November-December 2004

S A E M

Newsletter of the Society for Academic Emergency Medicine November/December 2004 Volume XVI, Number 6

PRESIDENT’S MESSAGE The Physician as Scientist: Thoughts from a Skeptic (and a Believer)

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

The SAEM Research Fund – Helping to Build Academic Careers Brian J. Zink, MD University of Michigan Chair, SAEM Development Committee

Our academic practice environment has grown increasingly challenging from a cognitive, affective and physical standpoint. At a time Carey Chisholm, MD when we seem to need to be all things to all people—being empathetic physicians practicing customer friendly care to all comers at all times and frugally using resources at a zero-error tolerance rate while supervising and teaching residents and students—why would I advocate that we remember our role as scientists as well?

Because our specialty's future depends on your efforts within the academic community. It is here that the science of discovery (without which we cannot progress), the science of application (without which new discoveries are meaningless to society) and the science of education (without which we have no future) are practiced.

Looking back over my relatively brief 24 year career in Emergency Medicine, there are numerous examples of how each of these "sciences" have profoundly changed the way we practice Emergency Medicine as a specialty. Examples are easy to find. ● Nasotracheal intubation has been replaced by RSI techniques. ● "Brutane"and “bite the bulletol” have been replaced by procedural sedation and analgesia. ● Sensitive bedside pregnancy testing and ultrasonagraphy have taken much of the guesswork away from diagnosing ectopic pregnancies. (Does anyone remember the culdocentesis?)

Medicine can be characterized as the art of caring layered on the foundation of science. It cannot exist without attention to both. Neither caring nor science is alone successful in healthcare when practiced in isolation. In Carl Sagan's book, The Demon-Haunted World: Science as a Candle in the Dark, he writes about the unique combination of a globalized society dependent upon science and technology existing within systems that increasingly do not understand basic scientific principles. He notes this to be a "prescription for disaster".

In the chapter "The fine art of baloney detection," Sagan describes the need for us to be skeptics (as opposed to cynics, who have predetermined and negative beliefs undeterred by further data) in our role as scientists. The scientif-

In the few short years since it was founded, the SAEM Research Fund has had a remarkably positive impact on the academic careers of scores of young emergency physicians. These physicians are working hard in research and education toward the end result that all of us strive for – improved care for our emergency patients. The comments of our SAEM grant recipients provide the best testimony to the success of the Research Fund.

Samuel Yang from the Johns Hopkins School of Medicine wrote, “As a recent recipient of the SAEM Research Training Grant, I would like to say that the grant has been instrumental in jump-starting my career in academic emergency medicine. It has afforded me the ‘protected’ time to develop essential research skills and grantsmanship in order to pursue my research inquiry further and become competitive for additional intra- and extramural funding.”

Daniel Davis of the University of California, San Diego notes, “The SAEM Scholarly Sabbatical Grant was pivotal in allowing me to explore both basic science and clinical research and receive mentorship from two world-class scientists from my institution. It was directly responsible for my successful acquisition of both an R01 in experimental models of ischemia and a U01 as part of a resuscitation consortium.”

At the special reception held at the Annual Meeting in May 2004, donors to the Research Fund discussed their motivations and reasons for contributing. For some it was to give a chance to young physicians that they never had. For others it was the advancement of original research in emergency medicine. For a few, the cycle was being completed - they had benefited from receiving training grants early in their careers, now were acknowledging the importance of this by contributing back to the cause.

The Research Fund now sits at over three million dollars, and many SAEM members have contributed to the Fund. However, the largest donor remains our parent organization. In the past two years SAEM has donated $0.5 million of its reserves to the Research Fund. This is a great example of a putting our money where our mouth is. However, we cannot count on this level of donation from SAEM each year, and in order to increase the size of the Research Fund we must have a higher contribution from SAEM members. One of the most disappointing activities for SAEM each year is when the Grants Committee must choose only one recipient for the Research Training Grant, Institutional Research Training Grant, and Scholarly Sabbatical Grant, and highly qualified applicants are turned down. Our goal is that the Research Fund will function as a sustainable endowment that can provide many more grants than we are currently able to fund.

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

Call for Nominations Deadline: February 4, 2005 Nominations are sought for the Hal Jayne Academic Excellence Award and the Leadership Award. These awards will be presented during the SAEM Annual Business Meeting in New York City. Nominations for honorary membership for those who have made exceptional contributions to emergency medicine are also sought. The Nominating Committee wishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or any SAEM member. Nominations should include a copy of the candidate's CV and a cover letter describing his/her qualifications. Nominations must be sent electronically to saem@saem.org. The awards and criteria are described below: Academic Excellence Award The Hal Jayne Academic Excellence Award is presented to an individual 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 Previous recipients of this award are: Tom Aufderheide, MD, William Barsan, MD, Charles Brown, MD, Steven Dronen, MD, Richard Edlich, MD, PhD, Lewis Goldfrank, MD, Glenn Hamilton, MD, Jerris Hedges, MD, MS, Judd Hollander, MD, Gabor Kelen, MD, Arthur Kellermann, MD, MPH, John Marx, MD, James Niemann, MD, Emanuel Rivers, MD, James Roberts, MD, Ernest Ruiz, MD, Arthur Sanders, MD, Corey Slovis, MD, Ian Stiell, MD, and Blaine White, MD. Leadership Award The Leadership Award is presented to an individual 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.

Previous recipients of this award are: Louis Binder, MD, E. John Gallagher, MD, Lewis Goldfrank, MD, Glenn Hamilton, MD, Jerris Hedges, MD, MS, Robert Knopp, MD, Ronald Krome, MD, Richard Levy, MD, Louis Ling, MD, James Niemann, MD, Peter Rosen, MD, Arthur Sanders, MD, David Sklar, MD, William Spivey, MD, Judith Tintinalli, MD, Joseph Waeckerle, MD, and David Wagner, MD.

The SAEM Research Fund‌(continued from page 1) The Development Committee will be embarking on a new initiative to increase contributions from our individual members. If the membership can contribute at a higher rate and at a higher amount, we can potentially provide more young emergency physicians with the academic boost of a training grant.

As much as we seek and hope for major support from industry and philanthropic organizations, the type of unrestricted donation needed to provide general

research training grants is best raised from our own ranks. If we don’t believe in ourselves, we will never convince others to contribute to our cause.

Please consider donating to the SAEM Research Fund as an investment in the future of our field. A donation envelope is enclosed in this Newsletter, and a letter and brochure will be sent to SAEM members in the next month. You can also make a donation on-line at www.saem.org.

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SAEM Membership as of 10-11-04 Active - 2329 Associate - 259 Resident - 2264 Fellow - 55 Medical Student - 303 Emeritus - 22 Honorary - 7 TOTAL: 5,239

Two New Residency Programs Approved by the RRC-EM During the September meeting of the Residency Review Committee for Emergency Medicine (RRC-EM) two new Emergency Medicine residency programs were approved. Because of the timing of the approval, neither program will participate in ERAS this year, but will participate in the Match in 2005. Congratulations to these institutions and their faculty.

University of Medicine and Dentistry of New Jersey - New Jersey Medical School

University of Utah The University of Utah Affiliated Residency in Emergency Medicine is based at the 430 bed University Hospital, a Level 1 Trauma Center. The Universitiy of Utah School of Medicine has three other campuses including the 500 bed LDS Hospital and residents will also rotate through the ED and PICU at Primary Children’s Medical Center. A fourth campus, the 102 bed Salt Lake City Veterans Medical Center, will provide medical intensive care. The program was approved as a 1-3 program and this year will be recruiting 7 residents. The Chief of the Division of Emergency Medicine is Erik Barton, MD, MS, and the Program Director is Stephen C. Hartsell, MD. The Associate Program Director is Susan Stroud, MD, and the Assistant Director at LDS Hospital is Todd Allen, MD.

The University of Medicine and Dentistry of New Jersey (UMDNJ)/New Jersey Medical School Center Emergency Medicine Residency Program will be located at the University Hospital in New Jersey, a large city hospital that is a major trauma center and referral center, as well as a large research center. The program will be a four year program, and was approved for 32 residents. Currently the program will be recruiting for 6 residents. The Chief of the Division of Emergency Medicine is Ronald B. Low, MD. The program director is Joseph Rella, MD, and the assistant program director is Tiffany Murano, MD.

SAEM 2005 Research Grants Research Training Grant This grant provides financial support of $75,000 per year for two years of formal, full-time research training for emergency medicine fellows, resident physicians, or junior faculty. The trainee must have a concentrated, mentored program in specific research methods and concepts, and complete a research project. Deadline: November 4, 2004.

Institutional Research Training Grant This grant provides financial support of $75,000 per year for two years for an academic emergency medicine program to train a research fellow. The sponsoring program must demonstrate an excellent research training environment with a qualified mentor and specific area of research emphasis. The training for the fellow may include a formal research education program or advanced degree. It is expected that the fellow who is selected by the applying program will dedicate full time effort to research, and will complete a research project. The goal of this grant is to help establish a departmental culture in emergency medicine programs that will continue to support advanced research training for emergency medicine residency graduates. Deadline: November 4, 2004.

Scholarly Sabbatical Grant This grant provides funding of $10,000 per month for a maximum of six months to help emergency medicine faculty at the level of assistant professor or higher obtain release time to develop skills that will advance their academic careers. The goal of the grant is to increase the number of independent career researchers who may further advance research and education in emergency medicine. The grant may be used to learn unique research or educational methods or procedures which require day-to-day, in-depth training under the direct supervision of a knowledgeable mentor, or to develop a knowledge base that can be shared with the faculty member’s department to further research and education. Deadline: November 4, 2004.

Emergency Medical Services Research Fellowship This grant is sponsored by Medtronic Physio-Control. It provides $60,000 for a one year EMS fellowship for emergency medicine residency graduates at an SAEM approved fellowship training site. The fellow must have an indepth training experience in EMS with an emphasis on research concepts and methods. The grant process involves a review and approval of emergency medicine training sites as well as individual applications from potential fellows. Deadline: November 4, 2004.

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

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Call For Nominations Young Investigator Award Deadline: December 17, 2004 In May 2005, 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 mentor-trainee 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 candidate must have training and board certification in emergency medicine or pediatric emergency medicine. Criteria taken into consideration in determining the award recipient include prior research grant awards, publications, presentation, and other awards. Research grant awards are most highly weighted, especially if from federal or major foundation sources. Research publications will be weighted based on their quality and number. Publication in high impact or moderate impact journals will be weighted higher than publications in low impact journals. Research presentations at national meetings and non-monetary awards will be given relatively less weight in the overall evaluation.

The deadline for the submission of nominations is December 17, 2004, and nominations should be submitted electronically to saem@saem.org. Nominations should include the candidate’s CV and a cover letter summarizing why the candidate merits consideration for this award. Candidates may nominate themselves or any SAEM member may nominate a deserving young investigator. Candidates may not be senior faculty (associate or full professor) and must not have graduated from their residency program prior to June 30, 1998.

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.

Call for Photographs Deadline: February 18, 2005 Original photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data are invited for presentation at the 2005 SAEM Annual Meeting in New York City. Submissions should depict findings that are pathognomonic for a particular diagnosis relevant to the practice of emergency medicine or findings of unusual interest that have educational value. Accepted submissions will be mounted by SAEM and presented in the “Clinical Pearls” session and/or the “Visual Diagnosis” medical student/resident contest.

No more than three different photos should be submitted for any one case. Submit one glossy photo (5 x 7, 8 x 10, 11 x 14, or 16 x 20) and a digital copy in JPEG or TIFF format on a disk or by email attachment (resolution of at least 640 x 48).

Radiographs and EKGs should also be submitted in hard copy and digital format. Do not send X-rays. The back of each photo should contain the contributor’s name, address, hospital or program, and an arrow indicating the top. Submissions should be shipped in an envelope with cardboard, but should not be mounted.

Photo submissions must be accompanied by a brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding, 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.”

The case history must be submitted on the template posted on the SAEM website at www.saem.org and must be submitted electronically. The case history is limited to no more than 250 words. If accepted for display SAEM reserves the right to edit the submitted case history. Submissions will be selected based on their educational merit, relevance to emergency medicine, quality of the photograph, the case history and appropriateness for public display. Contributors will be acknowledged and photos will be returned after the Annual Meeting. Academic Emergency Medicine (AEM), the official SAEM journal, may invite a limited number of displayed photos to be submitted to AEM for consideration of publication. SAEM will retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Call for Submissions Innovations in Emergency Medicine Education Exhibits Deadline: February 22, 2005 The Program Committee is accepting Innovations in Emergency Medicine Education (IEME) Exhibits for consideration of presentation at the 2005 SAEM Annual Meeting, May 22-25, 2005 in New York City. Submitters are invited to complete an application describing an innovative new educational methodology that they have designed, or an innovative educational application of an existing product. The exhibit should not be used to display a commercial product that is already available and being used in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teaching setting. Commercial support of innovations is permitted but must be disclosed. IEME exhibits will be published in a summer 2005 issue of Academic Emergency Medicine, as well as in the Annual Meeting on-site program. However, if submitters have conducted a research project on or using the innovation, the project may be written up as a scientific abstract and submitted for scientific review in the appropriate subject category by the January 6 deadline.

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

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

Robert A. Barish, MD, Professor of Surgery and Medicine, has been promoted from Associate to Senior Associate Dean for Clinical Affairs in the Dean’s Office at the University of Maryland School of Medicine.

Roger Barkin, MD, has been named as the recipient of the James D. Mills Outstanding Contribution to Emergency Medicine Award by the American College of Emergency Physicians (ACEP).

Steven L. Bernstein, MD, has been promoted to Associate Professor of Clinical Emergency Medicine at the Albert Einstein College of Medicine.

Laura Bontempo, MD, will become the Residency Director at the Yale University Emergency Medicine Residency Program on October 27. She previously served as the Associate Residency Director at the Brigham and Women's/Massachusetts General Hospital Harvard Affiliated Emergency Medicine Program.

Jane Brice, MD, MPH, has been promoted to Associate Professor with Tenure at the University of North Carolina at Chapel Hill.

Gregory Connors, MD, MPH, MBA, Associate Professor of Emergency Medicine and Pediatrics at the University of Rochester School of Medicine & Dentistry, has been appointed chief of the Division of Pediatric Emergency Medicine. He also remains Vice Chair of Emergency Medicine for Academic Affairs.

Marc Dorfman, MD, has been named the Program Director of the Emergency Medicine Residency Program at Resurrection Medical Center.

Howard A. Freed, MD, has been promoted to Clinical Professor of Emergency Medicine at Georgetown University and Clinical Professor of Medicine at Howard University. In addition, Dr. Freed and his son, Max, became the first father/son duo to present separate papers at the same SAEM meeting. At the 2004 Mid-Atlantic Regional Meeting Dr. Freed presented "Knowledge Among Washington DC's Emergency Physicians About the Initial Presentation of Smallpox." His son presented,

"Impact of Depression on ED Recidivism: A New Approach to the Frequent Flyer."

Jerris R. Hedges, MD, is the principal investigator at Oregon Health & Science University's Center for Policy and Research in Emergency Medicine of the Resuscitation Outcomes Consortium.

This national consortium, which will provide 30 million dollars over five years at ten sites, is being funded by the national Heart, Lung, and Blood Institute.

Cherri Hobgood, MD, Assistant Professor, at the University of North Carolina at Chapel Hill has been appointed Associate Dean for Curriculum and Educational Development. Dr. Hobgood has also been selected as the North Carolina Emergency Physician of the Year.

Gregory D. Jay, MD, PhD, Associate Professor of Emergency Medicine and Engineering at Brown University, presented an oral presentation entitled, “Lubrication and Mechanisms of Articular Cartilage at the Bioengineering and Musculoskeletal Biology meeting of the Gordon Research Conferences”. Dr. Jay has also been awarded a two-year R41 (STTR) entitled, Pulsus Pardoxus Monitor, by the National Heart Lung and Blood Institute. This award will support efforts to embed pulsus paradoxus monitoring capabilities in pulse oximetry and determine the clinical impact of measuring pulsus paradoxus routinely among dyspneic ED patients.

Jeffrey A. Kline, MD, is the principal investigator of a 1.12 million dollar Small Business Technology Transfer grant from the National Heart Lung and Blood Institute. The title of the grant is "Pretest Probability Assessment for Pulmonary Embolism" and the major goals of the study are to measure the prevalence of pulmonary embolism in ED patients and to develop a large database to use as the basis of a novel method to estimate the pretest probability of ED patients with possible pulmonary embolism.

John B. McCabe, MD, has assumed the presidency of the American Board of Emergency Medicine. He has been a member of the ABEM Board of Directors since 1996 and has served as the chair

of the Academic Affairs Committee, the Emergency Medicine Continuous Certification Task Force, and the Nominating Committee. Dr. McCabe is the Professor and Chair of Emergency Medicine at the State University of New York, Upstate Medical University.

Roland C. Merchant, MD, MPH, has received a one-year $120,000 grant from the Centers of Disease Control and Prevention to support his research, “Evaluation of Video-based Rapid HIV Test Counseling in the Emergency Department.” Dr. Merchant is an Assistant Professor at Brown Medical School.

James Scott, MD, has been named Dean of the School of Medicine at Health Sciences at the George Washington University. Dr. Scott served as the interim dean since 2003 and the associate dean since 2000. He was named Professor of Emergency Medicine in 1998. Previously he served as residency director, assistant dean for Graduate Medical Education, and assistant dean for Student Affairs. Dr. Scott is the fourth emergency physician to serve as Dean of a U.S. medical school, joining John Prescott, MD, at the West Virginia University, Paul Roth, MD, at the University of New Mexico, and Vince Verdile, MD, at the Albany Medical Center.

Joshua Stillman, MD, MPH, a faculty member of the New York Presbyterian Emergency Medicine Residency Program, as a co-principal investigator with the Department of Neurology, has been awarded a SOTRIAS grant (Specialized Program of Translational Research in Acute Stroke) from the National Institute of Neurological Disorders and Stroke.

The five-year grant, worth 12 million dollars, will accelerate the process of taking bench research to human applications in the acute care of patients with stroke.

David Townes, MD, Assistant Professor of Medicine, Division of Emergency Medicine at the University of Washington has assumed the role of Associate Residency Director of the Madigan Medical Center/University of Washing-

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The SAEM Research Fund‌(continued from page 6) ton Emergency Medicine Residency Program.

Jacob Ufberg, MD, has become the Residency Director of the Emergency Medicine Residency Program at Temple University Hospital. Dr. Ufberg previously served as the Assistant Program Director.

Robert H. Woolard, MD, has been

named Chair of the newly established Department of Emergency Medicine at Brown Medical School.

Brian S. Zachariah, MD, Associate Professor and Chief of the Division of Emergency Medicine at the University of Texas Medical Branch in Galveston has been named the innaugural holder of the Elaine Mantooth Fleming, MD, Professorship of Emergency Medicine.

Brian Zink, MD, has been named as the Associate Dean for Student Programs at the University of Michigan Medical School. Dr. Zink will provide leadership for all medical school programs that support medical students, including advising and counseling, admissions, financial aid, special events and government, and medical student research.

In Memoriam: Two Leaders in Emergency Medicine It is with deep regret that the death of Daniel L. Storer, MD, on September 21 is announced.

Dan was very well known to many in emergency medicine, prehospital care, and ACLS training for over 30 years. He was one of the four founding academic faculty for the emergency medicine program at the University of Cincinnati, and founded the Air Care helicopter program at the University of Cincinnati Hospital in 1984. He educated countless residents, medical students, and paramedics over the last three decades. He also served nationally as a paramedic educator and site surveyor for the Joint Review Committee on Educational Programs for the EMT-Paramedic, a liaison representative to the National Registry of EMTs, and as a Medical Assistance Team (MAT) Medical Commander for the American Red Cross Disaster Services. In the greater Cincinnati area, Dan was the head of every prehospital care organization and truly a legend among prehospital providers. Dan was the President of Ohio ACEP in 1987, and was awarded the ACEP EMS Award in 1987 and the Dr. Peter J. Safar-American Heart Association Award of the American Heart Association for the Ohio Region ECC Committee in 2003. The above serves as only a partial listing of Dan's major career accomplishments and awards. He will be sorely missed by all of us here at the University of Cincinnati, as well as by our field of Emergency Medicine.

Brian Gibler, MD University of Cincinnati

The EMS community was saddened by the death of James O. Page, JD, on September 4.

Page was known throughout the EMS and fire service world as the founder and publisher of JEMS magazine and as one of the most influential fire/EMS leaders in the nation.

Page began his public safety career in 1957 with the Los Angeles County Fire Department. In 1971, he was assigned the task of developing a countywide paramedic rescue program. In 1973, he retired as a Battalion Chief and accepted the newly created position of state EMS director in North Carolina. He founded JEMS in 1979, and returned to the fire service in 1984, retiring five years later from the position of chief of the fire department in the City of Monterey Park. He then returned full time to JEMS Communications as its president.

A prolific writer and speaker, Page authored six textbooks and over 400 articles. At the time of his death, he was continuing to serve as publisher emeritus of both EMS and FireRescue Magazine.

Throughout his career, Page promoted EMS within the fire service, and probably did more to bring these two fields together than anybody else. NAEMSP honored him last January with its Ronald D. Stewart Award, which is awarded annually to a person who has made a lasting, major contribution to EMS. Dr. Page was also selected to receive the 2004 ACEP Award for Outstanding Contribution in EMS. David Cone, MD Yale University

Cochrane Prehospital and Emergency Health Field On August 23, the Cochrane Collaboration formally approved the registration of the Cochrane Prehospital and Emergency Health Field. The Cochrane Prehospital and Emergency Health Field seeks to represent the unique needs and concerns of prehospital care and emergency health clinicians, researchers, managers and educators.

The Field’s primary role will be to promote the production and use of systematic reviews of the effectiveness of prehospital care and emergency health interventions. At the request of the Cochrane leadership, the Field was expanded from a prehospital focus to include care in the emergency department. Michael Sayre, MD, serves on 7

the Advisory Board for the Field. Contact him at Sayre.84@osu.edu if you have questions or would like additional information. You can sign up to receive additional information and keep up to date on the Field activities on the website at: www.cochranepehf.org.

New York State SAEM 2004 Regional Meeting Theodore C. Bania, MD, MS St. Luke’s-Roosevelt / Columbia University Chair, 2004 SAEM New York State Regional Meeting St. Luke’s-Roosevelt Hospital / Columbia University was honored to host the 4th Annual New York State Regional Meeting on March 31, 2004 at Lerner Hall on Columbia University Morningside Campus. This conference was the largest of any regional meetings to date with 492 registered participants.

The conference attracted participants from 25 Emergency Medicine Residency Program in the New York/New Jersey/Pennsylvania area, as well as programs from Massachusetts, Rhode Island, Delaware, Washington DC, Florida, North Carolina and Michigan. A total of 150 abstracts were presented (8 oral presentations, 16 moderated poster presentations, and 126 poster presentations).

Dan Wiener, MD, chair of the Department of Emergency Medicine at St. Luke’s-Roosevelt/Columbia University provided opening remarks. Highlights of the meeting were the keynote address given by Dr. Glenn Hamilton, Professor and Chair of Emergency Medicine at Wright State University and a lecture given by Dr. Roger Lewis, Director of Research, Department of Emergency Medicine, Harbor-UCLA Medical Center.

Dr. Hamilton spoke on “Updates in

Cerebral Resuscitation” and Dr. Lewis spoke on “Myths in Emergency Medicine Research.”

The afternoon sessions included didactic sessions titled “Debunking of EM Myths using Evidence Based Medicine” by David Newman, MD, and “Emergency Medicine and Toxicology in the Philippines” by Ginno Blancaflor, MD, Ramona Sunderwirth, MD, MPH and In-Hei Hahn, MD. An Advanced Emergency Medicine Ultrasound Course was given after the meeting by the St. Luke’s-Roosevelt Ultrasound Division. In addition, the Research Directors of New York (RDNY) held their first meeting.

Best Oral Research Presentation William Chang, MD, Bellevue/NYU “Headache and Hypertension – Is There an Association?”

Shari Platt, MD, New York Presbyterian – Weill Cornell Medical Center “Predictor of Pneumonia in Young Febrile Infants Objective: To Identify Predictor of Pneumonia in Young Febrile Infants” Best Oral Research Presentation by a Resident Christine Ortiz, MD, St. Luke’s-Roo-

sevelt/Columbia University “Rate of Outcomes of Unrecognized Esophageal Placement of Endotracheal Tubes by Paramedics in an Urban Emergency Department” Best Moderated Poster Presentations Kendra Dolan, MD, York Hospital “Beta-Blocker Use in Elderly ED Patients with AMI” Rafael Torres, MD, New York Methodist Hospital “Need for Training in Informed Consent among Emergency Medicine Residents” Stephen J. Leech, MD, Christiana Care Health System, Delaware “Emergency Physician Performed Ultrasound Accurately Identifies Upper Extremity Deep Venous Thrombosis” Melanie O’Neil, MD, St. Luke’s-Roosevelt/Columbia University “Optimal Dosing Regimen to Produce Gamma-hydroxybutyrate (GHB) Withdrawal in an Animal Model” Next year’s meeting will be sponsored by the State University of New York, Downstate Medical Center, Kings County Hospital on April 3, 2005. For information about next year's meeting, please contact Dr. Richard Sinert at nephron1@bellatlantic.net.

2004 SAEM New York Regional Meeting Research Award Recipients: (L-R) Stephen J. Leech, MD, Christiana Care Health System, Christine Ortiz, MD, St. Luke'sRoosevelt/Columbia University, Kendra Dolan, MD, York Hospital, Melanie O'Neil, MD, St. Luke'sRoosevelt/ Columbia University, and Rafael Torres, MD, New York Methodist Hospital.

Not pictured: William Chang, MD, Bellevue/NYU, and Shari Platt, MD, New York Presbyterian-Weill Cornell Medical Center.

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Becoming a Leader in the Medical School Dean’s Office Yvette Calderon, MD Jacobi Medical Center SAEM Faculty Development Committee Multiple faculty development seminars were held at the 2004 SAEM Annual Meeting. The seminar on "Becoming a Leader in the Medical School Dean’s Office" included five Deans who are leaders in academic Emergency Medicine: Brian J. Zink, MD, Assistant Dean for Medical Student Career Development, University of Michigan Medical School; Vincent Verdile, MD, Dean, Albany Medical College, John E. Prescott, MD, Dean, West Virginia University School of Medicine; David Sklar, MD, Senior Associate Dean for Clinical Affairs, University of New Mexico School of Medicine; and Katherine Heilpern, MD, Assistant Dean for Medical Education and Student Affairs, Emory University School of Medicine.

Each presenter discussed his/her views in the following areas: 1) the characteristics and qualifications needed to become a Dean; 2) a day in the life of a Dean; 3) the challenges and rewards of being a Dean; and 4) the struggles of a Dean serving in two worlds - the medical school and Emergency Medicine.

The Dean of a medical school possesses the highest authority in academic medicine. Leadership skills are essential for the Dean to meet the complex demands of the institution. To meet these demands, the Dean must have a clear vision for his/her medical school and inspire and direct collaboration among the faculty, administrators and students1. “What the dean does as an individual is not nearly as important as what a dean enables others to do1.”

Therefore, the most important responsibility of a medical school dean is to create an environment where individual and institutional goals, which complement each other, are nurtured and supported.

The average Dean tenure is very short. However, there are multiple qualities that define a successful Dean and may expand the tenure. The Dean must be able to multi-task. There are multiple issues that need to be addressed every day, and the pace is rapid. The ability to be diplomatic, and to relate and successfully communicate with others is a vital skill. Extraordinary interpersonal skills are crucial. It is important that the Dean be familiar with federal and state policies that will have an impact on the medical school and its mission2.

Whether the Dean’s background is aca-

demic, clinical or administrative is not as important as having impressive managerial skills. Most Deans have previously been Department Chairs or served in a major management role in an academic medical center. The Dean must balance the tension between administrative, academic, and professional leaders3. It is less important to have had experience as an Assistant or Associate Dean.

The daily responsibilities of a Dean start with protecting and championing the educational mission of the medical school1,2,4. The Dean must advocate and negotiate the support needed to insure the “development of an educational strategic plan, critically evaluate the educational process, determine the desired outcomes, and hold the faculty and academic administration accountable for the medical school’s mission”2.

It is equally important that the Dean have a savvy business sense. The financial success of the medical school has a direct impact on the realization of its educational and research missions.

The funding that medical schools receive for research can be a large part of the financial success of the medical school2. Therefore, the Dean must be able to direct the faculty to research areas that are currently a priority for the NIH and other funding sources so the institution successfully competes for research dollars. Equally important in the daily responsibilities of the Dean is fund raising. The Dean dedicates significant time to securing the financial viability of the school through fundraising and philanthropy2. Lastly, a critical element to ensure ongoing success is the development of leaders in other departments who can work with the Dean.

These can be chairs, section chiefs, associate deans or committee chairs.

The reality is that there is a constant state of flux in these leadership roles. It is critical that the Dean continually recruit, develop and retain leaders with whom he/she can work to make certain the mission of the medical school is accomplished.

The qualities that make emergency physicians successful are shared with individuals who are successful Deans.

When caring for patients, the stellar emergency physician has a mastery of interpersonal skills, is multitasking, has patience and flexibility, and possesses 9

sound managerial skills. These characteristics and skills are relevant in both career paths1. Some Deans with emergency medicine backgrounds have chosen to wear both hats. The advantages to keeping leadership roles in both the Dean’s office and the Department of Emergency Medicine are: having the ability to be more powerful than in either single role; using resources from one role to solve problems in another; and having pre-established working relationships with other clinical leaders5. The disadvantages are: you can not advocate for your own department as well; you may be seen as too powerful or threatening by other chairs or associate deans; and you must remain impartial when there is a conflict of interest5.

A strong and enduring Dean must have good knowledge and background of medicine and business while possessing excellent managerial, diplomatic and interpersonal skills. The stability and long-term survival of medical schools are directly related to the leadership from the Dean’s office. The Dean represents the values, commitment and vision of a medical school. Emergency physicians can and should aspire to become a Dean. It is clear that the fundamental skills of a Dean are demonstrated as part of the daily routine of an emergency physician. When considering senior leadership roles in emergency medicine, a position in the Dean’s office can be an achievable goal for the academic emergency physician.

References 1. Daugherty RM, Jr. Leading among leaders: the Dean in today's Medical School. Acad Med. 1998; 73: 649-53 2. Verdile V. Becoming a Dean. 2004 SAEM Annual Meeting, Orlando, Fla; May 2004. Website address: http://www.saem.org/facdev/fac_dev _handbook/4-8_on_becoming_ the_dean1.

3. Lee A, Hoyle E. Who would become a Successful Dean of Faculty of Medicine: Academic or Clinician or Administrator? Med.Teach. 2002; 24: 637-41.

4. Chapman JE. Reflections on the Medical Deanship. Acad Med. 1998; 73: 654-6.

5. Sklar, D. Serving Two Masters. 2004 SAEM Annual Meeting, Orlando, Fla; May 2004.

2004 SAEM Mid-Atlantic Regional Research Conference David Milzman, MD Providence Hospital Chair, 2004 SAEM Mid-Atlantic Regional Meeting The 2004 Mid-Atlantic Regional Meeting was hosted by the Washington Hospital Center and Georgetown University Medical Center’s Department of Emergency Medicine at the Georgetown University Conference Center on October 1. Mark Smith, MD Chair of the host program welcomed Glenn Hamilton, MD, President-Elect of SAEM and Chair and Professor of EM at Wright State University. Dr. Hamilton, who literally drove to D.C., highlighted the meeting with an important keynote address seeking additional input from the regional researchers on how the Society can better assist research development. He gave a superb lecture on future directions on the Society. In addition, John Younger, MD, gave the Research lecture on the intricacies of writing one’s first grant.

Break-out lectures on International Medicine Opportunities were given by Dr. Jim Holliman and Dr. Terry Mulligan. Dr. Jeff Love led an overflowing room of medical students through a ‘How to’ EM Residency application process.

The meeting once again used an all oral format for the presentation of six plenary papers by Dr. Jim Manning, Dr. George Shaw, Dr. Robert Freishtat, Dr. Michael Witting, Dr. Jesse Pines and Dr. Howard Freed. The 44 briefer presentations were given in 5 minutes and allowed for outstanding discussions usually not afforded in the standard poster presentations. The outstanding presentations were awarded to the following: George Shaw, MD, the former Georgetown alumnus and current University of Cincinnati attending: Best Overall with: “Microscopic Imaging of Recombinant TPA Thrombolysis

with 120 kHz Ultrasound in an In-Vivo Human Clot Model.”

Best Resident: Jason Gukhool MD, precepted by Paul Sierzenski MD, Christiana Care Health Systems, “EP Ultrasound Decreases Time to Diagnosis, Time to CT Scan and Time to Operative Repair in Patients with Ruptured AAA.” Best Student: Johnny Parvani: “Why Call 911 for Pre-Hospital Cardiac Arrest: Analysis of an Urban Experience and Post-Arrest Survey of Pre-Arrest Life Quality” and Tom Rozwadowski: “Poor Predictive Value of Vital Signs in Predicting Need for Admission on ED Presentation and Value of Bio-markers.”

Both students were from the University Georgetown and precepted by Dave Milzman, MD. Once again, Dr Charlene Irvin was acknowledged for largest travel group of presenting residents, representing the ED from St. John Hospital in Michigan. Dr Reeder also was acknowledged for having three presenting residents from the program at East Carolina. The meeting included over 20 medical student presentations. Letters of Accommodation were prepared for all of the student presenters by the meeting’s program committee for their outstanding presentations.

The meeting once again allowed a great deal of research interaction and exchange of ideas. Future meetings were discussed and the fall may likely become the usual time for this regional event. Dave Milzman served as Chair for the meeting and was assisted, most ably by Karen Jones of the Washington Hospital Center.

Newsletter Submissions Welcomed

Dave Milzman, MD, Meeting Chair awards the Best Student presentation award to Georgetown University students: Johnny Parvani and Tom Rozwadowski.

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SAEM invites submissions to the Newsletter pertaining to academic emergency medicine in the following areas: 1) clinical practice; 2) education of EM residents, off-service residents, medical students, and fellows; 3) faculty development; 4) politics and economics as they pertain to the academic environment; 5) general announcements and notices; and 6) other pertinent topics. Materials should be submitted by e-mail to saem@saem.org.

Be sure to include the names and affiliations of authors and a means of contact. All submissions are subject to review and editing. Queries can be sent to the SAEM office or directly to the Editor at david.cone@yale.edu.

Highlights of the North American Congress of Clinical Toxicology 2004 Research Symposium Brad Weir, MD Indiana University Emergency Medicine Residency 2004 Spadafora Scholarship Recipient Seattle, the “Emerald City,” proved to be an ideal setting for an enthusiastic audience to experience the many intriguing presentations by world leaders in medical toxicology at the 2004 North American Congress of Clinical Toxicology (NACCT).

The meeting began with a breakfast during which the venerable Dr. Bruce Ames (of Ames’ test fame) spoke about micronutrients and public health. Dr. Ames proposed that daily multivitamins might more economically and effectively reduce the incidence of cancer than EPA surveillance and remediation. With all of us inspired to pop some multivitamins, we went on to other lectures.

During the European symposium, Dr. Nick Bateman discussed the role of continuous veno-venous hemofiltration (CVVH) versus hemodialysis for toxic alcohols, theophylline, and salicylates.

For hemodynamically stable patients, hemodialysis is favored over CVVH for more rapid removal of a toxin. In another interesting talk, Dr. Peter Meier-Abt discussed the emerging role of NAcetylcysteine and silybin as antidotes for Amanita mushroom ingestions.

In a thorough evidenced-based review, Dr. Andrew Gee described digitalis and TCA–associated EKG changes. He posited that bidirectional ventricular tachycardia is not pathognomonic for digitalis toxicity. Among tricyclic antidepressant overdose patients, an R wave in aVR > 3mm may more accurately predict the development of seizures or arrhythmia than QRS widening, QTc prolongation, or rightward terminal 40 ms deviation. This session provided valuable information on the validity of the abnormal EKG findings in two common presentations.

The 256 well-researched abstracts that were presented in oral or poster sessions represented the many aspects of toxicology (J.Clin.Tox.42(5)2004). I have summarized several abstracts that I found particularly interesting and germane to Emergency Medicine.

A new flavor of stuffing. Fourteen methamphetamine body stuffers were described by Rhyee et al. All were sympathomimetic upon ED presentation.

Eight received charcoal and/or whole

bowel irrigation. Six were discharged after 2-9 (mean 5.2) hours of observation. Seven were admitted, five of whom to the ICU. One developed rhabdomyolysis and remained intubated for three days, while the others were discharged within 48 hours. Further study will determine the optimum observation period for methamphetamine stuffers, whose presentations are increasingly common.

Atropine alternatives. In the event of a chemical mass casualty incident, atropine supplies could be rapidly consumed. Glycopyrrolate was equally efficacious as atropine (and more so than diphenhydramine) for treating organophosphate toxicity in an animal model by Schaeffer et al.

Escitalopram escapades. Olsen et al portrayed an isolated escitalopram ingestion that resulted in a severe and prolonged serotonin syndrome. This is the second such case of serotonin syndrome with escitalopram alone, though single-agent serotonin syndrome cases are rare. Ho and colleagues reported that seizures (6.9%) and QTc prolongation (3%) remain the most common serious complications of 261 patients exposed to escitalopram or citalopram.

Kids aren’t just little toxic alcohol drinkers… or are they? DesLauriers and colleagues conducted a two year review of 33 pediatric patients (1-10 years) with suspected methanol or ethylene glycol ingestions. Only 64% had an anion gap calculated, and 36% had an osmol gap calculated. Prior to obtaining toxic alcohol levels, fomepizole was recommended in 5/12 (42%) cases and was delayed in 3/5 because “the patient was a child.” Methanol or ethylene glycol toxicity was confirmed in 25% of these 33 patients. Poison Center recommendations are inconsistently followed in pediatric overdoses.

Forget about poppy seeds on bagels… what about coca leaf tea?

Mate de coca, or coca leaf tea, does not cause sympathomimetic symptoms (per report of five healthy subjects) but will cause a positive drug screen for cocaine. Two abstracts (Mazor et al and Perrone et al) demonstrated positive urine drug screens and subsequent confirmatory tests for benzoylecognine 11

and ecognine methyl ester. This should be considered when discussing test results with patients.

Pediatric antiepileptic potpourri.

Lamotrigine, at a level 5x therapeutic, caused two grand mal seizures in a 19 month old boy (Thundiyil et al). An eightfold overdose of tiagabine caused seizures one hour, one and a half hours, and three and a half hours post ingestion (Kazzi et al). Topiramate overdose caused four days of ataxia, slurred speech, and hallucinations in a 3 year old (Lin et al). Among another series of topiramate exposures, the mean onset of symptoms was two hours and tachycardia, GI symptoms, and lethargy predominated. Only 2 of 76 (3%) of patients seized (Marquardt et al). There is no consensus on the duration of monitoring needed for overdoses of these agents.

Selling strychnine, auctioning arsenic. Cantrell shopped eBay® for 10 months and found 121 poisonous products, 63 of which contained arsenic, cyanide, phosphorus, pilocarpine, nicotine, and strychnine. Multiple heavy metals were also available, for the right price. Clinicians must consider exposure to these somewhat uncommon poisons via this dangerous new commerce.

QTc query. Medlock et al examined several resources (including a popular PDA program, web-sites, full-text reference databases, and a textbook) for their completeness and accuracy of reporting of QTc prolongation. To prevent adverse drug effects or to ascribe QTc prolongation to a drug interaction, one must learn the various medication classes that cause QTc prolongation and utilize current references.

Treat the patient, not the test. Or don’t even send the test. Two abstracts by Maloney and colleagues underscore the poor yield of comprehensive toxicology screens among pediatric patients. The send-out comprehensive drug screen took 540 minutes whereas a standard drugs-of-abuse screen took 98 minutes. Comprehensive testing led to a change in diagnosis of 1/94 patients, but the clinical management would not have changed for

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Academic Department Established at Brown University Brown Medical School has announced that the Section of Emergency Medicine was granted full departmental status effective July 1, 2004 becoming the second ivy-league school with a Department of Emergency Medicine. Robert H. Woolard, MD, has been named the Interim Chair of the Department of Emergency Medicine, having served as the Chair of the Section since 1992. There are four emergency departments in the Brown Medical School system. The Rhode Island Hospital ED cares for 75,000 patients

annually and is a level 1 trauma center.

The Hasbro Children’s Hospital ED cares for 45,000 patients annually and is a pediatric trauma center. The Miriam Hospital ED is a community-teaching hospital and cares for 40,000 patients annually. The Memorial Hospital of Rhode Island ED is a community-teaching hospital and cares for 32,000 patients annually. The four-year residency program, which was the first Emergency Medicine Residency in the ivy-league, has 48 emergency medicine residents. The three-year Pediatric

Emergency Medicine Fellowship has 6 fellows. Other fellowships are offered in International Emergency Medicine, EMS/Disaster, Injury Prevention, Medical Simulation and Geriatric Emergency Medicine. There are centers in Medical Simulation, Injury Prevention and Disaster Medicine, as well as a basic science laboratory within the Department of Emergency Medicine. The Department looks forward to continued growth with the opening of a new 54,000 sq. foot “state-of-the-art” ED at Rhode Island Hospital in February 2005.

Advocacy – More Than a Right Vernon Smith, MD Mayo Clinic Jill Baren, MD University of Pennsylvania SAEM National Affairs Committee “Ten people who speak make more noise than ten thousand who are silent.” - Napoleon Bonaparte area of interest or expertise. A targeted email message highWith the rapid change in healthcare, health policy, reimlighting the issue and recommended member action will be bursement issues, HIPAA, EMTALA regulations, resident work sent. The emails may contain suggested key points for a memhours and changes in Residency Review Committee guideber’s response as well as contact information for various agenlines, there is little doubt of the importance of staying informed cies (Congress, governmental and non-government agencies of current issues. Physicians must have the opportunity to be or organizations such as ACGME, AAMC) enhanced by direct involved in legislative, regulatory and non-government agency web links, if possible. An SAEM member can respond to the advocacy for themselves and on behalf of healthcare educaissue by writing an email, letter or printing the text provided tors.1 A study by Landers and Sehgal concluded that physician advocacy is effective and that policy makers are receptive to and sending the response to one or more individuals, agencies increased physician input on a broad range of healthcare relator organization leaders. ed issues.2 Advocacy is most effective when it is focused with a clear However, healthcare educators are often reluctant to message6 and the policies (laws) that are ultimately selected engage in advocacy activity due to perceived barriers.3 These depend largely upon who is most effective at mobilizing supinclude “lack of time” and “lack of access to key individuals”. To port for their choice7. With the implementation of the ANP, address some of these barriers, the SAEM National Affairs SAEM will strengthen it’s ability to represent our specialty and Committee was charged with developing an Advocacy Netits interests to policymakers. work Plan (ANP) designed to keep members apprised of curReferences rent regulatory, legislative and educational agency actions that 1. Caira NM, Lachenmayr S, Sheinfeld J, Goodhart FW, Canare open for comment or advocacy efforts. This plan is meant cialosi L, Lewis C The health educator's role in advocacy and to empower SAEM members to actively participate in the policy: principles, processes, programs, and partnerships Health Promot Pract 2003 Jul;4(3):303-13 advocacy process. The ANP has recently been approved by 2. Landers SH, Sehgal AR How do physicians lobby their memthe SAEM Board of Directors and this article is intended to bers of Congress? Arch Intern Med 2000 Nov raise awareness of the membership of its implementation.

27;160(21):3248-51 Many professional organizations have developed advocacy 3. Galer-Unti RA, Tappe MK, Lachenmayr S Advocacy 101: getnetworks including the American College of Emergency Physiting started in health education advocacy Health Promot Pract cians (ACEP) 911 Legislative Network and the American Med2004 Jul;5(3):280-8 ical Associations (AMA) in Washington.4,5 The SAEM ANP will 4. ACEP 911 Legislative Network Available at: be complimentary to these established programs and will http://www.acep.org/1,28,0.html focus on issues relevant to academic emergency medicine 5. American Medical Association In Washington Available at: physicians such as education, research, documentation, and http://www.ama-assn.org/ama/pub/category/4015.html 6. Zink BJ Advocating for Emergency Physician Advocacy SAEM teaching rules.

Newsletter 2001 Jan/Feb;13(1)1 The advocacy network will use existing SAEM listservs to 7. Peterson MA Motivation, mobilization, and monitoring: the role communicate with members. Issues of importance will be of groups in health policy J Health Polit Policy Law identified and forwarded to the SAEM President and Board of 1999;24:415-419 Directors for approval. Following endorsement, a recipient list will be determined based on the issue under consideration and 12

Report from National Asthma Education and Prevention Program Carlos A. Camargo, MD, DrPH Massachusetts General Hospital SAEM Representative to NAEPP has developed a public education campaign that will launch in 2004. The centerpiece of the campaign is a video that will be aired through local media outlets. The video describes ways in which coalitions can be a useful asthma resource, and provides contact information for connecting viewers with asthma coalitions in their community.

The National Asthma Education and Prevention Program (NAEPP) had a busy year! The annual meeting was held in Washington, DC on December 8, 2003. Highlights of this meeting are summarized below: ●

●

The group affirmed the success of the “National Conference on Asthma 2003” that was held in Washington, DC in June 2003. The meeting covered all aspects of asthma and included several speakers/moderators from emergency medicine (e.g., Jill Baren, Carlos Camargo, Richard Nowak, Robert Sapien).

Research on pharmacist-managed asthma programs indicates that pharmacists have the knowledge and skills to improve asthma outcomes for patients. The presenter summarized several successful interventions and continued obstacles to implementation.

●

The transition to non-CFC inhalers is occurring—several formulations are already considered nonessential in the United States and others are voluntarily being converted by manufacturers to HFA and DPI delivery systems. Most controversial is albuterol because of potential cost burden to patients. The FDA is scheduled to publish a final rule by March 2005.

●

PACE (Physician Asthma Care Education) is an educational program aimed at primary care providers. Results indicate increased use of written plans, increased use of inhaled anti-inflammatory therapy, and reduced ED visits—all without requiring additional time by the physician during the patient visit. Several challenges still exist (eg, acceptance of “well” asthma visits).

●

Research has identified important issues relative to physician-patient communication that can influence a patient’s adherence to therapy. The presenter summarized these issues (eg, language, education, and cultural differences between patients and providers) and emphasized the importance of communication to medication adherence and, ultimately, health outcomes.

●

An outreach and education program for high-risk children living in public housing is being implemented by Allies Against Asthma in Hampton Roads, VA. Women are trained to be lay health visitors within their housing complexes. The women use a case-finding approach to identify children with asthma and then, through a series of four home visits, provide education and referral services to improve and stabilize asthma care. Although the process of implementation has been well honed, clinical outcomes are still pending.

●

Allies Against Asthma also maintains an asthma resource bank that allows users to search for educational materials, program resources, evaluation/survey instruments, and coalition-related materials from a library of more than 400 items. ●

More than 500 health care providers have passed the National Asthma Educator Certification Board (NAECB) exam since its inception in September 2002 (www.naecb.org). The first-time pass rate is 70–75 percent. Nurses and respiratory therapists make up the largest proportion of health professionals taking the exam. A “Reimbursement” link on the NAECB home page leads to a section dedicated to asthma coding, billing, and reimbursement information. An interactive feature provides state-specific coding information and allows users to post tips on asthma education reimbursement.

●

An Expert Panel is in the process of updating guidelines for the management of asthma during pregnancy. The focus of the evidence review is pharmacologic management. The final report should be available in late 2004.

●

The Centers for Disease Control and Prevention (CDC) continues to develop and improve the national asthma surveillance system. Surveys that comprise the core of asthma surveillance data include the National Health Interview Survey (NHIS), Behavioral Risk Factor Surveillance Survey (BRFSS), and the National Asthma Survey (NAS). These tools offer information on the national burden of asthma and should, over time, provide more useful information for planning and evaluating state and local interventions.

●

The Professional Education Subcommittee has agreed to partner with the CDC in the development of guidance for prehospital management of asthma exacerbations. A draft report will be available to all Committee members in late 2004.

The next NAEPP Coordinating Committee meetings will be held on September 20, 2004 and June 20, 2005. For more information about the NAEPP, please check: www.nhlbi.nih.gov/about/naepp/

Allies Against Asthma (http://asthma.umich.edu/) also

SAEM is grateful to Dr. Camargo for serving as the SAEM representative to NAEPP. After a number of years of service, Dr. Camargo has decided to resign as the representative. The SAEM Board of Directors invites interested members to submit nominations to serve as the new SAEM representative to NAEPP. Nominations must include a letter of interest and CV and must be submitted electronically to saem@saem.org no later than Friday, December 3, 2004.

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Nominations Sought for Resident Member of the SAEM Board of Directors The resident Board member is elected to a one-year term and is a full voting member of the SAEM Board of Directors. The deadline for nominations is February 4, 2005.

Candidates must be a resident during the entire one-year term on the Board (May 2005-May 2006) and must be a member of SAEM. Candidates should demonstrate evidence of strong interest and commitment to academic

emergency medicine. Nominations should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter. Nominations must be sent electronically to saem@saem.org. Candidates are encouraged to review the Board of Directors orientation guidelines on the SAEM website at www.saem.org or from the SAEM office.

The election will be held via mail bal-

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

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

14th Annual Midwest Regional SAEM Meeting Tom P. Aufderheide, MD Michael K. Kim, MD Medical College of Wisconsin SAEM Midwest Regional Meeting Directors The Department of Emergency Medicine and Section of Pediatric Emergency Medicine, Department of Pediatrics at the Medical College of Wisconsin hosted the 14th Annual Midwest Regional SAEM Meeting in Milwaukee, Wisconsin, on September 9-10, 2004 at the Wyndham Milwaukee Center Hotel.

In attendance were 140 staff physicians, residents, and medical students, with representatives from over 30 institutions from locations as far away as Hawaii, Puerto Rico, and California. There were 75 abstracts submitted. Of these, 60 presenters accepted the invitation to present their abstracts (10 oral and 50 poster presentations).

The meeting began the evening before with a catered symposium focused on “Building a Career in Emergency Medicine Research” attended by approximately 80 participants. Tom P. Aufderheide, MD, presented opportunities for research in emergency medical services; Marc H. Gorelick, MD, MSCE, presented aspects of pediatric emergency medicine research; and Stephen W. Hargarten, MD, MPH, discussed research in injury control. The nature of a career in emergency medicine research, the scope of potential opportunities, and methods for achieving career success were discussed. The symposium generated superb discussion and interaction with attendees.

Glenn Hamilton, MD, SAEM PresidentElect, opened Friday’s activities with an insightful lecture and interactive discussion titled “SAEM: Thoughts on the Near and Distant Future, and a Request for Input.” The 14th Annual Midwest Regional SAEM Meeting’s Keynote Speaker was Susan A. Stern, MD, who

presented a helpful and informative lecture on “Developing an Academic Career,” consistent with the theme of this year’s meeting. Many thanks to both Dr. Hamilton and Dr. Stern for their superb presentations, which helped make this such a successful event!

Oral abstracts were presented in a morning and afternoon session and were well received. Poster presentations were separated into nine categories with a maximum of six posters in each category. There were moderated poster sessions in morning and afternoon which generated questions, answers, and spirited discussion.

Medical students, residents, and other interested participants enjoyed the concurrent Ultrasound Workshop led by Mary Beth Phelan, MD, James Mateer, MD, and Tim Heilenbach, MD. Small participant groups at four skill stations allowed each participant “hands-on” experience in ultrasound diagnostics.

Stations offered experiences using ultrasound on a human model, an ultrasound simulator with normal and abnormal findings, ultrasound guided peripheral line placement, and foreign body identification and retrieval.

The conference concluded with the Excellence in Emergency Medicine Research awards. Congratulations to the following award winners:

Best Poster Presenter – Faculty Michael C. Plewa, MD, St. Vincent Mercy Medical Center, Toledo, Ohio “Outpatient prescriptions from an emergency department: What do we write for?”

Best Oral Presenter – Faculty Carlos A. A. Torres, MD, MPH, MSc, The Ohio State University, Columbus, Ohio “Substrate supplementation during low flow reperfusion of the globally ischemic heart”

The 15th Annual Midwest Regional SAEM Meeting will be held in 2005 and will be hosted by the Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, Michigan.

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Best Oral Presenter – Resident Matthew Empey, MD, Washington University Barnes-Jewish Hospital, St. Louis, Missouri “A prospective, randomized study to evaluate the antipyretic effect of the combination of acetaminophen and ibuprofen in neurological ICU patients” Best Poster Presenter – Resident Amer Aldeen, MD, Northwestern University, Chicago, Illinois “Clinical characteristics of emergency department neutropenic fever” Best Oral Presenter – Student Shane Allen, Medical Student, Injury Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin “The association of seatbelts with reduced hospital charges, disability, and death in Wisconsin” Best Poster Presenter – Student Matthew T. Nugent, Medical Student, The Chicago Medical School, North Chicago, Illinois “Validation of a verbal assessment tool of English competency for use in the emergency department”

Board of Directors Update The SAEM Board of Directors meets monthly, usually by conference call. This report includes the highlights from the August and September Board conference calls.

The Board of Directors agreed to develop a number of informational resources to submit to the Institute of Medicine. The topics will include: research, graduate medical education, undergraduate education, and the special role of academic emergency departments.

The Board approved a proposal of the National Affairs Committee to develop an advocacy network (see related article in this issue of the Newsletter).

The Board approved Dr. Terri Schmidt to represent SAEM at a FDA panel on clinical design.

The Board reviewed a request to provide a letter of support for a grant.

The Board agreed that SAEM should not write letters of support for grants from individuals or institution specific

grants. The Board agreed that a policy incorporating this decision should be developed.

The Board approved Dr. Roger Lewis to serve as the SAEM representative to the ABEM 25th Anniversary Celebration that will be held in November.

The Board approved a proposal to work with the other emergency medicine organizations to develop educational sessions to be held during the 2005 and 2006 AAMC Annual Meetings.

The Board approved the survey instrument proposed by the Faculty Development Committee for the 200405 Faculty Salary Survey. The survey will be sent to chairs and chiefs at institutions with emergency medicine residency programs in early October.

The Board reviewed proposed revisions to the SAEM Residency Catalog submitted by the Undergraduate Committee and Graduate Medical Education Committees and submitted additional

suggestions and comments for consideration.

The Board approved the regional meeting application for the 2005 New England Regional Meeting. Additional information about the New England Regional Meeting, and other regional meetings, is included in this issue of the Newsletter.

The Board approved a revised Survey Policy, which is published in this issue of the Newsletter. This document will serve as the Society's policy for future proposed surveys, not those that are current objectives or are currently under development. The Board approved a report submitted by the Web Page Task Force.

The Board approved a proposal from the Research Directors Interest Group to conduct a survey of research directors. SAEM will provide funding of approximately $500 to support the survey.

Jahnigen Career Development Scholars Awards Deadline: December 7, 2004 The Jahnigen Scholars program offers two-year career development awards to support junior faculty in the specialties of anesthesiology, emergency medicine, general surgery, gynecology, ophthalmology, orthopedic surgery, otolaryngology, physical medicine and rehabilitation, thoracic surgery, and urology. The award is intended to allow individuals to initiate and ultimately sustain a career in research and education in the geriatrics aspects of his/her discipline.

Each grant will provide two-year support of $75,000 per year for salary and fringe benefits and/or the costs of doing research. In 2005, each scholar's institution must provide a minimum match of $25,000 per year. The application should delineate the source of the matching funding and the line item budget should provide information on the allocation of the matching funds in support of the scholar’s work. Up to ten awards will be given in 2005. The Jahnigen Award may not be used to support indirect costs.

To be eligible, a candidate must: ● Be a physician who is a US citizen or permanent resident. ● Be certified or board eligible to practice in one of the ten specialties listed above. ● Have a primary academic appointment in a US institution in one of the specialty departments listed above. ● Have completed his/her training (residency and/or fellowship) on or after June 30, 1995. Exceptions to this limit will be considered for compelling reasons and must be reviewed and approved prior to application submission.

Such exceptions should be requested and justified in a letter to AGS received by November 5, 2004, so that, if approved, a competitive application can be prepared and submitted on schedule.

For each Jahnigen Career Development Scholar application, two senior faculty members at the candidate's institution must be selected to serve as 15

mentors to help guide the scholar's research and career planning and provide access to organizations, programs, and colleagues helpful to the applicant's efforts. Although more than two mentors may be selected, at least one must be from the department in which the candidate has a primary appointment and at least one must be from the geriatric medicine program within the same institution.

Letters of endorsement, including specific information on institutional support for the Jahnigen Scholar applicant, should be provided by the dean, the relevant department chairperson, and each mentor. In addition, three letters of reference should be provided by other faculty members and/or senior professionals with whom the applicant has worked and who are well acquainted with the candidate's capabilities, accomplishments, commitment and aspirations. The deadline for submission is December 7, 2004. For more information: http://www.americangeriatrics. org/hartford/2005_jahnigen.shtml.

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

Can you be an EM resident and still experience “Wellness”?

Adrienne Birnbaum, MD Marianne Haughey, MD Albert Einstein College of Medicine For the SAEM GME Committee “Wellness” describes a state of psychological and physical well being1.Physician wellness in EM has been defined as, “those skills, attitudes and beliefs that allow one to enjoy practicing EM for a long period of time, while at the same time allowing balance in one’s life”2. The concept of physician wellness acknowledges that multiple stressors related to the practice of medicine threaten this balance. Imbalance can lead to unhealthy feelings and behaviors, emotional distress, burnout, and impairment.

Just as health is more than the absence of disease, wellness is more than the absence of distress, burnout, and impairment3.

Physician wellness implies that the physician’s engagement in providing quality care to patients and the pursuit of other professional goals exist in harmony with other elements of life that enhance general happiness and well-being such as healthy relationships, friendships, spirituality, hobbies, and other interests.

Can a resident experience “wellness” during residency?

Residents share many common stressors during their training.

Sleep deprivation, excessive patient load, patient mortality, uncompromising attending physicians, and peer competition are common sources of stress among all residents4. Additional stressors described for EM physicians include: the unhealthy effects of shift work, difficult patients, violence in the ED, and exposure to infectious disease1. EM residents may experience additional stressors: ● negative interactions with other housestaff ● competition with other residents for procedures and learning opportunities ● lack of experience with essential negotiation skills ● low status in the hospital hierarchy due to the relative youth of EM as a specialty ● lack of time to rest, socialize, and eat optimally during busy shifts ● isolation from social support due to geographic and scheduling constraints ● loss of camaraderie resulting from shift work ● briefness of relationships with ED patients ● difficult interactions with ED staff 5 A survey of 1,100 EM residents suggested that women and unmarried residents report higher levels of stress and depression than their male and married counterparts6. Women with families deal with the added stress of balancing motherhood with professional life.

Fortunately, a body of literature has emerged since the 1980’s suggesting ways to reduce, identify, and manage physician stress, burnout, and impairment. Most strategies for achieving wellness emphasize the development of a “life plan” with personal goals that appropriately value and prioritize those goals. Without such a plan, a young physician may make personal sacrifices during training and postpone gratification indefinitely, with the assumption that life will automatically become re-balanced after graduation7. The balance between professional and personal goals is

unique to each individual.

What Are Some Signs of Unhealthy Behavior or Feelings?

Burnout is a syndrome of emotional exhaustion, depersonalization, and sense of low personal accomplishment that leads to decreased effectiveness at work8. Symptoms of burnout can overflow into one’s personal life, but unlike a more global state of depression, burnout is primarily related to feelings about work3.

Symptoms of burnout may include: ● loss of interest in work ● feelings of fear, avoidance, isolation, anger, ultimately loathing for work9 ● fatigue, exhaustion, inability to concentrate, anxiety, insomnia, irritability ● increased use of alcohol or drugs10 ● headache, back or neck pain, abdominal distress, nausea, malaise ● anxiety, divorce, broken relationships, and disillusionment3 Assessment tools may quantify burnout. The adult APGAR, a brief self-scoring instrument available on the ACEP website, was developed by the ACEP Wellness Task Force as a screening and educational tool11. Designed to rapidly assess and monitor physician wellness, it is less unwieldy than other wellness inventories and more global in scope. It consists of 5 questions, each measuring a component of wellness. These components are Access to emotions, satisfaction with life’s Priorities, commitment to personal Growth, satisfaction with ability to ask for Assistance from others, and satisfaction with Responsibility for self. Scores for each answer are summed to yield an overall score assumed to reflect the degree of wellness. The Maslach Burnout Inventory is a lengthy questionnaire that is considered the gold standard assessment of burnout. The inventory identifies three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment8,12.

Burnout may contribute to physician impairment, particularly when accompanied by illness (including mental or physical illness), aging, alcoholism, or chemical dependence13. Signs of impairment can be insidious and nonspecific: unkempt appearance, complaints by patients and nurses, arguments, bizarre behavior, emotional outbursts, irritability, depression, mood swings, unexplained absences, irresponsibility, incomplete work or medical error, accidents and injuries, excessive prescription writing, unusually high doses or wastage of controlled substances, intoxication at social events, odor of alcohol on breath while at work, and withdrawal from the social milieu14.

What strategies enhance wellness during residency and beyond?

Weiner asked physicians, “What methods do you use to solve dilemmas related to your physical, emotional and spiritual wellbeing?” Five general areas of wellness promotion used by this group of physicians were identified: relationships, religion/spirituality, self-care, work, and approaches to life. The “relationships” 16

category included relationships with friends, family, colleagues, and community involvement. “Religion and spirituality” included involvement in organized religion, as well use of meditation and prayer. “Self care” included hobbies, exercise, good nutrition, avoidance of alcohol and drugs, professional counseling and treatment of depression. The “work” category encompassed qualities that made work meaningful and allowed the physicians to receive satisfaction from work such as achieving goals.

“Approaches to life” included general philosophical outlooks including being positive, maintaining balance and focusing on successes15. Quill and Williamson reported self-care, relationships, limiting work and developing a life philosophy as healthy approaches for managing stress7. In an investigation of burnout in an internal medicine residency program, Shanafelt reported that residents recommended "talking with family or a significant other (72%)" and "talking with other residents or interns (75%)” as effective methods for managing stress4. If a physician becomes impaired for any reason programs in each state are designed to help16.

Maximizing wellness during EM residency training These suggestions are not necessarily evidence based but are a compilation of suggestions taken from the literature and from anecdotal experience: ● Develop a personal philosophy and prioritize professional and personal goals. Short-term objectives and activities should support these prioritized objectives. This exercise can guide job selection as residency ends. ● Maintain healthy relationships by spending time with those who are supportive of you. Set aside time for the relationships and share your feelings. Time devoted to healthy relationships contributes to well being. ● Care for your physical health: make healthy food choices, make time for an exercise regime that you enjoy, maximize the quality of your sleep. Create a sleeping space that is quiet and dark enough to allow sleep during day or night, unplug the phone, and consider using eye covers, earplugs, or a sound machine. Do not try to maintain a “day shift” life if you are working nights. ● Avoid intoxicants to relieve the stresses of the ED. ● Incorporate a sense of spirituality into your day. Spirituality can take many forms, such as meditation, and does not necessarily imply organized religion. Explore what works for you. ● Find something about each day at work that challenges you or brings you joy. EM brings opportunities to save lives and provides unique opportunities to connect with patients in times of great need. You can help in small ways that can be rewarding. ● Schedule your time carefully. Consider how each activity contributes to your sense of well being and your “life plan”. ● Make hobbies a priority; record television shows if necessary, read for pleasure, listen to music. ● Remember that to err is human. Medical errors and adverse events occur despite our best efforts. These events often result in pain, shame, guilt, and regret. Pathologic coping mechanisms may lead to loss of self-confidence, ongoing distress and even depression. Learn from your mistakes, talk to others who can provide support and empathy and learn to move on. Keep things in perspective and remember that adverse events do not mean that you are inadequate as a physician or person. ● Visit a therapist or psychiatrist if the stresses seem overwhelming. Talk to other physicians, family, and friends about how you are feeling.

Appreciate your accomplishments during this time of tremendous personal growth. Set reasonable goals and don’t expect too much of yourself.

Residency is a time of great personal growth. It is also a time of life when there are many challenges and many residents feel overwhelmed. Practical strategies exist to help a resident to thrive psychologically, physically, and educationally throughout this challenging life period. ●

Recommended web-based resources www.acponline.org/careers/catalog_resources.htm The physician renewal project is an annotated catalog of resources supporting physician wellness. www.acep.org/library/pdf/wellnessBookIntro.pdf Includes articles on planning for wellness in EM, stressors in EM, coping mechanisms for EM physicians, wellness for the EM resident, and APGAR-an instrument to monitor wellness. www.saem.org/publicat/chap12.htm Primarily directed toward faculty in an academic career, this article has many practical tips that will pertain to EM residents as well.

References 1. Lum G, Goldberg R, Mallon W, et al: A Survey of Wellness Issues in Emergency Medicine (Part 1). Ann Emerg Med 1992;21:1250-1258.

2. Perina DG, Chisholm CD: Physician wellness in an academic career. http://www.saem.org/publicat/chap12.htm 3. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114:513-518.

4. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–367.

5. Ellison DM: Wellness for the Emergency Medicine Resident. http://www.acep.org/library/pdf/wellnessBookResident Wellness.pdf 6. Whitley TW, Gallery ME, Allison EJ, et al: Factors associated with stress among emergency medicine residents. Ann Emerg Med 1989;1157-1161.

7. Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Internal Medicine. 1990; 150: 1857-1861.

8. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001; 52:397-422.

9. Vickman L: Stressors in Emergency Medicine. Burnout. Wellness Book For Emergency Physicians http://www.acep.org/ library/pdf/wellnessBookBurnout.pdf 10.Linda Gundersen: Physician Burnout. Ann Intern Med, Jul 2001; 135: 145 - 148.

11.Bintliff S: The Adult APGAR: An Instrument To Monitor Wellness. http://www.acep.org/library/pdf/wellnessBoodultAPGAR.pdf 12.Maslach C, Jackson S, Leiter M. Maslach Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologists Press; 1996.

13.Physician Impairment: ACEP Policy Statement. http://www.acep.org/1,636,0.html 14.Medical Society of the State of New York: Committee for Physicians’ Health: www.mssny.org/res_ctr/cph.htm 15.WeinerEL, Swain GR, Wolf B, Gottleib M. A qualitative study of physicians’ own Wellness-promotion practices. Western J of Medicine. 2001; 174: 19-23.

16.Federation of State Physician Health Programs. Available at: http://www.ama-assn.org; or http://www.amaassn.org/ama/ pub/category/5705.html

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Call for Papers 2005 AEM Consensus Conference "Research Ethics: Informed Consent and Research without Consent" Deadline: March 1, 2005 Clinical research hinges on the ability of investigators to identify, recruit and enroll human subjects into clinical trials. The process of informed consent for research participation is designed to protect potential research subjects by educating them about the trial and their rights as participants, allowing them to ask questions regarding the study and their role, and assisting them in making an informed decision about research participation.

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

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

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

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

SAEM Ethics Consultation Service Emergency physicians are faced with countless ethical dilemmas. We make choices based not only on our knowledge but also on our personal beliefs and value systems. Occasionally, an ethical issue arises that is outside our world view or consideration, or a situation confronts us that makes us uncomfortable. We may lack the knowledge to make a reasonable choice, we may be faced with something totally out of our experience, or we feel at a loss because we cannot determine the possible options. We may witness an ethically questionable act, may observe unprofessional and possibly harmful actions, may disagree about the correctness of another’s decision, or may feel we ourselves are being subjected to exploitation, abuse, or other unethical behavior. Such situations are frightening; it is difficult to distinguish reality from perception, to know who can be

approached for advice, or where resources can be found to assist in developing an appropriate response.

Some institutions have committees or other authoritative bodies designed to examine grievances, allegations of scientific misconduct or specific ethical dilemmas in clinical practice. The advice of these groups, however, may have limited applicability to emergency medicine; they may not include emergency physicians, or have the expertise to relate to the unique aspects of the ethics of emergency medicine. In addition, these groups are charged with developing a response to a particular crisis that has arisen locally. They are goal directed and not necessarily able to provide a thoughtful method to educate beyond the concrete response to the problem at hand.

For these reasons, SAEM has developed an Ethics Consultation Service to 18

assist SAEM members with questions concerning ethical issues or decisions they must make during the course of their clinical, academic or administrative responsibilities. Opinions from the Ethics Consultation Service will be offered to SAEM members in a timely manner; requests from nonmembers will be considered on a case by case basis.

The opinions rendered are not meant to be part of an ‘appeal process.’ All communications will be anonymous and confidential. However, because many ethical issues confronting emergency physicians are universal in their scope, and others may learn from the issue presented, we hope to develop a series of articles for publication, assuming that confidentiality can be maintained. All requests, inquiries, or correspondence should be directed to saem@saem.org.

Standardized Reporting Guidelines for Studies Evaluating Risk Stratification of ED Patients with Potential Acute Coronary Syndromes Gerard X. Brogan, Jr., MD North Shore University Hospital SAEM Representative to the ACS Standardized Reporting Guidelines Work Group Researchers evaluating patients for the potential of acute coronary syndromes have incorporated a wide range of eligible patients, historical factors and outcome parameters into their studies. This had led to difficulty comparing results and conclusion of diagnostic and prognostic studies.1 The patients’ selection criteria, time intervals, positive test and outcome definitions vary greatly between studies and investigators.2 As a result, the Emergency Medicine Cardiac Research and Education Group—International (EMCREG-I) initiated an effort to standardize operational definitions and reporting of studies involving Emergency Department patients with potential acute coronary syndromes. The EMCREG work group also involved representatives from SAEM, the American College of Emergency Physicians, the American Heart Association and the American College of Cardiology. The recommendations of this group, supported by the endorsement of these other professional groups, sought to integrate scientific rigor with practicality in an effort to increase the likelihood of obtaining scientifically valid data that may have an impact on the care of emergency cardiac patients. The goal of the group was not to develop an ideal study, but to convene a consensus panel to develop standardized reporting criteria that would more easily allow for comparison of studies.

Under the direction of W. Brian Gibler, MD, Chairman of EMCREG-I and Judd E. Hollander, MD, Chair, ACS Standardized Reporting Guidelines Work Group, members of EMCREG met in 2001 to draft the initial set of criteria that should be considered for incorporation into this document. Over the ensuing months, committee members continued correspondence to shape a draft document. In May of 2002, a work group meeting was convened during which committee members methodologically discussed each suggested criteria and how critical knowledge of the individual parameter would be to interpretation of individual studies. After discussion, the working group determined whether each criteria should be considered as “reporting criteria, supplemental reporting criteria or not further considered for the document”. Ten broad areas were defined and supporting documentation for the consensus recommendations was prepared. In 2004, the final “proposed document” was presented to the SAEM Board of Directors for their evaluation and endorsement.

of Evaluation: For emergency physician in particular, one can only rely upon patients self-reporting for many cardiac risk factors. This section defines those risk factors and the method of evaluation.

5. Emergency Department Presentation: Acute symptoms leading to presentation and the time from symptom onset until presentation and treatment should be described.

6. Biochemical Marker Performance: This section encourages assay specific information be recorded so that studies can be compared based on the cardiac markers utilized and the platform upon which they were measured.

7. Patient Course: The patient course should be described including both medications and interventions received by EMS, Emergency Department personnel and inpatient care, including disposition.

8. Defining Outcomes: Clear definitions for AMI and ACS is described in this section as well as adverse events and procedures to be reported.

9. Follow-Up Period: This section defines minimum follow-up intervals that would allow for optimal evaluation of management/interventional strategies.

10. Report Publish Scoring Systems: Reporting of scoring systems utilized in risk stratification (i.e. Goldman, ACITIPI, etc.) is encouraged.

How would this document best be used? Investigators planning clinical studies that involved risk stratification of ED patients with acute coronary syndromes should report the items that are considered core components (bolded items in the document). These items are those that represent the minimal amount of information for readers to compare studies with respect to patient enrollment, patient description and clinical outcomes. In addition, reviewers evaluating studies for potential publication are encouraged to utilize these criteria to determine whether investigators have reported sufficient information so that the reader can place the study in the appropriate context and compare results to other similar studies. Finally, and consistent with the original intent of the reporting guideline project, practicing clinicians can then use the core criteria to determine whether patients reported in clinical studies were similar to the patients they treat in their daily practice. It is hoped that this will facilitate appropriate incorporation of study results in medical practice.

It was an honor for me to interact with such an expert group of emergency medicine researchers and to represent SAEM in this endeavor.

References

The 10 major reporting categories are: 1. Inclusion/Exclusion Criteria: This allows the reader to understand exactly the patient population studied by understanding inclusion/exclusion criteria.

2. ECG Interpretation: This section is designed to encourage investigators to report sufficient ECG information so that the reader can evaluate the study population appropriately.

3. Demographic Patient Characteristics: A description of the study population and of the study sample is necessary to understand the relevance of the study to specific populations.

4. Presence or Absence of Cardiac Risk Factors and Method

1.

2.

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Bradford G, Shewakramani S, Hollander, JE. Incomplete Data Reporting in Studies of Emergency Department Patients with Potential Acute Coronary Syndromes Using Troponins. Acad Emerg Med 2003; 10(9):943-947 Hollander, JE. Risk Stratification of Emergency Department Patients With Chest Pain: The Need for Standardized Reporting Guidelines. Ann Emerg Med 2004; 43:68-70

Geriatric Emergency Medicine Benefits from John A. Hartford Foundation Funding Lowell Gerson, PhD Northeastern Ohio Universities College of Medicine SAEM Geriatric Interest Group The John A. Hartford Foundation supports the “Increasing Geriatrics Expertise in Surgical and Related Medical Specialties” program (Geriatrics for Specialists). SAEM has been an active participant from the beginning in 1994.

The Foundation recently announced it is continuing its funding for a fourth phase.

The award is for over $4.3 million for four years. The funding will begin July 1, 2005.

Ten participating specialties have been working and will continue to work to accomplish three goals: ● Improve the amount and quality of post-graduate geriatrics education received by residents in the targeted disciplines; ● Identify and support specialty faculty in promoting geriatrics training and research within their own professional disciplines; and ● Assist certifying bodies and professional societies in improving the ability of their constituencies to care for elderly patients.

Phase IV will also have two new major goals: ● Complete the transition to a permanent governance structure that is committed to advancing geriatrics within the specialties and which has the support of the

participating specialty societies.

Begin a planning process to integrate geriatrics into the continuing medical education programs offered by the specialties.

These Phase IV grants will be used to continue successful activities and introduce new initiatives. These include the Dennis W. Jahnigen Career Development Scholars, Geriatrics Education for Specialty Residents (GESR), discretionary grants, an up-to-date bibliography of relevant literature and continuing education.

The Jahnigen Program provides an opportunity to develop new leaders and also disseminate information about geriatrics to the specialty. Phase IV will provide for a continuation of the Jahnigen Scholars Program and conduct leadership skills training for present and past Scholars. This year the deadline for the applications is December 7, 2004 The Geriatrics Education for Specialty Residents (GESR) Program offers an opportunity to develop needed geriatric education curricula for specialty trainees allowing them to acquire the knowledge and skills necessary to provide quality care for their older patients.

The discretionary grants program will be more directed in Phase IV. The discretionary awards will be used to support development or organizational ●

plans for institutionalizing geriatrics within each specialty.

The bibliography initiative will support junior faculty in maintaining an updated review of the literature that will be available on line. This will allow the opportunity to track research developments in each specialty and engage junior faculty who may potentially become leaders in the geriatrics elements of the specialty.

Continuing medical education is a new initiative for Phase IV. The educational mission for earlier phases was to increase residents’ expertise. Incorporating geriatrics into the specialty’s CME programs is a fitting and logical next objective. The grant will support implementation of continuing medical education programs.

The number of older Americans is expected to double during in the next thirty years. The number of oldest-old Americans, those aged 80 years or older, will increase from 9.3 million in 2000 to 19.5 million in 2030. If life expectancy continues to increase at the same rate seen in the 1990s, the number of oldest-old people could balloon to 31.2 million by 2050. The effect this will have on emergency care is staggering.

The Geriatrics for Specialists program will go a long way to equip us for this future.

Call for Advisors The inaugural year for the SAEM Virtual Advisor Program was a tremendous success. Almost 300 medical students were served. Most of them attended schools without an affiliated EM residency program. Their “virtual” advisors served as their only link to the specialty of Emergency Medicine.

Some students hoped to learn more about a specific geographic region, while others were anxious to contact

an advisor whose special interest matched their own.

As the program increases in popularity, more advisors are needed. New students are applying daily, and over 100 remain unmatched! Please consider mentoring a future colleague by becoming a virtual advisor today. We have a special need for osteopathic emergency physicians to serve as advisors. It is a brief time commitment

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– most communication takes place via e-mail at your convenience. Informative resources and articles that address topics of interest to your virtual advisees are available on the SAEM medical student website. You can complete the short application on-line at http://www.saem.org/advisor/ index.htm. Please encourage your colleagues to join you today as a virtual advisor.

Resident Group Discount Membership Participation Katherine Heilpern, MD Emory University SAEM Secretary/Treasurer On behalf of the Board of Directors, I would like to thank the residency programs that have elected to participate in the resident group discount membership. These 62 programs bring 2,060 resident members to the Society. This program provides residents with invaluable exposure to all facets of academic emergency medicine. Each resident member receives subscriptions to Academic Emergency Medicine and the SAEM Newsletter, plus a discounted registration fee to attend the Annual Meeting. The participating programs are: Albany Medical Center Albert Einstein Medical Center, Philadelphia Allegheny General Hospital Baystate Medical Center Beth Israel Deaconess Medical Center, Harvard Affiliate Boston University Carolinas Medical Center Christiana Care Health System Cooper Hospital Duke University Eastern Virginia University Emory University Grand Rapids MERC/MSU Henry Ford Hospital Indiana University Loma Linda University Long Island Jewish Medical Center Maimonides Medical Center Medical College of Virginia Medical College of Wisconsin MetroHealth/Case Western Reserve University Michigan State University, Kalamazoo Newark Beth Israel Medical Center North Shore University Northwestern University Oregon Health & Science University Palmetto Richland Memorial Hospital Penn State University Regions Hospital Resurrection Medical Center St. John Hospital St. Luke's Roosevelt Hospital Center

St. Vincent Mercy Medical Center Stanford University State University at Buffalo State University at Syracuse Stony Brook University SUNY Downstate/Kings County Hospital Synergy Medical Education Alliance Texas Tech University Thomas Jefferson University University of Arizona University of Arkansas University of California, San Diego University of Chicago University of Cincinnati University of Connecticut University of Michigan University of New Mexico University of North Carolina - Chapel Hill University of Pennsylvania University of Pittsburgh University of Rochester University of Texas, Houston University of Virginia Wake Forest University Wayne State University/Detroit Receiving Hospital Wayne State University/Sinai-Grace Hospital West Virginia University William Beaumont Hospital Wright State University Yale-New Haven Medical Center York Hospital/Pennsylvania State University

2004 SAEM Medical Student Excellence Award Winners Listed below are additional names of recipients of the 2004 SAEM Medical Student Excellence in Emergency Medicine Award.

The intial list was published in the July/August issue of the Newsletter. This award is offered to each medical school in the United States to honor an outstanding senior medical student. This is the tenth year this award has been made available. Recipients receive a certificate and one-year membership to SAEM, including a subscription to the SAEM Newsletter and the SAEM journal, Academic Emergency Medicine. Information about next year's Excellence in Emergency Medicine Award will be sent to all medical school dean's offices in February 2005.

Albany Medical College Daniel Pauze

University of Pittsburgh Brian D'Cruz

Dalhousie University Andrew Barker

Western University of Health Sciences/ College of Osteopathic Medicine of the Pacific Gregory Kogan

University of Minnesota Katie Vogt

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

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

Neurological Emergencies Grant This grant is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE).

The goal of this directed grant program is to fund research based towards acute disorders of the neurological system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 will be awarded annually. Only clinical applications will be considered - no basic science applications will be accepted. Deadline: January 10, 2005. Notification: April 11, 2005.

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

Riggs Family/Health Policy Research Grant Between $25,000 and $50,000 for research projects in health policy or health services research topics is available. Applicants may apply for up to $50,000 of the funds, for a one- or two-year period. The grants are awarded to researchers in the health policy or health services area, who have the experience to conduct research on critical health policy issues in emergency medicine. Deadline: December 20, 2004. Notification: April 11, 2005.

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

Resident Research Grant A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level is available. Deadline: December 20, 2004. Notification: April 11, 2005.

Career Development Grant A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who need seed money or release time to begin a promising research project is available. Deadline: December 20, 2004. Notification: April 11, 2005.

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

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

AEM goes to on-line submissions!

The Editorial Board of AEM is pleased to announce that on-line submission is now available for Academic Emergency Medicine via the Elsevier Editorial System (EES). The easiest way to access the system is from the front page of the SAEM web site at www.saem.org or directly at http://ees.elsevier.com/acaeme/default. asp.

EES is a tool that enables Authors to submit articles on-line, reviewers to referee on-line and editors to manage the

peer-review process via an on-line submission and editorial system.

EES is an Internet-based tool that can be accessed from anywhere in the world and works on multiple platforms.

Available 24/7, the on-line submission system uploads files directly from your personal computer, and allows you to track the progress of your paper through the peer-review process. On-line submission and peer-review speeds up the whole publication process.

All authors and reviewers are now 22

required to submit their manuscripts and reviews on-line. On-line Submission: A Guide for Authors is available at: www.elsevier.com/locate/eesauthors guide. Reviewers should go to: www.elsevier.com/locate/eesreviewers guide to view Elsevier Editorial System: A Guide for Reviewers.

We welcome your feedback on the on-line submission site and value your continuing contributions to Academic Emergency Medicine as an author and as a reviewer.

Survey Policy The Survey Policy was developed by the Board of Directors in August 2004.

Society members sometimes request that SAEM sponsor, and assist with, conducting surveys of all or selected Society members. While surveys can be a valuable research tool, the design, distribution, collection, and data analysis of surveys are very resource-intensive with regard to staff time and expense for the Society, as well as time spent by SAEM members in completing the survey. Because the Society and its members do not have unlimited resources the Board discourages such projects and therefore has developed the following policy. ●

All SAEM sponsored surveys must further the mission and goals of the Society.

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SAEM does not assist with or sponsor surveys from non-SAEM organizations or individuals.

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Only those surveys that directly address an objective specifically assigned to a committee or task force for that particular year (current year objective) will be considered. SAEM will not sponsor surveys that fail to meet this criteria.

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audience, the proposed mechanism of distribution (mailing list, use of list-serv, web site posting, etc) and data analysis, and must include the survey instrument itself.

All project proposals must also include a budget and an estimate of staff time. The Board will review such proposals with regard to how well the survey fits the objectives of the committee or task force, the appropriateness and perceived ability of the survey tool to accomplish the stated objectives, as well as the resource requirements for implementation.

A project proposal form must be submitted to the national office for all proposed surveys (http://www.saem. org/inform/projpro.htm). The proposal should describe the goals of the survey, how these relate to the specific objectives the committee was charged with, the target

●

Any survey that is approved by SAEM becomes the property of SAEM with all rights reserved. To be approved, the SAEM Board may request revisions in the survey. Changes made to the survey after approval by the Board must be re-submitted before the survey is distributed. Reports, manuscripts, etc. that result from the survey must be reviewed and approved by the SAEM Board before they can be generally distributed or published.

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A summary of the findings of all approved surveys must be submitted to the Board within 3 months of completion.

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Interest groups may utilize their list-servs to survey their own members with regard to relevant topics without submitting a proposal to the SAEM Board.

President’s Message (continued from page 1) ic method revolves around hypothesis generation, testing, error identification, rejection or refinement and renewal.

The best efforts will only produce partial truth, as there is no absolute certainty in science. Skepticism entails critical thinking, and without this we are vulnerable to "pseudoscience". Sagan notes that pseudoscience frames hypotheses so that they are "invulnerable to any experiment that offers a prospect of disproof." Pseudoscience places heavy reliance on expert opinion and authority.

Sagan's advice in this chapter is a worthy read for all of us in the academic community, from basic scientist to administrator.

Our medical students and residents, while tremendously intelligent, aren’t necessarily good "skeptics". The system that has produced them has rewarded memorization of facts, often at the neglect of critical thinking. We can and should don our "scientist" persona in the classroom and at the bedside.

Troubling misconceptions are easy to find, and worthy of discussion. Allow me to list a few: ● The difference between efficacy and effectiveness of treatments

How statistical and clinical significance are often different. ● How correlation differs from causation. ● The lack of a perfect diagnostic test. ● How no test can be better than the selected gold standard (which may not be the best standard). ● The meaning of our constant companion – uncertainty.

Even the "art" of caring is largely based on social science principles that have characterized how humans react in predictable ways to stimuli and interaction. Our relationship should be more that of a colleague in learning than an "all-knowing expert." Concepts rather than isolated facts will likely have greater impact. Our graduates must remain "lifelong learners" (skeptics) no matter what career path they choose.

We need to mentor our scientist role and prepare them for the challenges of "junk science" and pseudoscience that await them. As Sagan notes, "The method of science, as stodgy and grumpy as it may seem, is far more important than the findings of science."

The bottom line is that we've accept●

23

ed an additional layer of ethical responsibility through our decision to practice in the academic environment. We are responsible for the "science" of our specialty. We are responsible for assuring that our current and future patients reap the benefits of that science. And we must be diligent in preparing the future of our specialty. Why seek a career requiring more time and more responsibilities at less pay? Perhaps the reason is that as academics, we are both teachers and life-long learners ourselves. We enjoy learning, being challenged, and doing our best to continually improve ourselves, our EM practice, our students and colleagues, and (most of) our patients. Can I show you the hard data about how we as academic emergency physicians make a difference years, decades, or generations from now? No. On this, you simply must be a believer.

Though I may not have an abundance of evidence, about this, not even I am a skeptic.

Sagan, C: The Demon-Haunted World: Science as a Candle in the Dark. New York, Random House, 1995.

SAEM Consulting Service Report and Information Glenn C. Hamilton, MD Wright State University Chair, SAEM Consulting Service ful process for making sure the issues of potential concern by the RRC-EM are addressed, and convincing institutional administration of the benefits of EM and its continued support.

3. Program Information Form (PIF) Review: This new service is a detailed review of the PIF for new or re-accrediting programs in advance of submission to the RRC-EM. 4. Research Consultation: This relatively new aspect of the service helps programs develop a research program suitable to their environment.

5. Faculty Development: EM remains one of the few specialties that requires faculty development as part of its program requirements. Programs that are initiating or having difficulty in this area may request a faculty development consultation to assist in planning effective program for their faculty.

The SAEM Consulting Service completed six consultations during the 2003-2004 academic year, many at academic medical centers applying for new residency programs. With their permission, here is feedback from two of the sites: “I would rate your consultant’s visit as an A+. He managed…to identify the key issues and broad themes we would need to address with the RRC site visitor, and he astutely picked upon the spirit and the soul of the program.” Mark S, Smith, MD, Professor and Chairman, Washington Hospital Center and Georgetown University School of Medicine.

“We found the consultant to be very prepared with good insight and reasonable recommendations. It was particularly helpful when he provided a ‘disinterested party’ view when discussing funding and departmental status with our Chair of Surgery.” Deana Young, Assistant Professor, University of Nevada School of Medicine

Consultations are done by experienced individuals who are program directors, academic chairs, and/or those who have served as RRC-EM site surveyors. Usually one or two individuals participate in the site visit consultation depending upon the needs of the institution. The individuals are selected with input from the institution and the consult service. Fees are $1,250 per individual per day plus expenses. An additional $500 is paid to SAEM to support the administrative aspects of the Service. PIF reviews are $750.

The SAEM Consulting Service is well prepared to offer its considerable capabilities to interested parties in our specialty.

Although a variety of services are available, our primary expertise is in the following: 1. Establishment of an EM residency: This consult is in advance of application to the ACGME and RRC-EM for consideration of a new EM residency. The consultation will assess the suitability and potential of the site for residency training and assist in the development of the program information forms required by the ACGME. 2. “Mock” survey prior to RRC-EM site survey: this service serves as a preparatory guide for new programs or as a “dress rehearsal” for re-accrediting residencies preparing for their official site survey by the RRC-EM. This is a use-

The SAEM Consulting Service has played a significant role in sustaining the quality of many EM residencies and assisting numerous program directors in developing and creating solutions to their problems. We look forward to assisting interested institutions in addressing their resident program or academic development needs.

Please contact me directly at glenn.hamilton@wright.edu (937-395-8839) or through SAEM saem@saem.org for further information and assistance.

The Top 5 Most-Frequently-Read Contents of AEM – September 2004 Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articles archived on AEMJ.org.

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Michael W. Donnino, Varnada Karriem-Norwood, Emanuel P. Rivers, Ajay Gupta, H. Bryant Nguyen, Gordon Jacobsen, James McCord, Michael C. Tomlanovich Prevalence of Elevated Troponin I in End-stage Renal Disease Patients Receiving Hemodialysis Acad Emerg Med Sep 01, 2004 11: 979-981. (In "BRIEF REPORTS")

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Andrew K. Chang, Gary Schoeman, MaryAnn Hill A Randomized Clinical Trial to Assess the Efficacy of the Epley Maneuver in the Treatment of Acute Benign Positional Vertigo Acad Emerg Med Sep 01, 2004 11: 918-924. (In "CLINICAL INVESTIGATION")

3 4

David C. Brousseau, J. Paul Scott, Cheryl A. Hillery, Julie A. Panepinto The Effect of Magnesium on Length of Stay for Pediatric Sickle Cell Pain Crisis Acad Emerg Med Sep 01, 2004 11: 968-972. (In "BRIEF REPORTS")

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Craig D. Newgard, Jerris R. Hedges, Melanie Arthur, Richard J. Mullins Advanced Statistics: The Propensity Score--A Method for Estimating Treatment Effect in Observational Research Acad Emerg Med Sep 01, 2004 11: 953-961. (In "SPECIAL CONTRIBUTIONS")

P. Richard Verbeek, Ian W. McClelland, Alexis C. Silverman, Robert J. Burgess Loss of Paramedic Availability in an Urban Emergency Medical Services System during a Severe Acute Respiratory Syndrome Outbreak Acad Emerg Med Sep 01, 2004 11: 973-978. (In "BRIEF REPORTS")

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Emergency Medicine Faculty Position Thomas Jefferson University

Medical College of Georgia

The Department of Emergency Medicine (EM) at Thomas Jefferson University (TJU) is seeking board-certified or board-prepared academic physicians to join its well-established faculty. Current faculty now teach 36 EM residents in our long-standing EM 13 year residency and approximately 235 medical students each year in our mandatory 4th year EM clerkship for medical students at Jefferson Medical College (JMC).

Faculty Position

The emergency departments at TJU Hospital and Methodist Hospital (MH) together see approximately 90,000 patients annually. TJU Hospital is a Level I Trauma Center and Regional Spinal Cord Center. The MH ED, currently under expansion and renovation to include a CT scanner, is the primary community affiliate for our EM training program.

The Department of Emergency Medicine has one opening for full-time Emergency Medicine attending. Must be board certified or board eligible in emergency medicine.

Experience in emergency ultrasound is highly desirable.

Be part of an emergency ultrasound section with an ultrasound fellowship and highly productive ultrasound research team. Opportunities also available in Disaster Medicine, Tactical Medicine, Wilderness and International Medicine. Established emergency medicine residency program with nine residents per year. Spacious ED facilities. New ten bed ED Observation Unit. New contiguous children's hospital and beautiful pediatric ED. Over 75,000 visits per year. Level 1 trauma center for pediatric and adult patients. Augusta is an excellent family environment and offers a variety of social, cultural and recreational activities. Compensation and benefits are excellent and highly competitive. Contact Richard Schwartz, MD, Chair and Associate Professor, Department of Emergency Medicine, 1120 15th Street, AF 2036, Augusta, GA 30912; 706-721-3548, rschwart@mail.mcg.edu . EOE

TJU Hospital is the primary teaching hospital for Jefferson Medical College and home to residencies in every medical field. This physician would join 23 faculty members with strong clinical, research, teaching and patient satisfaction interests. The Department supports 2 productive and nationally recognized basic science laboratories, as well as an active clinical research program. Academic rank, salary and benefits would be commensurate with experience.

Located in Center City Philadelphia, between Independence Hall and the theater district, TJU enjoys a reputation as one of the best hospitals and medical colleges in the east, and is the major academic institution of the Jefferson Health System (JHS).

Philadelphia has much to offer culturally, educationally and socially, plus provides easy access to New York, Washington, DC, the ocean and the mountains.

TJU is an Equal Opportunity Affirmative Action Employer and strongly encourages applications from women and minorities.

Please submit curriculum vitae and confidential letter of interest to:

Theodore Christopher MD, FACEP Chairman, Department of Emergency Medicine Thomas Jefferson University 11th and Walnut Sts., T239 Philadelphia, PA. 19107 theodore.christopher@jefferson.edu phone:215-955-6844 fax: 215-503-5686

Toxicology Research Symposium‌ (continued from page 11)

University of California San Francisco Faculty Research Position

any case. Comprehensive drug testing beyond the drugs-ofabuse screen increases length of stay without contributing to the care of pediatric patients.

New pharmaceuticals are frequent causes of fits. A review of 2003 California Poison Control System cases of toxin induced seizures implicated the following agents (in decreasing order of frequency): buproprion, diphenhydramine, tricyclic antidepressants, tramadol, amphetamines, isoniazid, and venlafaxine. These newer epileptogenic agents should be considered in the differential of toxin induced seizures.

In summary, the NACCT furthered my interest in Toxicology by imparting novel and clinically useful information, revealing current and future research endeavors, and affording me the opportunity to meet and discuss Toxicology with physicians from several nations. All emergency physicians who attend the NACCT will be rewarded with insight into overdoses on new pharmaceuticals, practical treatment of unusual toxins and envenomations, and evidence-based Toxicology information.

I want to thank Dr. Louise Kao and Dr. Dan Rusyniak for supporting my application, the SAEM and ACMT membership for funding the Spadafora Scholarship, and Dr. Leslie Dye for providing me this invaluable educational experience.

The Division of Emergency Medicine at the UCSF Medical Center is seeking candidates with a career goal of externally funded emergency medicine research for a position in the InResidence series at the assistant professor level. The Medical Center has the busiest teaching hospital inpatient service in San Francisco, 576,000 outpatient visits, and is rated by U.S. News & World Report as one of the ten best hospitals in the U.S. The ED census is approaching 40,000 visits a year not including urgent care patients seen in separate adult and pediatric clinics.

ED has extremely high acuity and complexity, 24-hour access to subspecialty consultation in most disciplines; an established realtime web based patient clinical research enrollment program, as well as being fully credentialed for ultrasound use. A complete renovation of the physical plant will be completed in 2005.

A residency in EM is planned based at this hospital, and this position has the potential of also assuming the role of research director for the program. There is a long tradition of research and leadership in EM, and collaboration with other faculty in other departments. Quality of the intellectual experience and resources are unmatched, as is the physical and cultural environment of the Bay Area. The successful candidate will have an existing track record of research and publication that will lead to successful funding in the first few years of appointment. UCSF is an affirmative action/equal opportunity employer.

Contact Michael Callaham M.D. at Box 0208, University of California San Francisco, San Francisco, CA 94143-0208 or mlc@medicine.ucsf.edu

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FACULTY POSITIONS NORTH CAROLINA: University of North Carolina at Chapel Hill - EMS Fellowship: A two-year fellowship in Emergency Medical Services. Facilities include a Level I Trauma Center, state-of-the-art Emergency Department with 65,000 annual visits, active aeromedical program with two BK-117 helicopters and four ground transport units, novel county-based EMS service, and Emergency Medicine residency. The fellow will obtain a Master’s degree while being exposed to county and state systems management and research. The University of North Carolina is an Equal Opportunity Employer and welcomes candidates from diverse backgrounds. The applicant must have a MD/DO medicine (or have similar experience). Send written inquiries to: Jane Brice, MD, MPH, University of North Carolina-Chapel Hill, Department of Emergency Medicine, CB#7594, Chapel Hill, NC 27599-7594 to receive additional information.

DEPARTMENT OF EMERGENCY MEDICINE TOXICOLOGY FELLOWSHIP The University of Cincinnati seeks candidates for a two-year fellowship in medical toxicology consisting of inpatient and outpatient clinical consultation, environmental and occupational toxicology, regional poison center experience, laboratory and clinical research and experience in hyperbaric medicine. Three medical toxicologists serve as faculty. Clinical experience is derived from an adult emergency room which is the regional level I trauma center with more than 90,000 visits annually and the second busiest pediatric emergency department in the country (83,000 annual visits). NIOSH and EPA have headquarters in Cincinnati and a NIOSH medical toxicologist is involved in training the fellow. The fellow takes call for the poison center, conducts inpatient and outpatient toxicologic consultations, and learns to use hyperbaric medicine for carbon monoxide poisoning and other indications for which it is used. The option exists to obtain additional training in occupational medicine leading to Board eligibility. Candidates should have completed residency training in emergency medicine, pediatrics, internal medicine, or occupational medicine, and must be eligible for Board Certification in one of these specialties. Submit letter of interest and CV to Curtis P. Snook, MD, Director, Toxicology Fellowship, University of Cincinnati, Department of Emergency Medicine, PO Box 670769, Cincinnati OH 45267-0769; phone (513) 558-5281; email snookcp@ucmail.uc.edu.

OHIO: The Ohio State University - Assistant/Associate or Full Professor.

Established residency training program. Level 1 Trauma center. Nationally recognized research program. Clinical opportunities at OSU Medical Center and affiliated hospitals. Send curriculum vitae to: Douglas A. Rund, MD, Professor and Chairman, Department of Emergency Medicine, The Ohio State University, 146 Means Hall, 1654 Upham Drive, Columbus, OH 43210, email Dailey.1@osu.edu, or call (614) 293-8176. Affirmative Action/Equal Opportunity Employer.

OREGON: TOXICOLOGY FELLOWSHIP: Oregon Health & Science University – Two-year Toxicology Fellowship. Fellowship includes EM residency program, EM observation unit to admit Tox patients, weekly Tox didactic conferences, Toxicokinetics course, Pediatric EM and PEDs Tox. We also have linkages with EMS, HAZMAT, AHLS course, certificate program or MPH in research, and pesticide surveillance program. The Oregon Poison Center serves Oregon, Nevada, Guam and Alaska, and receives 70,000 calls/year. For a full description see our website: http://www.ohsu.edu/som-EmergMed/fellowship/tox/index.htm. For an application please call 503-494-8600 or email Dr. Zane Horowitz at horowiza@ohsu.edu TENNESSEE: We are recruiting faculty interested in becoming expert clinical researchers. Vanderbilt offers a Masters in Clinical Investigation and a Masters of Public Health; either can be earned in combination with fully compensated reduction in clinical responsibilities over 12 – 18 months. Please consider advancing your career in academic emergency medicine, earning a masters degree and working at one of the best and friendliest emergency medicine programs in the country. Please reply to Corey M. Slovis, M.D., Chairman, Department of Emergency Medicine, Vanderbilt University, 703 Oxford House, Nashville, TN. 37232-4700. Email: corey.slovis@vanderbilt.edu. Vanderbilt is an equal opportunity employer.

EMERGENCY MEDICINE Academic Positions

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

Available in the

Department of Emergency Medicine of

Allegheny General Hospital, Pittsburgh, PA Practice Emergency Medicine in Western Pennsylvania’s Most Dynamic Emergency Department

The SAEM Newsletter is mailed every other month to approximately 6000 SAEM members. Advertising is limited to fellowship and academic faculty positions. The deadline for the January/February issue is December 1, 2004. All ads are posted on the SAEM website at no additional charge.

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

✩ ✩ ✩ ✩ ✩ ✩

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

$100 $125 $300

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

(412) 359-3961 mmalsch@wpahs.org

To place an advertisement, email the ad, along with contact person for future correspondence, telephone and fax numbers, billing address, ad size and Newsletter issues in which the ad is to appear to: Carrie Barber at carrie@saem.org

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

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

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Cook County Hospital

The University of Chicago Department of Medicine Section of Emergency Medicine

Department of Emergency Medicine

The Section of Emergency Medicine seeks full-time academic faculty members. Academic rank and salary commensurate with background and experience. Candidates must be BC/BE in Emergency Medicine and eligible for medical licensure in the State of Illinois. Excellent teaching skills required We currently have 14 faculty, 42 residents, and an overall ED volume of 76K. We are involved in regional and international aeromedical transport and direct one of the country’s busiest EMS systems. We also direct a resuscitation research center, a health services research group, and an informatics program.. We offer significant protected time and support for those interested in research. Send a curriculum vitae to James Walter, M.D., Chief, Section of Emergency Medicine, University of Chicago 5841 South Maryland, MC 5068, Chicago, IL 60637 or email to jwalter@medicine.bsd.uchicago.edu. The University of Chicago is an Affirmative Action/Equal Opportunity Employer.

Faculty Position The Department of Emergency Medicine at Cook County Hospital is seeking energetic and motivated candidates for a faculty position. Applicants must be residency trained and board certified / eligible in Emergency Medicine. The Department of Emergency Medicine has 54 residents in a PGY II-IV format and 26 full time faculty. The Emergency Departments care for 120,000 adult, 30,000 pediatric and 5000 Level I trauma patients each year. A new 463 bed Cook County Hospital was completed in December, 2002 with a state of the art ED electronic information system. The department offers a very competitive benefit package and protected time to pursue educational, administrative and research projects.

Faculty appointments are at our medical school affiliate, Rush Medical College.

Interested candidates should contact: Jeff Schaider, MD, FACEP, Associate Chairman, Department of Emergency Medicine, Cook County Hospital, 1900 West Polk Street 10th floor, Chicago, IL 60612, Telephone - 312-864-1985, jschaider@ccbh.org

Emergency Medicine Faculty Position Emergency Medicine Faculty Position The Department of Emergency Medicine at the Boston University School of The Department Emergency Medicine at the Positions Boston are available Medicine (BUSM)) of seeks academic faculty members. atUniversity Boston Medical Center (BMC) which is a Level 1 Trauma Center with School of Medicine (BUSM)) seeks academic faculty 127,000 visitsPositions annually.are Theavailable Department EM serves as anCenter independent members. at of Boston Medical academic department within BUSM and BMC.

(BMC) which is a Level 1 Trauma Center with 127,000 visits

annually.

Thehas Department EM serveswell-established as an independent acaThe department a nationallyofrecognized, residency program with academic facultyBUSM appointments through BUSM. BMC is the demic department within and BMC. medical control and academic base for Boston EMS. In addition, we have an active research section with particular focus on public health, administration, The and department has aemergencies. nationally recognized, well-established EMS cardiovascular Candidates must be ABEM board residency program faculty appointments throughof certified or eligible andwith mustacademic demonstrate a commitment to the training BUSM. BMC is the medical control and academic for benefits emergency medicine residents.

Competitive salary with an base excellent package.

Boston EMS. In addition, we have an active research section with particular focus on public health, administration, EMS and

Further information contact: Jonathan Olshaker MD, Professor and Chair, cardiovascular emergencies.

Candidates must beCenter, ABEM boardPlace, Department of Emergency Medicine, Boston Medical 1 BMC certified eligible and must demonstrate a commitment the Boston MAor02118-2393.

Tel: 617-414-5481; Fax: 617-414-7759;to E-mail: olshaker@bu.edu.

An Equal Opportunity/Affirmative Action Employer. training of emergency medicine residents. Competitive salary

with an excellent benefits package.

Further information contact: Jonathan Olshaker MD, Professor and Chair, Department of Emergency Medicine, Boston Medical Center, 1 BMC Place, Boston MA 02118-2393. Tel: 617-4145481; Fax: 617-414-7759; E-mail: olshaker@bu.edu. An Equal Opportunity/Affirmative Action Employer.

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UNIVERSITY OF COLORADO DIVISION OF EMERGENCY MEDICINE

ACADEMIC EMERGENCY MEDICINE FELLOWSHIP

The Division of Emergency Medicine at the University of Colorado Health Sciences Center in Denver, Colorado, is seeking full-time emergency medicine faculty to join our dynamic and growing Division.

Responsibilities include clinical practice, teaching of emergency medicine and other housestaff, as well as scholarship. Clinical and basic research will be supported based on applicants’ interest. Faculty applicants must be residency trained and board certified in emergency medicine with preference given to applicants who are fellowship trained.

Due to the expanding need for Academic Emergency Physicians the University of Florida & Shands Teaching Hospital, Department of Emergency Medicine are seeking emergency medicine residency trained or board certified emergency physicians as applicants for our Academic Emergency Medicine Fellowship at the University of Florida Gainesville.

This teaching hospital emphasizes active involvement with emergency medicine residents and medical students. Qualified applicants will be board certified in emergency medicine; preferred applicants will have a demonstrated academic career interest. More than a research fellowship, this 2-year program includes training in education, research, EMS and administration in academic emergency medicine. Fellows will have the opportunity to complete work for M.S. in Interdisciplinary Biomedical Science. Fellows will also perform as Faculty while developing bedside clinical teaching and supervision skills in the ED. Shands at UF is the hub of a multi-hospital network. Shands at UF Emergency Medicine provides county EMS direction, interhospital hospital transport including the ShandsCair aero-medical service, and provides medical support teams for NASA shuttle launches and landings. Great compensation, great benefits package, great city!

The University of Colorado’s Fitzsimons Campus is the only completely new academic medical center to be built in more than a generation. When completed, Fitzsimons Campus will house the University of Colorado Hospital, the Children’s Hospital, the VA Medical Center, the University of Colorado Schools of Medicine, Dentistry, Nursing and Pharmacy, and two new biomedical research towers. Fitzsimons is unique in its integration of public and private biotechnology.

The Emergency Department at Fitzsimons will be a state-of-the-art, acutecare clinical facility as well as a laboratory for the development of new technologies and pathways in emergency care.

Compensation is competitive. Minorities and women are encouraged to apply. The University of Colorado is committed to diversity and equality in education and employment. Please send (e-mail preferred) curriculum vitae and a brief description of career interest and goals by December 1, 2004, to:

Our Department is committed to improving diversity in academic emergency medicine; women and minorities are encouraged to apply.

University of Florida is an Equal Opportunity Employer.

Ben Honigman MD Head, Division of Emergency Medicine University of Colorado School of Medicine B-215 Denver, Colorado 80262 Benjamin.Honigman@uchsc.edu

Please send personal statement and CV to: Kevin L. Ferguson, MD, FACEP, Director of Graduate Medical Education, University of Florida, Department of Emergency Medicine P O Box 100186, Gainesville, FL 32610-0392

Brigham and Women's Hospital Harvard Medical School Faculty Position Full-time academic faculty position. Includes excellent academic support, appointment at Harvard Medical School, unparalleled research opportunities, competitive salary, and an outstanding comprehensive benefit package.

Brigham and Women’s Hospital is a major Harvard affiliated teaching hospital, level I trauma center, and the base hospital for the four year A accredited Brigham and Women’s Hospital/Massachusetts General Hospital Harvard Affiliated Emergency Medicine Residency Program. The Department of Emergency Medicine cares for over 54,000 ED patients per year, and the 43 bed ED includes a 10 bed ED Observation Unit, a 5 bed rapid assessment cardio/neuro unit and an advanced informatics system. The department is also home to STRATUS, a comprehensive medical simulation training center. The department has a robust International Emergency Medicine Program and offers international EM fellowships.

The successful candidate must have successfully completed a four year residency training program in emergency medicine or a three year program followed by a fellowship, and be board prepared or board certified in emergency medicine. Interest and proven ability in Emergency Medicine research and teaching are essential. Please send inquiries and CV to Ron M. Walls, MD, FACEP, Chairman Department of Emergency Medicine Brigham and Women’s Hospital 75 Francis Street, Neville House Boston, Massachusetts 02115. E-mail rwalls@partners.org

BWH is an Equal Opportunity/Affirmative Action Employer

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

Division of Emergency Medicine Fellowship

Department of Emergency Medicine

EM Teaching Attending Position

The Division of Emergency Medicine at the University of Utah School of Medicine in Salt Lake City, Utah offers a two-year Research Fellowship in Emergency Medicine, effective July 2005.

The University of Utah is the primary medical teaching and research institution in the state. This program allows for concentrated training and experience in research to prepare the fellow for a career in academic emergency medicine. Successful completion of the fellowship will include a Masters of Science in Public Health (MSPH) degree.

Participants will be given a junior faculty position in the Division of Emergency Medicine; however, clinical responsibilities will be limited. Areas of research can be performed in a variety of emergency medicine-related fields, including basic science, EMS, injury control, pediatrics, toxicology, trauma, etc. Compensation for this program is very competitive and includes all educational fees and expenses.

Applications must be completed by February 1, 2005. If you are interested in applying or need more information, please contact:

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

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

Erik D. Barton, M.D., M.S., FACEP Division Chief and Fellowship Director University of Utah School of Medicine 1150 Moran Bldg, 175 N Medical Drive E, Salt Lake City, UT 84132 (801) 581-2417, Fax: (801) 585-6699 erik.barton@hsc.utah.edu

Take Pride. Take Ownership. Deliver Excellence. Patients 1st.

Faculty Physician Department of Emergency Medicine We are seeking qualified candidates for a faculty position within the Indiana University Emergency Medicine Residency training program at the Methodist Hospital site. The successful candidate will join a highly motivated and energetic staff and will enable expansion of the current double, triple, and quadruple faculty coverage.

The Indiana University Emergency Medicine Residency Program has 51 categorical and 10 EM-Peds residents based at two large urban hospitals with a combined annual census of over 200,000 patients. The program sponsors fellowships in Medical Toxicology and Out of Hospital Care (EMS), and works closely with the IU Informatics Fellowship. This position includes an excellent compensation and benefit program. Faculty appointment is available at rank commensurate with experience and productivity.

A letter of interest and Curriculum Vitae should be submitted to: Charles M. Shufflebarger, MD Emergency Medicine and Trauma Center 1701 North Senate Boulevard Indianapolis, Indiana 46202

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Call for Abstracts Southeastern SAEM Regional Meeting

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

April 8-9, 2005 Chapel Hill, NC

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

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

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

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

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

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

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

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

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

Call for Abstracts Western SAEM Regional Meeting

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

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

April 3, 2005 Brooklyn, NY

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

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

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

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

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

Please make checks payable to UCLA Division of Emergency Medicine.

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

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

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

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

For questions or additional information, call 718245-2973.

31

S A E M

Newsletter of the Society for Academic Emergency Medicine

Board of Directors Carey Chisholm, MD President

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

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

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

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

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

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

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

The deadline for submission of abstracts is Wednesday, January 5, 2005 at 5:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instructions will be available on the SAEM website at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

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

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