMINATIONS SOUGHT FOR RESIDENT MEMBER OF THE SAEM BOARD OF DIRECTORS Nominations are sought from the membership for the resident member of the SAEM Board of Directors.

This is a rare opportunity for a resident to serve as a full, voting member of the SAEM Board. The resident Board member is elected to a one-year term and is a full voting member of the Board. The deadline for nominations is January 1, 2001.

Candidates must be a resident during the entire one year term on the Board (May 2001-May 2002). Candidates should demonstrate evidence of strong interest and commitment to academic emergency medicine.

Nominations should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter. Interested candidates are encouraged to review the Board of Directors orientation guidelines which are available on the SAEM web site at www.saem.org or from the SAEM office.

The election will be held during the Annual Business Meeting of the SAEM Annual Meeting which this year will be held in San Francisco on May 8. Only active members of the Society are eligible to vote.

The resident member of the Board will attend three SAEM Board meetings; in the fall, in the winter, and in the spring (at the 2002 SAEM Annual Meeting). In addition, the resident member will participate in monthly Board conference calls.

A REPORT FROM THE RESIDENT MEMBER OF THE SAEM BOARD Patricia Short, MD Resident Member, SAEM Board of Directors University of Indiana

responsibilities, plan on using your email, a lot! Most documents are distributed through cyberspace. Discussions are usually initiated through email, then summarized and voted upon during monthly conference calls.

Have you ever wanted to be a fly on the wall in an important meeting? Well, here’s your chance. Only you will be welcomed and treated as an equal member of the group, and not expected to hang out on the sheetrock. If this sounds appealing to you, I encourage you to apply for the resident position on the SAEM Board of Directors.

The resident member of Board of Directors was established three years ago in an effort to increase resident participation in the leadership of SAEM and to encourage the choice of academics as a career. It is a one-year elected term as a full voting member of the Board.

The position provides many rewarding and educational opportunities. It affords interaction with the leaders in academic emergency medicine, which portends the development of leadership skills. Working with the members of the Board provides numerous role models and can lead to mentoring relationships. In addition, participation in the Board’s activities offers a glimpse into the organizational structure and the enormous amount of work involved in operating a professional society. Most importantly being part of the decision making process is engaging and enlightening. It’s the opportunity to help shape the direction in which the Society is moving. At times, being the only resident on the Board is intimidating. Additionally, the history behind an issue is often unknown to you, making the ability to make informed comments difficult. That’s when you’re glad you can retreat to being a fly on the wall.

However, the feelings of intimidation are self-made, and questions regarding the background of an issue encouraged. You will be involved in major issues regarding the future of the specialty, an indelible role for a resident. Your comments are always welcome, regarded, and at times solicited, especially when the issue involves residents. In addition to participating in three Board face-to-face meetings and monthly conference calls, you will serve as the liaison to a task force/committee and an interest group. In this role you will work with the committee or interest group chairperson to aid in the completion of their goals and objectives for the year and facilitate communication to the Board regarding their concerns and ideas. Besides the above-mentioned

Key Functions of the Position 1. Full voting member of the Board 2. Participation in Board meetings and conference calls 3. Serving as Board liaison to task forces/committees and interest groups Highlights of the Position 1. Excellent role models and mentoring opportunities 2. Voice in key issues regarding the future of our specialty 3. Insight into the administrative aspects of running an organization 4. Experience, experience, experience Beware of the fly swatter, a.k.a. your residency director.

The position takes a lot of time, time away from your usual responsibilities at your residency program. You need your residency director’s full support prior to applying. Make sure he/she is willing to arrange the schedule such that you are able travel to all the face-to-face meetings and are available for monthly conference calls (that can last over two hours).

Though my year as the resident member of Board is only half over, it has already been a rewarding and enlightening time. The experience and exposure gained far out weigh the time consumed. I strongly encourage anyone with an interest in academic emergency medicine who enjoys being involved in leadership and administrative activities to apply.

Application Process The position is one year in duration and is open to all members of accredited emergency medicine residency programs who will be residents during the entirety of their term. The application process involves submitting a letter of application, curriculum vita, and a letter of recommendation from your program director. The letter of application should not only include a summary of your qualifications for the position but also an understanding of the responsibilities and time commitment involved. The Nominating Committee will review all applications and generally selects two nominees. The election will be held at the SAEM Annual Meeting in May in Atlanta. The deadline for application is January 1, 2001.

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SAEM Board of Directors The SAEM Board meets each month, mostly via conference call. The Board convenes face-to-face meetings at the SAEM Annual Meeting; in the fall at either the ACEP Scientific Assembly or AAMC Annual Meeting; and in the winter, usually in conjunction with an SAEM Regional Meetings. Most recently the Board met during the ACEP Scientific Assembly in Philadelphia.

This article will highlight some of the Board’s actions of the past few months.

The Board approved a 2000 budget that included revenues of $1.94 million and expenses of $1.57 million. The Board approved a contribution of $150,000 to FAEM. The Board approved funding in the amount of $5,000 to support the AEM Consensus Conference on Error in Emergency Medicine (see November issue of AEM).

The Board approved funding of $9,000 to support the 2000 SAEM Regional Meetings. The Board reiterated the policy that regional meeting profits should be used by the regions to fund future regional meetings. By the end of the year the Board expects to act upon the Regional Meeting Subcommittee recommendations regarding the 2001 Regional Meetings.

The Board reviewed and approved many manuscripts developed by committees, task forces, and interest groups. Once approved, the manuscripts are submitted to AEM for consideration of publication. Recent manuscripts approved by the Board include: the Women and Minorities Task Force manuscript, two Inservice Survey Task Force manuscripts, the Diversity Position Statement developed by the Diversity Interest Group, the Public Health Task Force manuscript on preventive screening, the GME Committee manuscript on residency downsizing, and the Ethics Committee manuscript on decision-making.

The Board reviewed a proposed outline of the joint ACEP/SAEM ultrasound manuscript. The Board asked that the manuscript focus on evidence based issues and define a research agenda.

A draft of the manuscript is expected to be submitted for review and approval by the ACEP and SAEM Boards in the next few months.

The Board approved the EMRA/ SAEM Academic Career Guide, edited

by Cherri Hobgood, MD, and Brian Zink, MD. EMRA and SAEM will share the cost of printing the Guide. SAEM has provided the administrative support and posted the Guide on the SAEM web site and provided it to the EMRA web site at no cost. The Board agreed to provide an additional $2,000 to reprint copies of the Guide if needed.

The Board approved the request from

ACEP/EMF to double the support of the EMF/SAEM Medical Student Grants from $4,800 to $9,600. The Board selected Don Yealy, MD, to serve as one of SAEM’s two representatives on EMF. The Board approved the FAEM Neuroscience Research Fellowship that was developed with funding provided by an unrestricted educational grant from AstraZeneca. The Board appointed a subcommittee to develop policies and procedures for to further develop FAEM. The Board approved the establishment and funding of list-servs for all interest groups that wished to develop list-servs. The Board agreed that interest groups should have at least 20 members to obtain a list-serv.

The Board asked the Program Committee to survey the membership and investigate the issue of the future of the Banquet held at the SAEM Annual Meeting. Subsequently, the Board approved the Program Committee’s recommendation to continue the Banquet, but to hold it earlier, rather than the last evening of the Annual Meeting. Additional details about innovations in the plans for the 2001 Annual Meeting will be published in the SAEM Newsletter and web site in the coming months.

The Board selected Mark Angelos, MD, to represent SAEM at the PULSE Conference; Arthur Sanders, MD, to serve as the SAEM representative to the National Acute Myocardial Infarction Project; and Dan DeBehnke, MD, to serve as the SAEM representative to revise the 1995 Competency Statement on Electrocardiography. The Board approved the Public Health Task Force to provide SAEM representation (Ed Bernstein, MD, Linda Degutis, MD, and Lynne Richardson, MD) at the Healthy People 2010 Conference in November.

The Board approved a proposal for Dr. Zink and Dr. Hoekstra to visit the ACEP Washington Office. The Board approved funding for these representatives for expenses incurred in attending various meetings.

As a sponsoring organization of the American Board of Emergency Medicine, the SAEM Board was asked to consider ABEM’s proposed Bylaws amendments. The Board approved ABEM’s proposed amendments, including the expansion of the number of ABEM seats selected by ABEM, and decreasing the number of ABEM seats selected by slates of nominees submitted by the sponsoring organizations.

The Board approved a set of slides on the topics of screening and a brief negotiated interview developed by the Substance Abuse Interest Group. The Board approved a Domestic Violence 12

web site developed by the Domestic Violence Interest Group. The Domestic Violence web site and the substance abuse slide set have been posted on the Educational Resources section of the SAEM web site.

The Board approved the document developed by representatives of the Federation of State Medical Boards (FSMB), AAEM, CORD, and SAEM. The document recommends the development of a “dependent practice” license (which would require supervision and working only in the specialty for which they are in training). The document also recommended development of instance electronic resident licenses and that institutional GME offices, not residency directors, handle reporting to state medical boards. Further details will be published in the SAEM Newsletter.

The Board reviewed and approved the Model of the Clinical Practice of Emergency Medicine, developed by the Core Content Task Force. It is anticipated that the Model will be approved by the other participating organizations (ABEM, ACEP, CORD, and EMRA) and will replace the Core Content document approved approximately five years ago.

The Model document will be published in the peer-reviewed literature in the coming months and will be periodically evaluated and revised.

The Board developed an application for satellite symposia to accompany the Satellite Symposia Policy developed last year. The Board also made minor editorial changes in the Satellite Symposia Policy, the Commercial Support Policy, and the Meeting Sponsorship/Cosponsorship Policy. All policies, and the new satellite symposia application, are posted on the SAEM web site.

The Board reviewed and approved an Editorial Independence Policy for AEM. The Board agreed to review and revise the AEM Policies first developed when the journal was established. A final version of the AEM Policies is expected to be approved by the end of the year and will be posted on the AEM and SAEM web sites.

The Board asked the Constitution and Bylaws (C&B) Committee to develop a number of amendments to the SAEM Constitution and Bylaws, including amending the voting procedures to possibly convene elections by mail or electronic ballot, rather than at the Annual Business Meeting at the SAEM Annual Meeting. In addition, the C&B Committee was asked to review the SAEM Bylaws which provides for ad hoc members (from EMRA, CORD, and AACEM) to the SAEM Board. The Board asked the (continued on next page)

President’s Message (Continued) positions and respond to legislative and regulatory mandates for the benefit of our members, but not for their individual financial gain. Almost all SAEM input into the national dialogue on emergency care focuses on threats to the quality of patient care, teaching, and research in academic ED’s. In this regard we can be proud of our positions and pass the test of how a professional medical association should behave, according to Pellegrino and Relman.

Later in the same JAMA article, the authors state that: “To avoid conflicts of interest, the professional medical association should not seek or accept support from companies that sell health care products or services.” SAEM is clearly in violation of this recommendation. We have a longstanding relationship with Medtronic PhysioControl, Inc., which funds our successful EMS Research Fellowship, and have recently partnered with AstraZeneca to fund, via the Fund for Academic Emergency Medicine (FAEM), a Neuroscience Research Fellowship. We have accepted unrestricted educational grants to help fund our Annual Meeting and Regional Meetings. Yet, despite these dalliances with the corporate world, I believe we are on solid ethical and moral ground, and believe that Pellegrino’s and Relman’s advice in this case is too restrictive. Training grants help advance the mission of SAEM, and eventually help patients and society by providing high quality academic emergency physicians. If corporate participation in

these grants caused SAEM to support the products of these companies in a biased manner, if we lost objectivity in our educational or research sessions that deal with cardiac care or neuroscience, or if emergency patients perceived a conflict of interest in our involvement, then we could not justify this partnership. Both corporations who support the SAEM fellowships have stated that they seek to improve patient care through their products. The corporations do not participate in the solicitation or review of applications, the selection of fellows, type of training, location of training, or type of research project(s) that the fellow chooses. Fellows who finish training will, like other physicians, have to make ethical and moral choices about whether they will selectively use the products of the corporation that funded their fellowship, accept gifts, or buy stock in the company, or accept gifts from any biomedical company.

SAEM provides members with education on ethics and professionalism that can help them make good choices.

Questions about SAEM’s interaction with the biomedical industry come up on almost a weekly basis. As our Interest Groups have grown in number, size and activities, they have found inventive and interesting ways to interact with the biomedical industry. Other organizations and corporations wish to capitalize on the success of the Annual Meeting by hosting sessions in conjunction with the meeting. Some of the questions that arise from these interac-

tions fall into gray zones that are not explicitly covered in our policies. We have rewritten our policies, but still find situations where a clear answer is difficult to find. In these cases, the Board of Directors must act like a Supreme Court, with all the discomfort one would expect when a group of doctors has to act like lawyers. The Board’s approach in assessing proposed SAEM interactions with the biomedical industry has been to follow the advice of D.H. Lawrence who said in his Selected Essays: “Try to find your deepest issue in every confusion, and abide by that.” In this “confusion” the deepest issue is the trust of our patients. If SAEM approves, endorses, or hosts interactions with the biomedical industry that limit academic freedom, objectivity, or have bias, or if the financial relationship causes a conflict of interest, then we may erode the trust that emergency patients have in us. In an address at the 2000 AAMC Annual Meeting, AAMC President Jordan Cohen pointed out that public trust fuels public support for academic medicine. At a time when we are enjoying increased federal (i.e. public) support for research, and we are facing increasing scrutiny about ethical behavior in clinical research, we must be especially careful not to violate public trust.

Dr. Cohen also noted in his address that “conflict of interest is a state of affairs, not a kind of behavior.” Most of the biomedical industry interaction gray areas that are presented to SAEM do (continued on next page)

recommendation of the Grants Committee. The Board approved the development of an Ethics Consulting Service.

The Board approved a proposal to participate in the National Alcohol Screening Day (NASD) on April 5, 2001. A NASD working group will be established to collect findings from 40 participating emergency departments and the results will be submitted to AEM for publication.

The Board approved a resolution promoting ED-initiated approach to improving asthma care. The resolution was proposed by Carlos Camargo, MD, the SAEM representative to the National Asthma Education and Prevention Program.

The Board approved Dr. Zink’s proposal to develop a Patient Safety Task Force and a Grants Committee. The Board approved Dr. Zink’s proposal that the EMS Research Task Force be discontinued this year and that an EMS Interest Group be developed in order to provide an opportunity for more

members to participate in EMS issues.

The Board approved an initial proposal from the Program Committee to post the Photography submissions on the SAEM web site as a teaching tool. The Board requested a more detailed proposal addressing the issues of copyright and appropriate release of the images.

The Board approved the proposal from the Foundation for the Education and Research in Neurological Emergencies (FERNE) to convene a satellite symposium at the 2000 Annual Meeting.

The Board conferred emeritus membership status on James Bouzoukis, MD, and Ernest Ruiz, MD. Both Dr. Bouzoukis and Dr. Ruiz provided many years of membership and service to the Society.

The next meetings of the Board are expected to be held at the CORD/ AACEM Faculty Development Conference in March in Washington, DC and at the SAEM Annual Meeting in Atlanta in May. All SAEM members are invited to attend the Board meetings.

SAEM Board of Directors (Continued) C&B Committee to consider how SAEM should define its relationship with emergency organizations since the Society currently is inconsistent. The Board is expected to review the C&B Committee recommendations before the end of the year and further information will be published in the SAEM Newsletter.

The Board approved a proposal from the National Affairs Task Force to develop an educational session on Error in Emergency Medicine at the AAMC Annual Meeting. The Board approved the development of a 24 Hours in the ED project being developed by the Public Health Task Force. The Public Health Task Force has submitted the proposal to the Robert Wood Johnson Foundation for possible funding.

The Board approved the Undergraduate Committee’s proposed medical school curriculum assessment survey.

The Board approved the funding of the Medical Student Interest Group grants.

The Board doubled the number of funded grants from three to six, upon the

13

President’s Message (Continued) not involve blatant, behavioral conflicts of interest. Rather, they are due to a “state of affairs” that introduces a conflict of interest that threatens objectivity or introduces bias. Members who propose these interactions are almost always well-intended, dedicated, passionate, and committed to their research area or proposed project. Perhaps the best way to demonstrate some of the decisions that the Board has to make on commercial support is to provide some examples.

Case 1. The Program Committee received a proposal to hold a lunch session at the Annual Meeting where invited pharmaceutical company representatives were to meet with SAEM members to discuss aspects of sponsored research and general information and tips on how investigators can best position themselves to participate in clinical trials. This session was approved because it did not involve promotion of particular products or a single company, but was a discussion of the process of clinical research. If the session had involved a single company promoting its own drugs or clinical trials, it most likely would not have been approved, as the session would be prone to bias and a lack of objectivity.

Case 2. An Interest Group (IG) proposed that during its meeting at the Annual Meeting, an invited expert speaker would be brought in to give a presentation on a particular disease process.

The IG noted that the speaker was part of the company’s speaker’s bureau and proposed that his travel, lodging, and an honorarium be funded by a pharmaceutical company that makes a drug for treatment of this disease. The pharmaceutical company also wanted to provide funds for the lunch. This request was not approved by the Board of Directors because it was felt that the conflict of interest with a speaker who was paid by a pharmaceutical company would introduce apparent bias or reduce objectivity in the presentation, even if it were disclosed. One could argue that our IG members could sniff out bias in a presentation on their own, and that SAEM does not need to limit this type of presentation. This is probably true for experienced members, but resident and medical students are also members of IG’s, and they may not be as aware of bias. Another approach that the IG could have taken to meet the same objective would be to submit a project proposal form to the SAEM Board to host a session at its IG meeting. A speaker could be invited, but the IG would request that SAEM fund his or her travel, lodging, and a reasonable honorarium. The speaker would disclose in advance, and at the session, that he/she had a conflict of interest as

a member of a speaker’s bureau for a pharmaceutical company. The IG would ensure that a balanced presentation was given that did not promote a single drug or product.

Case 3. This is a hypothetical case, but based on discussions with our IG Chairs, it is very likely to arise in the near future. An IG wishes to develop an educational curriculum and teaching program that includes the development of monograph, slide set, and webbased teaching aids. The total cost of the program is around $10,000. The IG has links with a company that will provide funding for the program, and wants this to be acknowledged in the materials. Direct funding of this program by the company would violate the SAEM Policy on Commercial Support, even though the end product could be consistent with SAEM’s mission. The reason for the violation would be the bias and potential loss of objectivity and academic freedom in the creation of the product due to knowledge of how it was supported. However, if the company provided an unrestricted educational grant to SAEM, the IG could submit a proposal for the educational program requesting that SAEM fund the program. SAEM could then publicly acknowledge the unrestricted grant, but it would not be tied to the specific product. If the SAEM Board agreed to support this program after receiving an unrestricted educational grant from a company, one could argue that this is a case of money laundering — the company is not permitted to directly fund and receive credit for funding a specific program, but SAEM accepts “unrestricted” money and is then able to fund the program. The purpose of this approach is to reduce potential bias in the development of the program, and to make sure that the eventual users of the educational program can feel comfortable that it was prepared without undue conflict of interest. It is also a test of the true intentions of the company. A company that is primarily focused on improving the knowledge of physicians will often provide unrestricted support, with the understanding that the company may eventually benefit by having knowledgeable physicians use its products. A company that has a more short term focus of increasing sales of its current product by promoting an educational program that includes that product, will be less likely to provide unrestricted support.

It is understandable that some SAEM members will find SAEM’s approach to commercial support to be too restrictive, but it should not be construed that SAEM is against commercial support of research and education.

SAEM recognizes the crucial role that 14

the biomedical industry plays in funding emergency medicine research and educational programs. We hold in high regard those members who have, in a professional and ethical way, advanced a research area by participating in industry-supported research.

Professional medical associations and individual physicians are facing increasing scrutiny of our professionalism and ethical behavior, particularly in clinical research. SAEM has lead the way in discussing and defining professionalism for academic emergency physicians.(2) It is essential that we as an organization adhere to the same standards of ethical and professional behavior as we advocate for our individual members. Over the past decade, SAEM has navigated the seas of commercial support, and tried to avoid murky waters. Our ship is currently safe in its harbor, but we may have potentially missed some opportunities for productive collaboration with the corporate world. We believe that the risk of violating our members’ and patients’ trust in us to maintain objectivity and promote academic freedom outweighs this down side perhaps missing some opportunities. Other professional organizations who have less restrictive policies on corporate interactions have had their reputations damaged by the presence or appearance of conflict of interest or bias.

SAEM hopes that the future will provide more opportunities for interaction with the biomedical industry, and that these interactions will help support improved research and education in emergency medicine. While we may sometimes irk members by turning down a small proposal for a corporate interaction that we judge violates our policies, we are working (perhaps with the same company) to develop larger, long-lasting funding relationships to help build FAEM and support training grants. We will continue to debate how best to forge interactions with the corporate world while maintaining the highest ethical standard for our professional organization. We welcome members comments on this issue.

References 1. Pellegrino ED, Relman AS: Professional medical associations — ethical and practical guidelines. JAMA 282(10): 984-986, 1999.

2. Adams JA, Schmidt T, Sanders A, et al: Professionalism in emergency medicine. Acad Emerg Med 5(12): 11931199, 1998.

Acknowledgements: Dr. Zink wishes to thank Dr. Roger Lewis, Dr. Michelle Biros, and Dr. Susan Stern for their review and suggestions for this article.

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

Candidates must be board certified or prepared in emergency medicine.

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

Emergency Medicine at Northwestern University School of Medicine Applications are invited for full-time faculty in the Division of Emergency Medicine (open rank). The Attending Physician, Emergency Medicine is responsible for clinical practice in the Emergency Department of Northwestern Memorial Hospital, for the teaching of residents and medical students, and for demonstration of academic productivity. The newly build (1999) Emergency Department serves over 60,000 patients/year and serves as a Level 1 Trauma Center for the city of Chicago. The residency program has enrolled its 27th class, currently accepting 7 EM residents/ year. The hospital is committed to service excellence and innovation. Applicants for this faculty position must have completed residency training in emergency medicine. Preference will be given to applicants with demonstrated research interest and to those who will serve as exceptional role models for residents and medical students. Women and minorities are encouraged to apply. Salary is commensurate with experience. Proposed start date is September 1, 2000. To ensure full consideration, please send a curriculum vitae, along with a brief description of career interests, prior to September 1, 2000, at:

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

Fellowship training, research experience, or other post-graduate education is preferred. All faculty are expected to participate in education, research, and clinical activities. Salary is negotiable.

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

JAMES ADAMS, MD NORTHWESTERN UNIVERSITY SCHOOL OF MEDICINE DIVISION OF EMERGENCY MEDICINE 216 E. SUPERIOR STREET, SUITE 100 CHICAGO, IL 60611 Northwestern University is an Affirmative Action/Equal Opportunity Employer. Hiring is contingent upon eligibility to work in the United States.

Mayo Clinic Rochester, Minnesota EMERGENCY PHYSICIAN The Department of Emergency Medicine is seeking a full-time academic emergency physician. Opportunities include: m Clinical practice in a Level 1 Trauma Center with 77,000 visits/year. m Involvement in a recently accredited Emergency Medicine Residency Program. m Supervising and teaching Emergency Medicine residents, offservice residents and medical students. m Research and administrative support and intramural funding available. m Prehospital/aeromedical care in base station hospital for paramedics, 2 helicopters/1 jet. m Academic appointment in Emergency Medicine at Mayo Medical School.

Candidates must be: residency trained emergency medicine specialists; ABEM board certified or eligible; individuals with established track records in academic emergency medicine as proven by performance in residency training, fellowship training, or faculty positions; Minnesota medical license or eligible. Competitive salary with excellent benefit package. For further information, contact: Thomas Meloy, MD Chair, Department of Emergency Medicine Saint Marys Hospital â&#x20AC;&#x201D; Mayo Clinic 1216 Second Street, SW Rochester, MN 55905 Phone: (517) 255-4399 Mayo Foundation is an affirmative action and equal opportunity employer and educator.

15

UNIVERSITY OF FLORIDA/JACKSONVILLE is expanding its Emergency Medicine operations. Full and part-time clinical opportunities available at Orange Park Medical Center and Shands Jacksonville (formerly Methodist Medical Center and University Medical Center). Positions are non-tenure accruing; salary is negotiable. Full-time (1.0 FTE) positions offer faculty appointments to the University. Part-time positions pay competitive hourly rates. If interested, fax current CV to Dr. Robert Luten, Chairman, Search Committee, (904) 549-5666 or e-mail luten. robert@ufl.edu. Application deadline: 4/30/01, anticipated start date 8/1/01. The University of Florida is a stable and reliable health care employer (EEO/AA) in Northeast Florida (Jacksonville).

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

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

Please send Curriculum Vitae to:

UNIVERSITY OF MISSOURI-KANSAS CITY/TRUMAN MEDICAL CENTER, Department of Emergency Medicine seeks academic faculty for a full-time appointment at the assistant or associate professor level.

Candidates must be board-certified or board-eligible in EM and have demonstrated research interests. TMC is the primary teaching hospital for the UMKC School of Medicine; fully accredited EM residency since 1973. Current research in infectious disease surveillance, trauma, ED ultrasonography, asthma, EMS, public health, and clinical process improvement. Contact Robert A. Schwab, MD, Truman Medical Center, 2301 Holmes S., Kansas City, MO 64108. (816) 556-3250. Schwabra@ trumed1.trumanmed.org. An equal opportunity employer.

UNIVERSITY OF TEXAS MEDICAL BRANCH in Galveston, Texas is seeking candidates for full-time faculty positions in emergency medicine.

Candidates must be BE/BC in emergency medicine or in a primary care specialty with emergency medicine experience. Opportunities for clinical care, teaching of housestaff and students, and research. The Emergency Department has a diverse, high acuity patient population with an annual census of 72,000. UTMB is an equal opportunity/affirmative action employer m/f/d/v. UTMB hires only individuals authorized to work in the US. Send inquires to: Paul W. English, MD, Co-Director, Emergency Medicine, UTMB-Galveston, 301 University Blvd., Galveston, TX 77555-1173; Phone: 409-772-1425; Fax: 409-772-9068.

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

NORTH CAROLINA:

North Carolina: Opening for Director of

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

Salary and benefits are extremely competitive.

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

Education/Assistant Residency Director at WakeMed, a private level II trauma center in Raleigh.

Join an independent democratic group of board certified emergency physicians staffing 2 hospitals including a large trauma center and a community hospital. WakeMed emergency department sees over 90,000 visits annually, includes a separate Childrenâ&#x20AC;&#x2122;s Emergency Department, and is a major teaching site for emergency medicine residents. Affiliated with the University of North Carolina at Chapel Hill emergency medicine residency. Academic appointment based on credentials. Excellent mix of clinical, research, educational, and administrative duties. Excellent compensation and benefit package with ample protected academic time. Interested applicants should send CV to Lance Brown, MD, MPH, Interim Director of Education, Department of Emergency Medicine, WakeMed, PO Box 14465, Raleigh, NC 27520-4465. (919) 350-8823, fax (919) 350-8874; e-mail: LBROWNMD@AOL.com.

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

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

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

WEST VIRGINIA UNIVERSITY EMERGENCY MEDICINE CHAIR The West Virginia University (WVU) School of Medicine is seeking a Chair of the Department of Emergency Medicine at the Robert C. Byrd Health Sciences Center. The Department of Emergency Medicine is an established academic department with strong teaching programs and leadership in research in rural emergency medicine. The WVU Hospital System includes a Level 1 Trauma Center and an active aero-medical program serving a large geographical area. The position requires an individual with strong leadership skills, experience in academic medicine and administration, and a commitment to service, teaching, and research. He/She must have a vision for the future of medical education in the context of a changing health care delivery system. Applicants should send a curriculum vitae and the names and addresses of three references.

These materials should provide evidence of qualifications as noted above.

Review of applications will begin after October 16, 2000. The position will remain open until filled. Applications should be directed to: C.H. Mitch Jacques, M.D., Ph.D. Chair, Department of Family Medicine Chair, Emergency Medicine Chair Search Committee Robert C. Byrd Health Sciences Center West Virginia University School of Medicine P.O. Box 9152 Morgantown, West Virginia 26506-9152 304-598-6920 jacquesm@rcbhsc.wvu.edu

Geriatric Emergency Medicine Resident/Fellow Grants Available SAEM with funding from the John A. Hartford Foundation and the American Geriatric Society (AGS), is pleased to announce the availability of grants to support resident/fellow research related to the emergency care of the older person. Investigations may focus on basic science research, clinical research, preventive medicine, epidemiology, or educational topics.

Awards may be up to $5,000 for each project.

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

WVU is an Equal Opportunity/Affirmative Action Employer.

Women and minorities are encouraged to apply.

WEST VIRGINIA UNIVERSITY

D ISTRICT OF C OLUMBIA

Department of Emergency Medicine

T

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

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

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

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

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

17

Duke University

MICHIGAN:

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

The Division of Emergency Medicine at Duke University Medical Center is working to develop an Emergency Medicine Residency Program. We are currently seeking an Emergency Medicine Residency Director to start and develop a residency training program in Emergency Medicine. Duke University Medical Center Emergency Department is a Level 1 Trauma Center in Durham, North Carolina, with an annual volume of 65,000 patient visits. Competitive salary and benefits. Qualified faculty are invited to apply.

ACADEMIC EMERGENCY MEDICINE

NORTH SHORE-LONG ISLAND JEWISH HEALTH SYSTEM

Duke University Health System EXCITING OPPORTUNITY FOR RESIDENCY DIRECTOR

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

The Department of Emergency Medicine, Wright State University School of Medicine seeks a faculty member at the Instructor, Assistant or Associate Professor level. Faculty rank and salary are commensurate with the candidateâ&#x20AC;&#x2122;s professional qualifications and School of Medicine standards.

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

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

Kettering, Ohio 45429

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

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

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

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

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Academic and Private Practice Emergency Medicine Positions Available

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

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

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

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

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

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

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

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

Advertising Rates: Classified Ad (100 words or less) Contact in ad SAEM member ...............................$100 Contact in ad non-SAEM member ........................$125 1/4-Page Ad (camera ready) 3-1/2â&#x20AC;? wide x 4-3/4â&#x20AC;? high .......................................$300 To place an advertisement, e-mail, fax or mail the ad, along with contact person for future correspondence, telephone and fax numbers, billing address, ad size and Newsletter issues in which the ad is to appear to: Jennifer Mastrovito at <Jmastrovito@saem.org>, via fax at 517-485-0801 or mail to 901 N. Washington Avenue, Lansing, MI 48906. For more information or qustions, call 517-485-5484 or <Jmastrovito@saem.org>.

19

NEWSLETTER

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

Bulk Rate U.S. Postage P A I D Lansing, MI Permit No. 485

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

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

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

CALL FOR ABSTRACTS 2001 Annual Meeting May 6-9 — Atlanta The Program Committee is accepting abstracts for review for oral and poster presentation at the 2001 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 January 9, 2001 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 2001 SAEM Annual Meeting.

Original abstracts presented at other national meetings within 30 days prior to the 2001 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