September-October 2000

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE The Best Job in Medicine This is the time of year when the halls of our academic health centers are buzzing with the energy of career planning. Emergency medicine resident physicians are starting to seriously consider the employment options available to them in the coming months, and medical students are deciding if emergency medicine is the right career for Brian Zink, MD them. A natural part of this process is that academic emergency physicians are asked: Why did you go into academic emergency medicine, and are you happy that you did? This is my answer.

I never planned on going into academics. As a medical student, I liked the feel of the teaching hospital, and had great respect for the faculty physicians who taught me the science and art of medicine, but I had no interest in research, and did not see myself as an academician. When I entered emergency medicine residency at the University of Cincinnati, I thought that I would be very happy practicing in a community emergency department. I had some thoughts of going back to my small hometown in rural upstate New York and becoming the ED director. I would save the lives and limbs of the people I grew up with (even those who were mean to me), and they would be eternally grateful. But a funny thing happened. It was never a “eureka” event, rather a steady, but powerful influence that drew me toward academic emergency medicine.

At that time, the mid to late 1980’s, Richard Levy had assembled at the University of Cincinnati a group of emergency medicine faculty who were brimming with intellectual energy and curiosity. Like a child learning to blow a bubble, they were expanding the academic realm of emergency medicine, while experiencing the occasional sticky face. Their enthusiasm and drive to know more, to try out new ideas and things, and to challenge their residents and students made for a magical learning environment. They were superb, compassionate clinicians and bedside teachers, but also innovative thinkers who generated a constant stream of research questions and ideas. When my memory does the roll call on that collection of faculty — Bill Barsan, Jerris Hedges, Steve Dronen, Jim Roberts, Mel Otten, Alexander Trott, Jim Amsterdam, Dan Storer, to name a few – I am not surprised that I gravitated toward academic emergency medicine.

Their pull was irresistible. Peer pressure can also be a powerful, positive force. My chief residents, senior residents, and classmates were some of the best and brightest people I

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

September-October 2000 Volume XII, Number 5

Neuroscience Research Fellowship Available The SAEM Board of Directors is pleased to announce a new Neuroscience Research Fellowship that has been made possible by an unrestricted educational grant from AstraZeneca LP to the Fund for Academic Emergency Medicine (FAEM). AstraZeneca has agreed to fund the fellowship for three years. The FAEM Neuroscience Research Fellowship provides for one year of funding at $50,000 for a mentored research training experience in cerebrovascular emergencies. The research training may be in basic science research, clinical research, or a combination of both. Completion of a research project is required, but the emphasis of the fellowship is on acquisition of research skills.

SAEM would like to thank Dr. Dexter Morris from the University of North Carolina and the Chair of the SAEM Neurologic Emergencies Interest Group. Dr. Morris functioned as the primary liaison between SAEM and AstraZeneca LP in developing the neuroscience research fellowship. SAEM would also like to thank Dr. Steven Dronen, Chair of the Financial Development Task Force for his role in developing the funding plan and the structure of the fellowship.

Cerebrovascular diseases are a major source of morbidity and mortality in our country. Although some progress has been made in the past decade there is an unquestioned need for further research and new treatments for stroke and other acute cerebrovascular emergencies. SAEM is hopeful that the new FAEM Neuroscience Research Fellowship will help to train the next generation of emergency physician scientists who will make a difference in reducing morbidity and mortality from cerebrovascular diseases. The call for applications for the FAEM Neuroscience Research Fellowship will appear in a future issue of the Newsletter.

Emergency Medicine Activities at the AAMC Annual Meeting The AAMC Annual Meeting will be held in Chicago on October 27 - November 1. On October 28 the Association of Academic Chairs of Emergency Medicine (AACEM) will meet at 8:00 am in the Trade Room of the Inter-Continental Hotel, followed by an educational session sponsored by AACEM at 1:00-2:30 pm in the Burnham Room on the topic, “The Role of Chairs in the AAMC.” A second educational session developed by the SAEM National Affairs Task Force will follow in the Burnham Room at 2:30-3:30 pm on the topic of “Errors in Emergency Medicine.” All emergency physicians are invited to attend the educational sessions. Contact SAEM at saem@ saem.org for more information or questions.

Constitution and Bylaws Committee Seeks Membership Input Susan S. Fish, PharmD, MPH Chair, Constitution and Bylaws Committee The Constitution and Bylaws Committee would like membership input about suggestions for changes to the current SAEM election process. As SAEM President Brian Zink stated in last month’s Newsletter, one of our Committee’s objectives for this year is to “explore options for amending the SAEM process for filling elected positions, and make recommendations to the Board of Directors by November 1, 2000.” While the current election process has been effective in choosing strong leadership for the Society, only about 10% of active members participate in the election.

Our goal is to increase member participation in the election process. The Committee has been discussing the strengths and weaknesses of our current system, and trying to identify alternative methods of conducting the election. We have been investigating the election process of other professional organizations to which we belong, and others that we have heard about. But I am sure this is a small sample of possible options. We are most interested in hearing about other systems that are successful. If you belong to an organization whose election process may have features that you think would be applicable to SAEM, we would love to hear about them. Please email the SAEM office at saem@saem.org or me at sfish@bu.edu. Please tell us the name of the organization, and describe the election process as you see its applicability to SAEM. The Constitution and Bylaws Committee will be meeting in October to finalize its proposal to the Board, so we need your suggestions by October 18, 2000. With your input, we will make recommendations to the Board of Directors and improve the current system. Thanks.

Medtronic Physio-Control to Support EMS Research Fellowship Deadline: December 15, 2000 SAEM is pleased to announce that Medtronic Physio-Control Corporation will sponsor the 12th Annual EMS Research Fellowship. Medtronic Physio-Control provides $50,000 each year to fund an EMS Fellow, so the funding for the 2001-2002 fellowship means that $600,000 have been dedicated to support the fellowship. All funds are used to directly sponsor the fellowship.

The application materials for individuals wishing to apply for the EMS Fellowship commencing July 1, 2001, can be found on the SAEM web site at <www.saem.org> or from the SAEM office. The application, including personal statement and letters of reference, must be received by SAEM by December 15, 2000.

Institutions interested in applying for consideration as a EMS Fellowship training site can also find application materials at www.saem.org or from the SAEM office.

Additionally, previously approved institutions whose programs have undergone significant changes must apply for renewal. All materials must be received by SAEM by December 15, 2000.

Notification to both prospective fellows and institutions will be made by January, 2001. The selected EMS Fellow will then have a brief period to officially designate his/her fellowship site.

Emergency Medicine: An Academic Career Guide Now Available SAEM and EMRA have worked together to develop the publication, “Emergency Medicine: An Academic Career Guide.” The Career Guide, edited by Cherri Hobgood, MD, and Brian Zink, MD, was originally designed as a reference for senior residents, but with considerable expansion will be valuable to medical students, faculty, residency and research directors, and department chairs. The Career Guide includes 15 chapters and is available at no charge. It is downloadable from the SAEM web site at: www.saem.org/publicat/intro.htm and a limited number of hard copies are available upon request to the SAEM office.

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Information on Grants Requested There is a common misconception among some SAEM members that emergency physicians as a group have difficulty competing for extramural funding, especially from federal funding agencies such as the National Institutes of Health or the Agency for Health Care Research and Quality (AHRQ). This belief persists, in part, because we hear about only a small fraction of the emergency physicians who have successfully competed for funding.

SAEM would like to publish announcements about grants received by its members in the SAEM newsletter.

Please send information regarding grants received, including research grants, fellowship and training grants, and conference grants funded by foundations, state, or federal funding agencies, to the SAEM office. Include the title of the project, the name of the funding agency, the name and affiliations of the principal investigator and contact information. This information will be published in the SAEM Newsletter in the section entitled “Academic Announcements.”

Geriatric Emergency Medicine Resident/Fellow Grants Available SAEM with sponsorship from the John A. Hartford Foundation and the American Geriatric Society (AGS), is pleased to announce the availability of grants to support resident/fellow research related to the emergency care of the older person. Investigations may focus on basic science research, clinical research, preventive medicine, epidemiology, or educational topics. Awards may be up to $5,000 for each project.

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

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

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

Occasionally, an ethical issue arises that is outside our world view or consideration, or a situation confronts us that makes us uncomfortable. We may lack the knowledge that we need to make a reasonable choice, we may be faced with something totally out of our experience, or we feel at a loss because we cannot determine the possible options. We may witness an ethically questionable act, may observe unprofessional and possibly harmful actions, may disagree about the correctness of another’s decision, or may feel we ourselves are being subjected to exploitation, abuse, or other unethical behavior. Such situations are frightening; it is difficult to distinguish reality from perception, to know who can be approached for advice, or where resources can be found to assist in developing an appropriate response.

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

The advice of these groups, however, may have limited applicability to emergency medicine; they may not in-

clude emergency physicians, or have the expertise to relate to the unique aspects of the ethics of emergency medicine. In addition, these groups are charged with developing a response to a particular crisis that has arisen locally.

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

For these reasons, the SAEM Board of Directors charged the Ethics Committee to develop an Ethics Consultation Service. As the title implies, the Ethics Consultation Service is now available to assist SAEM members with their questions concerning ethical issues or decisions they must make during the course of their clinical, academic or administrative responsibilities.

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

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

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

SAEM Membership Drive Underway Again this year SAEM is promoting a membership drive directed towards the colleagues of current members. Individuals who join SAEM in the last quarter of 2000 will receive membership benefits through January 15, 2002 and will therefore receive up to 15 months of membership benefits with payment of one year’s dues.

SAEM members are asked to encourage their colleagues to consider joining SAEM. A membership application is published in this issue of the SAEM Newsletter.

Membership applications can also be submitted electronically from the SAEM web site at www.saem.org SAEM dues have not increased for a number of years, yet the Society’s activities have continued to expand. Some examples include the continued development of Academic Emergency Medicine (including the online version of the journal), increased funding for Society research grants (such as the Resident Research Year and Scholarly Sabbatical), an ever-increasing Annual Meeting, continued development of the SAEM web site, and expanding programs and activities for the increasing number of medical student and resident members of the Society. Please encourage your colleagues to join SAEM. A strong academic presence is necessary for the continued growth and development of education and research in emergency medicine.

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

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

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

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

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

Deadline: December 1, 2000

Academic Announcements

SAEM is pleased to announce the third annual Resident Research Year Grant. The award will provide financial support of up to $50,000 to the residency program for a year of concentrated training in research methods and concepts for emergency medicine residents. Any resident in an ACGME approved emergency medicine residency program who will have completed at least one year of training is eligible.

The purpose of the award is to encourage further development and research involvement of residents in training to enhance the selection of an academic and research career by recipients, and to establish a departmental culture that will continue to support resident research training.

Applications for the Resident Research Year Grant will be sent to each residency program or can be obtained from the SAEM office or the web site at www.saem.org. The deadline for the submission of applications for academic year 2000-2001 is December 1, 2000. Notification will be made in January 2001.

Robert S. Hockberger, MD, has assumed the presidency of the American Board of Emergency Medicine (ABEM). Dr. Hockberger has been a member of the ABEM Board of Directors since 1995 and has served as chair of the Test Administration Committee and the Core Content Task Force, and as editor of the recertification exam. Dr. Hockberger is a Professor of Medicine at the UCLA School of Medicine and Chair of the Department of Emergency Medicine at HarborUCLA Medical Center.

CORD/AACEM Faculty Development Conference: Navigating the Academic Waters

Jim Pribble, MD, a second year resident at William Beaumont Hospital has been selected to receive a Robert Wood Johnson Clinical Scholar position. This prestigious two-year award is given to individuals who have demonstrated excellence in research and scholarly activity. Dr. Pribble has coauthored several papers and presented at national meetings on the topic of the ED management of chest pain patients. Dr. Pribble will spend his tenure as a RWJ Scholar at the University of Michigan.

SAEM Resident Research Year Grant

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

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

Nominations Being Accepted for Robert Wood Johnson Health Policy Fellowships The Robert Wood Johnson (RWJ) Foundation is accepting nominations for the RWJ Health Policy Fellowships 2001, a program that seeks to develop the capacity of mid-career health professionals in academic and community-based settings to assume leadership roles in health policy and management. The program is funded by the RWJ Foundation and conducted by the Institute of Medicine (IOM). The six chosen fellows will participate in a September-to-August program of orientation and full-time work experience in Washington, D.C. Nominations may be made by chief executive officers of academic health centers and community-based health care organizations and agencies, and will be accepted at the IOM until November 17. For more information, go to http://www.rwjf.org, click on “Applying for a Grant,” and then on “List of Open Calls for Proposals.”

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Lynne Richardson, MD, of Mt. Sinai Medical Center, has been appointed to a two-year term on the Health Care Research Training (HCRT) Study Section of the Agency for Healthcare Research and Quality (AHRQ), formerly AHCPR. Dr. Richardson is the only emergency physician to serve on this standing committee that will review grant proposals submitted to AHRQ. Specifically, Dr. Richardson will participate in the review of F32 and F31 post-doctoral awards, RO3 dissertation grants, and KO8 career development awards.

Vincent Verdile, MD, chair of the Department of Emergency Medicine, has been named interim dean of the Albany Medical College and interim executive vice president for health affairs. Dr. Verdile was unanimously approved as interim dean by the Medical Center’s Board of Directors.

In addition to serving as chair of one of the Medical Center’s largest academic departments, Dr. Verdile has also played a leadership role in the faculty practice as well as serving, since 1993, as an attending physician in the department of emergency medicine.

A resident of Saratoga Springs, Dr. Verdile received BS and MS degrees at Union College and his MD degree in 1984 from the Albany Medical College.

He did his residency in emergency medicine at the University of Pittsburgh.

SAEM Response to the Prospective Payment System for Hospital Outpatient Services SAEM’s full response is published below and is published on the SAEM web site.

The Society for Academic Emergency avoided through the use of these seruntenable position where hospitals and Medicine (SAEM) appreciates the vices. A disincentive to observation unit physicians are forced to choose beopportunity to comment on the Prospecservice is inconsistent with the health tween two poor outcomes.

HCFA’s policy will increase Meditive Payment System for Hospital Outpolicies of the current administration, care costs. Currently, many patients patient Services final rule published in which places a high priority on patient receive appropriate care by observation the Federal Register on April 7, 2000. safety. In light of President Clinton’s services and thus avoid unnecessary (HCFA-1005-FC). SAEM represents and Secretary Donna Shalala’s hospital admission. The management 5000 academic emergency physicians, in personal commitment to quality care, it of chest pain is a good example. Since teaching hospitals and academic medical is surprising that HCFA would implemost patients with acute MI do not have centers throughout the United States. ment a policy jeopardizing patient an initially positive test, many need These comments express our consafety, especially given the successes either emergency evaluation and obsercern that the new payment system inof emergency observation services in vation, or hospital admission, to identify appropriately precludes separate payenhancing patient safety.

HCFA’s policy threatens access to their heart attack. Since physicians ment for emergency observation sermedically necessary care. If not sepcannot rely solely upon a initial testing, vices and represents our formal recomarately covered, many present emerobservation identifies those presenting mendations to HCFA. This letter is gency observation units are at closure with atypical signs or symptoms. This similar to a letter submitted on behalf of risk. Without separate revenue, emerprocess has been shown to reduce the American College of Emergency gency observation units cannot opercosts significantly compared to inpatient Physicians, the American College of ate. Progress made in this area over admission. Without observation, physiCardiology, the American Heart Associthe last decade will suffer greatly. If this cians will admit patients to the hospital ation, the American Society of Nuclear service is inadequately covered, HCFA to rule out MI. Many more patients will Cardiology, the Society of Chest Pain will inadvertently penalize hospitals be admitted as inpatients rather than Centers and Providers, and the Ameriattempting to provide high quality, costmanaged in the observation unit. When can College of Physicians-American effective health care. Furthermore, these patients are admitted to an inSociety of Internal Medicine. packaging observation services into patient bed, costs will increase. Many Our concerns are the net effect of APCs will discourage the addition of studies have shown significant charge HCFA’s policy packaging payment for these services in hospitals not currently and cost savings with the use of obserall observation services, including providing them. vation, rather than hospital admission, emergency observation services, into Many third party payers (including to evaluate patients with chest pain. other APCs, will jeopardize patient HCFA carriers) use increasingly strinPreventing hospitalization of nonsafety and quality of care, threaten acgent admission criteria. They refuse inchest pain patients by use of a period of cess to medically necessary care, and patient admission, but allow observaobservation also has great cost increase total Medicare costs. Furthertion. If HCFA refuses observation sersavings. Since 5% to 10% of ED pamore, this policy is inconsistent with vice reimbursement, it creates a large tients are appropriate for observation, current emergency medicine practice, it and growing patient population too sick the cost savings in the United States, is biased against emergency observato go home, but not sick enough for inwith over 100 million annual ED visits, tion services, and inappropriately atpatient admission. Forcing EDs to prois billions of dollars. Clearly, a movetempts to control prior observation servide up to 24 hours of uncompensated ment back to the inpatient setting will vices coding abuses by packaging all care will greatly increase the financial increase Medicare’s total costs. observation services into APCs. burden and gridlock in EDs. This will Chest pain comprises only 10% to We are proposing a policy that is further weaken the nation’s primary 15% of patients who benefit from ED easy for HCFA to implement, will overhealth care safety net, the ED. Conobservation units. The range of condicome all of the problems associated versely, discharge of patients not meettions evaluated and treated in emerwith HCFA’s new policy, and eliminate ing admission criteria may lead to poor gency observation units is broad and the potential for abuse. Please note that health outcomes. The current packagincludes the full range of conditions the outpatient prospective payment sysing of observation services creates an found in EDs. tem has no direct effect on physician payment. Our objections, and our proposed solution, are offered in the best Categories of Conditions Observed: interests of our patients and the hospitals who serve them.

Evaluation of Critical Abdominal pain, chest pain, confusion, dizziness, HCFA’s policy jeopardizes patient Diagnostic Syndromes fever, gastrointestinal hemorrhage, headache, safety and quality of care. Refusing seizure, shortness of breath, syncope, toxicology/ to provide payment for emergency oboverdose, trauma, vaginal bleeding, weakness servation services creates a disincenTreatment of Emergent Asthma, congestive heart failure, dehydration, tive to their use and jeopardizes the Conditions: hyper/hypoglycemia, infections, pain management/ quality care derived from these serback pain vices. Improved safety by observation services is supported by the medical Meet Psychosocial Alcohol abuse, psychiatric problems, social problems literature. Observation of ED (emerProblems and Needs gency department) patients is extensively studied and provides improved health care outcomes. For example, HCFA’s policy is inconsistent with current medical practice. HCFA’s discustheir use leads to a ten-fold decrease in sion of observation services in the final rule demonstrates a fundamental misunderthe rate at which heart attack patients standing of the current practice of emergency medicine. HCFA states: are inappropriately sent home. Prevent(continued on next page) able deaths and complications are 5

Prospective Payment System (Continued) “We assume that chest pain patients, such as those described by the commenters, are sent to the CCU or ICU for observation. We believe that, in general, if a patient needs to be monitored in the ICU or CCU for any length of time, then that patient should be admitted as an inpatient . . .”

It is simply untrue that most chest pain patients who would require observation “are sent to the CCU or ICU for observation.” There has been a fundamental change in health care delivery for chest pain patients with respect to the use of CCUs and ICUs in the last decade. A move back to having these patients sent to the CCU will markedly increase health care costs, increase missed heart attacks, and decrease patient satisfaction.

HCFA’s policy fails to recognize the increased costs of observation services. Traditional emergency services only involve the immediate care of acutely ill/injured patients, with admission or discharge within 2 to 4 hours. In the past, these patients would be admitted and used inpatient resources.

The use of emergency observation services moves patient care from the inpatient setting to an outpatient setting with an overall decrease visit costs.

This accelerated care, over an additional 6 to 24 hours, represents a significant increase in service and cost taken on by the ED. HCFA policy is biased against observation services. HCFA attempts to control abuse of some types of observation services by packaging all observation services is inappropriate. In the final rule, HCFA states: “Observation service is placing a patient in an inpatient area, adjacent to the emergency department, or, according to some comments, in the intensive care unit (ICU) or coronary care unit (CCU), in order to monitor the patient while determining whether he or she needs to be admitted, have further outpatient treatment, or be discharged.

After 1983, many hospitals began to rely heavily on the use of observation services when peer review organizations questioned admissions under the hospital inpatient prospective payment system. However, in some cases, patients were kept in “outpatient” observation for days or even weeks at a time.”

We appreciate HCFA’s concern regarding observation abuses in the postoperative and inpatient settings. However, observation of ED patients over 624 hours is a well-established practice that preceded the introduction of DRGs. In the ED, HCFA defined observation services, can be provided most reliably.

A number of points differentiate ED ob-

servation from prior abuses. The undifferentiated unscheduled nature of ED patients best fits the original description and intent of “observation services” set forth by HCFA. ED observation units do not generally “observe” post-operative patients. Finally, unlike inpatient observation, it is virtually impossible to keep a patient in an ED observation unit for “days to weeks.” Observation medicine is a diagnostic tool where focused testing or treatment is repeated over a specific time frame to identify the need for inpatient admission. It more rigorously studied and better proven than many more expensive technical innovations for which HCFA provides reimbursement. It is inappropriate to jeopardize this valuable service in an attempt to control the abuse noted by HCFA. Proposed solution. The objective of our proposed policy guidelines is to limit observation services to a small subgroup of patients (less than 5% of ED visits) who require continued clinical management to determine the need for admission, or those who need extended treatment of an acute condition.

1. Clearly identify the observation services for which separate payment is appropriate. Hospitals report and bill for observation services through the use of revenue code 762 - Observation Services. Current HCFA instructions direct the reporting of the number of hours of service in the units field on the bill. This same revenue code is used to report postoperative or post-procedure observation services, ED observation services, “23 hour admission” services in an inpatient bed, and holding unit services. Of these services, only ED observation services should be eligible for separate payment.

2. Restrict observation services to only ED patients.

3. Require extensive and well-documented physician involvement in the observation services.

4. Assign the new HCPCS to a new APC. Payment for extended emergency evaluation and management services should be made in addition to the payment for the ED APC in recognition of the added costs for the services.

5. Do not limit payment to a list of certain clinical conditions. Restricting emergency services to specific conditions conflicts with the “prudent layperson” standard of defining an emergency based on presenting symptoms, not final diagnoses.

Symptoms should be used. Furthermore, while emergency observation services are shown to be effective for many common conditions, there are many other less common prob6

lems that do very well in this setting and should not be excluded. A “list of conditions” would either be so restrictive that it would not reflect reasonable practice, or would be so large as to be difficult. Progress in this area has rapidly shifted care from the inpatient setting to the observation unit. Maintaining a restrictive list will be slow and unlikely to match medical progress, and it is likely these transitions would be stalled by a restrictive list.

6. Changes to the system must be made promptly. We ask that HCFA reconsider waiting for further claims data before changing the current policy.

HCFA must recognize that if observation services are inadequately covered, asking hospitals to provide unfunded care while studying the losses, will result in a dramatically biased practice behavior toward admission.

This will skew the proposed cost data analysis. Additionally, because of the historically slow rule making process, a large portion of U.S. observation units will close before all data is collected and analyzed.

By statute, payment rates are based on the median costs of the services in the APC. HCFA should select from the 1996 claims file those bills that include charges for both ED services and observation services to compare them to bills for ED services alone. This should allow the determination of the marginal costs of observation services without waiting for future claims data.

7. Proposed payment rate. We recognize problems in 1996 data may preclude the determination of an appropriate payment rate for extended emergency evaluation and management services. If that occurs, we recommend the assignment of a payment of $375 based on our estimates of the cost. Our cost estimates are based upon the ACEP observation section’s national survey, VHA observation unit benchmarking study, and ACEP observation section leader’s experience. Generally, payment for extended emergency evaluation and management services should not exceed payment for an inpatient day, which we estimate to be $600. The key determinants of costs are staff, space, support services and time.

Cost elements: Nurse staff — Observation units typically staff with a nurse/patient ratio between a regular med-surg floor and a step-down unit; usually 1 nurse to each 4 - 8 patients. The average is 1:5.

Support staff — On average, 1 clerk and 1 tech are needed for 15 to 20 pa-

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Prospective Payment System (Continued) tients. This is comparable to an inpatient med-surg unit.

Space — Observation rooms are usually about 10 X 10 feet in size Services — Observation services need support (e.g. food, linens, etc.) similar to med-surg units.

Time — On average, patients in an observation unit require services for 15 hours, not 24 hours.

A reimbursement estimate can be made by comparing these services to inpatient services. Modifications may be made over time as accurately coded data is collected in the future. If we assume that 24 hours of inpatient care costs $600, then 15 hours of observation would cost $375. This is a conservative cost estimate since observation units actually staff at a higher level than traditional med-surg floors.

Conclusion: HCFA’s decision to package payment for all observation services into other APCs jeopardizes patient safety, quality care, and increases total Medicare costs. The policy fails to recognize the increased costs of emergency observation services and, unless appropriate changes

are made, access to medically necessary emergency observation care by Medicare beneficiaries will be seriously compromised. Forcing EDs to provide up to 24 hours of uncompensated care increases the financial burden and gridlock in the ED. HCFA’s policy will only further weaken the nation’s primary health care safety net, the ED. The current packaging of observation services creates an untenable position for hospitals and physicians. On the one hand, sending patients home too early will lead to poor health outcomes, on the other, admitting them for inpatient care will drive up costs and decrease patient satisfaction.

We have proposed a policy that HCFA could readily implement, will overcome all of the problems associated with the recently announced policy, and eliminate the potential for abuse. We appreciate the opportunity to offer these comments look forward to continuing to work cooperatively with HCFA to address this important issue. We ask that necessary and appropriate changes be made as soon as possible in order to ensure that patients are not put at risk.

More Medical Student Excellence Award Winners The July/August issue included the listing of the 2000 SAEM Medical Student Excellence Award recipients. However, since that time, a few more award recipients have been received, or need to be corrected: Albany Medical College Chris M. Davison George Washington University Curtis C. Sandy Texas Tech University Steve Arze Also, the name of the recipient of the award from the University of California, San Francisco was incorrect. The recipient of the Medical Student Excellence Award is Susan M. Fitzgerald.

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

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

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

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

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

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

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

All photo submissions must be accompanied by a case history written as an “unknown” in the following format: 1. Chief complaint 2. History of present illness 3. Pertinent physical exam 7

Call for Nominations for SAEM Board of Directors Position Marcus Martin, MD SAEM President-Elect Chair, SAEM Nominating Committee University of Virginia Have you considered becoming a member of the Board of Directors of SAEM? SAEM will have two positions on the Board of Directors to fill by election for the term beginning May 2001. The Board of Directors position is for 3 years. Typically members elected to the Board have shown dedication to SAEM through committee, task force and/or interest group involvement and participation in other ways such as the Annual Meeting. However the only absolute requirement is to be a member in good stead. The Nominating Committee will look closely at service and dedication to SAEM. As a Board of Directors member for SAEM I have been honored to serve in that capacity. The experience has been rewarding and beneficial to me in many ways. The SAEM staff members are very knowledgeable and supportive and my peers on the Board are great leaders in academic emergency medicine. Most importantly, Board members are charged with carrying out the business of the Society, including making sure that we are on target with our mission. There are generally 2-3 Board meetings per year with one being held at the SAEM Annual Meeting and the others being held at other locations such as a winter regional SAEM meeting, the AAMC Annual Meeting or the ACEP Scientific Assembly. There are monthly teleconferences held by the Board. Each Board member is assigned liaison responsibilities too committees, task forces and interest groups.

I hope you will consider becoming a candidate for the SAEM Board of Directors, but if not, the Nominating Committee would like to know the names of SAEM members that you may recommend as a potential candidates for the Board of Directors positions. On behalf of SAEM, I thank for your consideration.

Nominations Requested for Resident Member of the SAEM Board of Directors Nominations are sought from the membership for the resident member of the SAEM Board of Directors. This is a rare opportunity for a resident to serve as a full, voting member of the SAEM Board. The resident Board member is elected to a oneyear term and is a full voting member of the Board. The deadline for nominations is January 1, 2001.

Candidates must be a resident during the entire one year term on the Board (May 2001-May 2002). Candidates should demonstrate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter. Interested candidates are encouraged to review the Board of Directors orientation guidelines which are available on the SAEM web site at www. saem.org or from the SAEM office.

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

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

Fellowship and Clerkship and Residency Catalog Updates Requested The Emergency Medicine Fellowship and Undergraduate Rotation Lists on the SAEM web site are very popular, receiving many "hits" each week. These lists are updated continuously, but it is difficult to ascertain if any institutions or residency programs are being missed. If your institution has an Emergency Medicine fellowship or offers a clerkship, please take a few moments to review these sites on the SAEM web site and contact SAEM at saem@saem.org to help make the lists are accurate as possible.

The SAEM Residency Catalog is also undergoing its annual update. Residency directors are encouraged to update their institution's listing for the upcoming interview season.

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Call for Nominations Deadline: January 1, 2001

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

The Nominating Committee wishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or any SAEM member. Nominations should include a copy of the candidate’s CV and a cover letter describing his/her qualifications. The awards and criteria are described below: Academic Excellence Award The Hal Jayne Academic Excellence Award is presented to a member of SAEM who has made outstanding contributions to emergency medicine through research, education, and scholarly accomplishments.

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

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

2. Emergency medicine academic productivity.

3. Growth of academic emergency medicine.

2000 Annual Meeting Report Susan Stern, MD Chair, 2000 SAEM Annual Meeting Program Committee University of Michigan It is my pleasure to report on the events of the SAEM 2000 Annual Meeting held in San Francisco this past May. Once again, the SAEM Annual Meeting can be considered a roaring success with all of the indications that emergency medicine is progressing and thriving in the academic arena. There were approximately 500 scientific presentations ranging in topics from educational methodology, to domestic violence, to ischemia/reperfusion. The exchange of information that occurred at the poster and scientific platform presentations was informative, at times provocative, of very high caliber, and indicative that as a specialty we are making great strides in the area of research that should benefit our future patients.

In addition to the numerous outstanding scientific presentations, there were over 40 hours of didactic session offerings. These too covered a wide variety of research and education topics, and involved well over 100 speakers and panelists most of which

were from our own specialty. In addition, there were several outstanding externally recruited national and international speakers. Among these were Dr. Drummond Rennie, Deputy Editor of JAMA, and Dr. Kenneth Shine, President of the Institute of Medicine, who provided the the Kennedy Lecture and the Keynote Address. Dr. Rennie provided a provocative presentation on research and publication ethics, while Dr. Shine addressed “Sustaining Excellence in Academic Medicine in the New Millennium.”

There were several new programs and innovations at the Annual Meeting.

Among these was the institution of oral paper presentations with extended time for audience and panel interaction. In addition, a session entitled “Highlights From Other Meetings” was introduced.

During this hour, data from high profile abstracts presented at other meetings with the potential for immediate impact on patient care were presented. This year the presentations included “Results of a Controlled Trial of Benzodiazepines for the Treatment of Status Epilepticus,” “The Utility of B-Type Natriuretic Pepetide in the Diagnosis of CHF,” and “Abciximab for the Treatment of Actue

Stroke.” The Annual Meeting evaluations indicate that attendees are very enthusiastic about these innovations, and the Program Committee will consider this feedback during the planning of next year’s meeting.

The topic discussion poster sessions first introduced last year were continued and again the feedback was very positive regarding this presentation format.

The Program Committee acknowledges that there has been difficulties with noise and acoustics during these sessions and is working hard to come up with solutions for this problem. We also implemented a new awards process, in which award candidates were required to submit an expanded abstract or draft manuscript prior to the meeting. This new process provides several advantages. This better enables the awards subcommittee to judge the science of the presentations, it encourages investigators to develop manuscripts for submission for publication, and it allows the sub-committee to select the award winners at the meeting itself. There was certainly stiff competition and the Program Committee spent many hours

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Call for Nominations Deadline: January 1, 2001

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

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

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

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

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

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

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

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Annual Meeting Report (Continued) reviewing a large number of excellent draft manuscripts. All of the award candidates should be congratulated on their outstanding submissions. The Program Committee will continue to evaluate the newly implemented awards process next year and look for ways of enhancing it.

The meeting was not all business; attendees were able to partake in several social activities as well. These included the opening reception at which for the first time there was live music, an opportunity to see the San Francisco Giants take on the Montreal Expos in the new Pacific Bell Park, and a production by the Beach Blanket Babylon players. The closing banquet was held at the California Academy of Sciences where attendees were allowed to walk through the Aquarium and the Earthquake Exhibit. Banquet attendees were treated to some very special and outstanding entertainment provided by Drs. Paul Pepe, Chuck Cairns, Terry Vanden Hoek, Jeff Coben and the Cyanosis Blue Band with Milea Menckhoff. In addition, we introduced the first “SAEM, Who Wants to be a Billionaire” contest. A team comprised of Henry Ford Hospital and Wayne State University participants proved their genius and medical prowess during these very competitive games.

Incidentally, despite extensive research and remarkable intellect, the committee which provided the questions and answers for this contest has been unable to definitively determine the origin and meaning for the SAEM logo. If there is any member who has researched this very vital topic and knows the answer to the question, “what does the SAEM logo stand for?” the SAEM President, Brian Zink, would appreciate it if you would step forward and provide us with that information. Dr. Zink recognizes the seriousness of this knowledge deficit and hence one of his primary goals as president is to correct this ignorance. You will receive an appro-priate reward, of course. On a serious, note I would like to offer my gratitude and a million thanks to Drs. Pepe, Cairns and Vanden Hoek for providing such excellent entertainment and making the banquet a great success. They worked tirelessly to put this together and much of the planning prohibited them from enjoying and partaking in several of the Annual Meeting offerings.

On a more administrative note, I’d like to discuss the issue of obtaining hotel reservations at the host hotel.

SAEM booked 3,260 room nights for the 2000 Annual Meeting. Four weeks before the Annual Meeting the hotel had reservations for 3,656 rooms. This caused some registrants to get a room at the host hotel only by paying a higher

rate, or going to another hotel. However, because of cancellations in the last month before the conference, SAEM actually utilized only 2,729 of the rooms in the block.

The Program Committee understands the frustration of its members when they call the hotel a month or two before the conference and they cannot get a room reservation in the block.

However, SAEM can only “block” as many rooms as the hotel believes SAEM will use. Because the block was 3,260 and only 2,729 were used, it will be very difficult for SAEM to increase the block for future years. The problem continues to be that members make room reservations well in advance of the conference, not yet knowing whether they will be able to attend, when their paper will be presented, or before the Annual Meeting schedule is published. They are worried that if they don’t make a reservation early, they may not get one. However, our data shows that in the last month before the Annual Meeting, the hotel received nearly 1,000 room night cancellations.

The Program Committee would like to urge the membership to do two things: 1) try not to make a reservation for the whole week of the Annual Meeting before knowing whether you will be able to attend, or which days you will attend. If you must make a reservation, please be sure to release dates that you

will not use or cancel well in advance of the Annual Meeting. 2) If you call for a reservation and find that the block is full, be patient. As this year’s data shows, about 1,000 room nights will be cancelled within the last month. In short, be kind to your colleagues. In the coming months the SAEM web site will include information on the host hotel at the 2001 Annual Meeting in Atlanta. There should be plenty of rooms for all SAEM members who wish to attend.

In closing, I would like to take this opportunity to thank the SAEM 1999-2000 Program Committee. It was truly an honor and a privilege to work with them during this past year. This Committee worked continuously from from May of last year up through the end of this year’s Annual Meeting to provide the membership with an outstanding experience.

Special thanks go to the Subcommittee Chairs: Steven C. Dronen (Regional Meeting Subcommittee), Sue Fish (Didactic Subcommittee), Judd Hollander (Scientific Subcommittee), and John Howell (Medical Student and Resident Programs Subcommittee). In addition, I would like to thank the general membership of SAEM for all of their abstract and didactic submissions. It is your input and participation which makes the Annual Meeting so successful and the premiere academic meeting for Emergency Medicine. I thank you for the privilege of being able to serve in this capacity.

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

Deadline for receipt: January 15 (Jan./Feb. issue), March 15 (March/April issue), May 15 (May/June issue), July 15 (July/August issue), September 15 (Sept./Oct. issue), and November 15 (Nov./Dec. issue). Ads received after the deadline can often be inserted on a space available basis.

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

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SAEM Response to HCFA June 2000 DGs SAEM’s full response is published below and is published on the SAEM web site.

The Society for Academic Emergency Medicine (SAEM), as a member organization of the Association of American Colleges (AAMC) Council of Academic Societies, serves as the voice of over 5000 academic emergency physicians at more than 130 teaching hospitals. SAEM is responding to the June 2000 Documentation Guidelines (DG2000), specifically to the following section relating to documentation of history: “The physician should document efforts made to obtain a history from the patient, accompanying family members, friends or attendants or emergency personnel (e.g., paramedics) or available medical records (e.g., previous hospital records, nursing facility records, ambulance records). It is rare that no history will be available. Any history obtained will be evaluated according to the guidelines.” (page 5) SAEM is extremely concerned about its potential effects on patient care, appropriate reimbursement for services by faculty physicians, and on Emergency Medicine residency training programs.

Discussion Evaluation and Management codes 99281 through 99285 are used to bill for E/M services provided in the ED. Code 99285 requires a comprehensive Patient History, which includes an extended History of Present Illness (HPI), a complete Review of Systems (ROS) and a complete Past, Family and/or Social History (PFSH). Current E/M codes for the ED do contain an exception, however, known as the “History Caveat”, which states that the history should be taken “within the constraints imposed by the urgency of the patient’s clinical condition and mental status.”

HCFA apparently proposes to remove this “History Caveat” from the documentation guidelines on the grounds that ”it is rare that no history will be available.” Complete inability to obtain a history is indeed relatively infrequent, although every emergency physician can provide examples of such situations.

However, elderly and/or acutely ill or injured patients in the ED are frequently unable to provide a comprehensive history sufficient to meet 99285 requirements. Even if old records, friends or family can offer additional information, this will often not substantiate the level of service actually needed by and provided to these patients.

The three emergency department cases below describe some of these situations:

Vignette #1: An elderly man is found by passers-by sitting on the sidewalk, confused, unable to give his name and trying unsuccessfully to stand up. He is transported by EMTs to the nearest emergency department (ED). He has no identification papers and is unable to give ED staff his address or telephone number. After extensive evaluation in the ED, he is admitted to the hospital under the name “John Doe.” Vignette #2: A 72 year old woman develops chest pain while in a shopping center, and EMS is called. By the time the ambulance reaches the ED she is pale, diaphoretic, almost unable to talk, and clinging to the hand of one of the paramedics, repeating “Help me.” In her pocket-book ED staff find a prescription bottle of nitroglycerin tablets, as well as a card giving the name and telephone number of a son living in a distant state.

It is Friday evening. The physician’s office is closed, and the answering service pages the physician on-call who is unfortunately not acquainted with this patient. The son is called, and a message is left on his answering machine.

Vignette #3: An elderly man is found in a wooded area with a gunshot wound to his face and jaw. A handgun is on the ground nearby. During transport to hospital, the man repeats “Let me die.”

On arrival he is unable or unwilling to answer any questions. The ED staff search his pockets for identification papers, but find only a hand-written suicide note, which does include the name and telephone number of his health-care proxy. The telephone at that number is disconnected.

Emergency physicians cannot wait for additional historical information before treating their patients. Surely HCFA does not believe that the missing historical information should be obtained and entered into the medical record at a later date? Information obtained after the patient has left the ED may be helpful to other physicians, but gathering this data is not part of the responsibilities of an emergency physician.

The alternative, systematic downcoding of E/M services in all patients in whom a comprehensive history cannot be obtained would be inappropriate, legally dubious and financially catastrophic to emergency physicians and emergency departments.

SAEM strongly recommends that the History Caveat be maintained, and that it should be made applicable to emergency department visits, new patients in an outpatient setting, and initial hospital care codes. SAEM endorses language such as the following: “If the physician is unable to obtain a 11

sufficient history from the patient or other source within a clinically appropriate time frame, the record should describe the patient’s medical condition or other circumstance that precludes obtaining a sufficient history.

These may include patients who are unable to communicate, and where one or more of the following apply: lack of interpreter, lack of medical record, absence of family or significant other or legal guardian unavailable by telephone or in person. These may also include critically ill patients where immediate treatment is necessary, and no or minimal historical information is available.

Documentation of the circumstances related to the inability to obtain a sufficient history will be deemed equivalent to a comprehensive history for code selection purposes.”

Conclusion SAEM agrees with HCFA that “any counting in the DGs should be minimized and, if needed, should be restricted to areas where it reflects clinically relevant care.” (6/22/00 Town Hall Status Report) Therefore, SAEM is strongly opposed to the elimination of the “History Caveat”.

SAEM believes that this would place undue emphasis on details of history at the expense of care and management of patients in critical need. It would interfere with the dual efforts of patient care and education of our residents in teaching hospital EDs. Finally, it would jeopardize the care of the most vulnerable members of our society, who often seek care from the ultimate safety net of our health care system, the emergency department.

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

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

Edited by the SAEM GME Committee

Resident Debt Judith Brillman, MD SAEM GME Committee University of New Mexico

The first place for the indebted resident to look for help is the AAMC web site located at www.aamc.org. Once at their site, follow the prompts through to Medical Education and Residency Issues then to Educational Debt Management Services for Residents. The Layman’s Guide to Educational Debt Management for Residents and Graduate Medical Education Staff is a step-by-step strategy to organize your loan portfolio and understand it. It consists of eight strategies that identify and explain the major points needed to understand the debt you have accumulated and how to manage it. The first section prompts you to identify and understand what loans you have taken. It offers descriptions of the major loans available and touches on key aspects such as interest and capitalization. The second and third describes in detail the concepts of grace, interest accrual and capitalization, as well as the entirety of options available after graduation to postpone payment of your loans.

Developing a calendar or a timeline is the focus of the fourth section followed by strategies regarding choosing a repayment plan when the time comes. The sixth section gives advice on how to keep efficient records and describes many of the financial terms used in your statements such as secondary market and servicers. The final two sections concentrate on where to look for help if you need outside assistance from a financial planner and other support systems available to the student/resident. A video presentation available through Real Player is offered on each separate strategy to help explain important aspects. The presentations require a password, appropriately named “debthelp”.

This is probably the most comprehensive and easiest to use resource available to the medical student or resident.

Moneymatters Listserv is an email server designed to allow you to ask specific questions about your loans and can be subscribed to through the AAMC web site. (MD)2: Medical Decisions for Medical Doctors and the corresponding web site at www.aamc.org/md2. May also be helpful to the resident interested in finances and debt management. It is an electronic resource manual for financial planning for medical students and residents published by the AAMC. The National Association of Residents and Interns is an organization whose membership entitles the medical student, resident, fellow or practicing physician special discounts on medical equipment such as lab coats, stethoscopes and eyewear. Furthermore, they offer their members special loans, mortgages and specialized services such as dental care and life insurance if they qualify. Their web address is at www.nari-assn.com. Access Group is a non-profit organization whose goal is to provide information and help for students wishing further education. Their website at www. accessgroup.org offers valuable information on the loan process, as well as managing debt. They additionally offer

Resident debt has become an important priority for SAEM. A Resident Debt Task Force was established in 1999 and was rolled into the SAEM Graduate Medical Education Committee this year. The purpose of the task force was to identify the extent of resident indebtedness and identify mechanisms to alleviate the impact of indebtedness on EM residents. The next few issues of the SAEM newsletter will tackle the important issues of managing debt and avoiding excessive debt during residency. Indebtedness of EM applicants has been reported by the AAMC as one of the two highest of all specialty choices. Not adjusting for inflation, the average debt of EM applicants has tripled in the past one and half decades (Table I). The median debt of EM residents was 100,000 in the year 2000 as compared to the average medical student debt of $90, 000 reported by the AAMC for the year 1999.

There are factors that affect resident debt over which the individual has little control: cost of living increases, the rapid rise in medical school tuition, and a shrinking pool of available sources to fund one’s medical education. Starting debt is compounded by the fact that the deferment of resident loan repayment does not extend for the full duration of residency. The 2-year grace period for repayment of federal loans expired with loans originating in 1993. Residents can try to delay federal loan repayment by applying under an economic hardship provision or by placing loans in forbearance which exponentially builds overall debt. While loans may weigh heavily on a resident’s shoulders, they are often not the most pressing financial concern. Rather, the concern lies in day-to-day financial survival. A typical resident’s salary is modest at best, especially when attempting to support a family. The time period during which long hours are spent in residency happens to correspond with the same time that many people are getting married, having children and beginning to expand their families. For those in this situation, there may be a resultant loss or decrease in a spouse’s income in order to care for a child or to accommodate a move for residency. There are new costs (e.g. childcare, life and disability insurance, home-owners insurance, higher rent, mortgages) notably absent when life was more simple. There are other factors that affect debt accumulation over which the individual does have some control.

Spending habits and the avoidance of credit card debt during residency is vitally important in maintaining financial health. This involves prioritizing spending and delaying gratification despite being tired of second-hand furniture, unreliable cars, and living in questionable apartments since beginning college. There are several on-line resources available to help residents understand and organize student loan debt and repayment plans.

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federal Stafford loans, as well as some private loans through their organization to eligible individuals. Additional resources to begin looking at managing your debt include the Graduate Medical Education office of your residency program or financial aid office of your medical school. Some individual state chapters of national organizations such as ACEP or the AMA may offer additional information in the forms of management tutorials or scholarships available to students and in the rare case, residents.

The following is a list of printed material published in the last two years which address the issue of resident debt management.

• Dealing with Your Debts, ACP Observer, December 1999 • Say goodbye to medical school debt, Medical Economics, December 6, 1999 • Med Students Seek Cure for Debt — For Doctors in Training, Profession’s Outlook is Hardly Lucrative, Los Angeles Times, November 27, 1999

• Financial Planning Takes Sting Out of Educational Debts, Academic Physician and Scientist, May/June 1999 • Understanding and Managing Your Student Loans, Inspirations — The Anesthesia Residents’ Quarterly, Fall 1998 • Managing Medical Student Educational Loan Indebtedness, Contemporary Issues in Medical Education (CIME), December 1999 Table I EM Resident Average Indebtedness 1986: $33,500 AAMC survey 1989: $48,700 AAMC records 1996: $72,300 393 EM applicants in 54 programs (1996) 1999: $85,224 29 EM applicants interviewing at UC Irvine 2000: $95,689 48 EM applicants interviewing at UC Irvine

EMF Call for Grant Proposals The Emergency Medicine Foundation is currently accepting applications for its annual grants. Funding is for research done within the academic year of July 1, 2001 through June 30, 2002 unless otherwise specified. To request an application, contact EMF, P.O. Box 619911, Dallas, Texas 75261-9977 or call (972) 550-0911 ext. 3340. The following is a description of the awards and application deadlines: EMF Career Development Grant A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who needs seed money or release time to begin a promising research project.

Deadline: November 6, 2000

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

Deadline: January 15, 2001

EMF Creativity and Innovation in Emergency Medicine Grant A maximum of $5,000 to support small pilot projects that are new and innovative. It is intended to provide release time or provide equipment and supplies for new investigators or for experienced investigators who have a novel idea.

Deadline: November 13, 2000

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

Deadline: January 29, 2001

EMF Research Fellowship Grant A maximum of $35,000 to emergency medicine residency graduates who will spend another year acquiring specific basic or clinical research skills and further didactic training in research methodology.

Deadline: November 20, 2000

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

Deadline: February 12, 2001 EMF/ENAF Team Grant A maximum of $10,000 to be used for physician and nurse researchers to combine their expertise in order to develop, plan and implement clinical research in the specialty of emergency care.

Deadline: March 5, 2001

EMF Resident Research Grant A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level.

Deadline: December 4, 2000 Riggs Family/EMF Health Policy Research Grant Between $25,000 and $50,000 for research projects in health policy or health services research topics. Applicants may apply for up to $50,000 of the funds, for a one- or two-year period. The grants are awarded to researchers in the health policy or health services area, who have the experience to conduct research on critical health policy issues in emergency medicine.

Deadline: January 8, 2001

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

Deadline: March 19, 2001 13

2000-2001 Interest Group Objectives and Report Interest groups were developed to allow members to participate with other SAEM members in areas of mutual interest.

Currently there are approximately 25 interest groups. All interest groups are asked to meet at the SAEM Annual Meeting and the chairs were asked to develop objectives for the 2000-2001 academic years, as well as provide a narrative report on their meetings in San Francisco. Because the Newsletter has limited space, some of the reports have been extensively edited. The full text of the reports can be found on the SAEM web site at: www. saem.org/inform/intgrps.htm All SAEM members are invited to participate in the interest groups. Contact the SAEM office at saem@saem.org or 517-4855484 to become a member of an interest group. Dues are $25 per year per interest group. For information on specific interest groups, please feel free to contact the interest group chairs listed below. For general information on interest groups or how to develop an interest group, please review the Interest Group Orientation Guidelines on the SAEM web site at: www.saem. org/inform/igorient.htm. The SAEM Board recently approved the development of list-servs for interest groups that request a listserv and have at least 20 members. Many Interest Groups now have active list-servs.

Airway

questions: what are the necessary skills to run an academic emergency department, what is the role of formal training (either a fellowship or degree program), what administrative support is necessary to succeed in the job and how does one balance the role with other personal academic growth issues like research and education?

The second major topic focused on the clinical operations of our departments and how it fits into the mission and vision of the larger SAEM body. The members were particularly concerned about the continued development of the educational and research missions when departmental operations are undergoing the pressures of healthcare and have the ability to negatively affect those areas. There was discussion about current and future benchmarking initiatives so that members would have the opportunity to share information. It was hoped that this type of information would have a place on the Annual Meeting agenda. Approximately 10 members attended the meeting. Elections will be held at the 2001 SAEM Annual Meeting.

Carlos Camargo, MD, DrPH, Chair: ccamargo@partners.org Objectives 1. To support collaborative research on asthma, COPD, and other airway disorders.

2. To provide national leadership on asthma education of ED patients and staff.

3. To prepare an airway-related didactic session, workshop, or satellite symposium for the SAEM Annual Meeting.

4. To provide SAEM representation to the National Asthma Education and Prevention Program (NAEPP).

Approximately 30 people attended the meeting which began with a general update, including the latest membership count (60), completion of the new AIG website (http://healthcare. partners.org/saem-airway), and some NAEPP initiatives (eg, a proposed resolution to support increased multicenter research on ED-based asthma care). Each the committee chair (Drs Brian Rowe, Steve Emond, and Charles Pollack) reviewed their 1999-2000 agenda, discussed what their committee had accomplished during the past year, and solicited comments and ideas from the general membership. Dr. Emond announced that Barry Brenner will chair the Education Committee for the duration of the two-year term. Minutes from each committee chair will be posted on the AIG website, and include the current committee objectives and timeline. At the next SAEM Annual Meeting elections will be held for the 2001-2003 AIG chair, who may choose three new committee chairs shortly thereafter. The AIG chair also may nominate to the SAEM Board a new AIG member to represent SAEM on the NAEPP Coordinating Committee. Contact Drs. Camargo (ccamargo@partners.org), Rowe (brian.rowe@ualberta.ca), Brenner (doctor2315@aol.com), or Pollack (pollack@primenet.com) if you have any questions or concerns.

Clinical Skills William Rennie, MD, Chair: rennie@lij.edu The Clinical Skills Interest Group did not meet in San Francisco and has not yet submitted objectives for 2000-2001.

CPR/Ischemia/Reperfusion James Manning, MD, Chair: jmanning@med.unc.edu The CPR/Ischemia/Reperfusion Interest Group did not meet in San Francisco and has not yet submitted objectives for 2000-2001.

Disaster Medicine Lester Kallus, MD, Chair: lkallus@earthlink.net Objectives 1. A listserver of all members will be created.

2. Review a bibliography of Disaster-related articles and to maintain this bibliography annually. The bibliography is to be published on the internet.

3. A didactic course on Disaster Medicine authored in the 1980s and last offered in the early 90s will be updated.

An international disaster medicine course currently in use in Europe will be reviewed.

4. CME credit for a disaster medicine course and funding for creation of such a course will be investigated.

Sixteen people attended the interest group meeting and Dr. Kallus was elected to continue serving as chair of the Disaster Medicine Interest Group. It was suggested that a meeting of the Disaster Medicine Interest Group be held one day prior to the ACEP Scientific Assembly to compile various lectures.

Clinical Directors Leon L. Haley Jr., MD, MHSA, Chair: lhaley@emory.edu Objectives 1. Promotion of the role of the ED Clinical Director within Academic Emergency Medicine.

2. Improving ED operations through administrative research, benchmarking and education 3. Development of a didactic program for the entire SAEM body at the May 2001 annual meeting 4. Growth and development of the interest group itself.

The meeting focused on four major topics: • Promotion of the role of the ED Clinical Director in academic emergency medicine • Improvement in ED operations through administrative research, benchmarking and education.

• Development of a didactic program for next year’s annual meeting.

• Growth and development of the interest group.

The role of the ED Clinical Director is interesting since some members of the group have had the role thrust upon them without adequate preparation. The group debated several

Diversity Thea James, MD, Chair: theaj@bu.edu Objectives 1. Addressing mission of recently approved Diversity Interest Group (DIG) position statement. (continued on next page) 14

Interest Group Objectives and Report (Continued) EMS

2. Determine our diversity baseline in SAEM: Completion of 2 studies on our research agenda.

3. Solicit feedback from CORD on DIG position statement and its relationship to residency training programs.

4. Create and establish a comfortable space for open dialogue about diversity.

The interest group will develop a focused mission and research agenda; the major objective for 2000-2001. The interest group plans to query all SAEM faculty and residents to determine our diversity baseline in SAEM, to inquire about thoughts on necessity for, want of, or understanding of diversity initiatives in emergency medicine, and to provide the opportunity for open expression from both residents and faculty.

Hopefully this query will reveal data to stimulate open and comfortable discourse about diversity in medicine and particularly, EM. A previous survey was done by the Women and Minorities Task Force. The ethnicity demographic data from this study has not been published, however it will be interesting to compare those data to some of the data that will be collected in the DIG study, given the time difference. The query will be administered in a participant-friendly, convenient manner.We also have a qualitative survey planned.

In addition, we would like to solicit feedback from CORD about the DIG position statement as is relates to EM training programs.

A dozen people attended the Diversity Interest Group meeting (DIG) and Kevin Ferguson, MD, was elected incoming chair with his term to begin May, 2001.

Ted Delbridge, MD: delbridget@pitt.edu A group of 15 EMS physicians and professionals attended a planning meeting to lay the groundwork for the new EMS Interest Group. The primary focus of the meeting was planning for the transition from the present EMS Task to an interest group. This transition will allow for much broader participation

by SAEM members and may allow for discussion of a wider variety of topics and the completion of a larger number of projects.

Potential activities for the interest group might include exploring the role of EMS in public health, updating the EMS curriculum for EM residents, developing an EMS curriculum for medical students, and the facilitating of EMS mentoring relationships, particularly for young EMS researchers. These and other possible projects should blend EMS with SAEM’s academic focus on research and education.

Possible early action items for the group include the development of an inventory of funded EMS research projects, a position paper regarding EMS in academic EM centers, and a list of EMS research priorities. The group will also begin examining possible didactic session proposals for future SAEM Annual Meetings.

Those who attended the meeting will continue to work with the EMS Research Task Force and the SAEM leadership toward the implementation of the interest group. Interested SAEM members may contact Dr. Delbridge (delbridg+@pitt. edu), Dr. Michael Sayre (Michael.Sayre@uc.edu), or Dr. David Cone (david.cone@yale.edu) for further information.

Domestic Violence

Ethics

Carolyn J. Sachs MD, MPH, Chair: csachs@ucla.edu Objectives 1. Sponsor an educational session for the 2001 conference “Challenges and Solutions to Longitudinal Outcomes Research of ED Based Interventions.”

2. Sponsor an educational session for the 2001 conference “Development of a national web based emergency medicine education tool.”

3. Complete the project started in year 1999-2000 which examines reporting requirements for patients with violently inflicted injuries in all 50 states.

4. Improve communications with the SAEM Board to assure that our educational sessions are implemented in year 2001.

The meeting was attended by 35 individuals and Barbara Herbert MD, was elected incoming chair with term to begin May, 2001.

The interest group developed a collection of reference protocols for our website. As the SAEM DV Education Site will have these protocols, we decided to add our efforts to theirs by giving them our representative protocols and leave our web site as an interest group member reference site to be maintained by Dr. Ron Moscati.

The SAEM Domestic Violence Education Site was demonstrated by Dr. Heidi Queen. Dr. Queen continues to solicit assistance from SAEM members for the web site for the following ongoing projects: case reports with photos, updated legislative and bibliographical information, research project descriptions, referral forma, and web site management.

Contact her at hfqueen@hotmail.com for any contributions.

A national update on state legislation regarding violent injury reporting, was accomplished under the leadership of Dr. Debra Houry. Members shared various research projects with one another and expressed frustration on the question of how to improve DV screening in the ED. Drs. Karin Rhodes and Bruce Becker shared their projects aimed at increasing screening and Drs. Ron Moscoti and Greg Larkin informed us about their ongoing research to show improved outcomes with ED based intervention.

John Krimm, MD: jkrimmaemc.pol.net Objectives 1. To support collaborative research into ethical issues as they relate to emergency medicine; 2. To identify the uniqueness of ethical issues as they relate to emergency medicine; 3. To provide emergency medicine related didactic sessions and/or workshops at the Annual and/or regional SAEM Meetings; 4. To establish and review annually a bibliography of emergency medicine related articles and publications; and, 5. To increase the awareness of ethical problem areas for emergency medicine educators and researchers.

In response to numerous inquiries from SAEM members, the formation of a new interest group, focused on ethical matters has been proposed. This notice serves to inform the general membership of the Ethics Interest Group, which has as its goal to bring together like-minded SAEM members for discussions of ethical issues in emergency medicine. Proposed activities include: • To meet for collegial discussions at the Society’s Annual Meeting and the ACEP Scientific Assembly; • To increase the awareness of ethical issues as they impact on emergency medicine, by creating a forum for discussion; • To help identify the uniqueness of ethical decision making in emergency medicine; • To assist members in the publication of articles germane to emergency medicine ethics; • To create resources for SAEM members; And, • To communicate with other emergency medicine organizations to open discussions on common ethical issues.

Evidence Based Medicine Peter Wyer, MD, Chair: pwyer@worldnet.att.net

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Interest Group Objectives and Report (Continued) Objectives 1. To draft an outline of needs and guidelines for faculty development required for emergency medicine programs to incorporate the teaching of evidence-based medicine skills and principles into their curricula.

2. Initiate the development of a proposed curriculum plan for EBM within EM programs.

3. Undertake a systematic exploration of possible modalities for training of EM faculty in EBM. 4. Develop specific educational resource initiatives relevant to EBM faculty development and curricular designs.

Approximately 25 individuals attended the meeting and Peter Wyer was re-elected chairman for the coming year. The preliminary results of the survey of EM program directors were distributed and reviewed. The lack of faculty interest and training and of monetary and time resources were identified as limiting to incorporation of EBM in the curricula. Projects identified for the coming year include development of a proposal for EBM didactic presentations at the 2001 SAEM Annual Meeting and a project to abstract the tables of sensitivities, specificities and likelihood ratios for elements of history and physical from the JAMA Rational Clinical Exam series into an online and printed resource for use by EM programs. Committees were established for each of these projects.

Steve Hayden (SH) agreed to chair a sub committee charged with formulating the didactic proposal(s) on behalf of the IG. There was discussion on modalities appropriate to realization of a faculty development and broader educational EBM agenda, once formulated. Modalities proposed included: Workshops, Teleconferencing, Web-based learning instruments, and On-Site workshops by mobile EBM teaching/ tutorial teams There was discussion on the appropriateness of a kind of ‘certification’ for faculty EBM training. Some participants opposed this from the standpoint that EBM learning and development of skills constitute a process that cannot be adequately ‘certified’ as the result of a discrete course experience. Bill Cordell proposed “point-of-care” as the strategic guide to a curriculum design. Closing the ‘evidence transfer gap’ at the point where decisions happen-the bedside. It was proposed that Dr. Cordell formulate his proposal as a strategy statement that can be used to guide the development of a curriculum plan. Differentiation of learner-specific goals and identification of existing EBM training options were also mentioned as important considerations.

Dr. Kuhn described a project to compile and disseminate tables of likelihood ratios, sensitivities and specificities for elements of clinical examination as part of an educational vehicle for teaching EBM at the EM bedside. A formatted and categorized bibliography of the RCE series has already been done by Dr. Kuhn and can be obtained on the EBEM.org website. Dr. Kuhn proposed a project to abstract the relevant tables from the RCE series, compile them and make them available on-line and possibly as a printed compilation through SAEM. A committee was formed for the purpose of pursuing this project.

had an informal discussion with Dr. Landefeld. This led to a decision to focus our didactic session proposal on educational innovations.

The instructional materials and text have been scanned thanks to Wayne Satz and are ready to be put on the SAEM web site. It was decided that we should consider updating these materials next year. The elder abuse case-based teaching module has been receiving a lot of hits and downloads. Bert Woolard, the original author, agreed to update it.

We agreed that a network of collaborating departments would facilitate research. Steve Meldon agreed to head up an effort to develop a research network. Some projects that were considered are short-term outcomes and prediction of patients who are likely to return to the ED. We agreed that a speaker was a beneficial part of the interest group meeting. Next year the group would like to have a speaker talk about issues in geriatric injury prevention or management. Lowell Gerson will arrange for a speaker, probably from the CDC. Steve Meldon told us about the availability of Geriatric Emergency Medicine Reports, a publication by American Health Consultants.

Health Services and Outcomes Research Robert J. Rydman, PhD and Lawrence Melnicker, MD, CoChairs: rjrydman@uic.edu and lam9004@nyp.org Objectives 1. Submit proposals for 2 didactic sessions for 2001 Conference in Atlanta: Introductory session “Measuring health services performance indicators: access, cost, quality-outcomes, and organization of care” and Advanced session “Econometrics in HSR: Microeconomic analyses of diagnostic and treatment interventions in EM.” Possible others.

2. Work with SAEM program to plan for HSORIG sponsorship of Spivey Lecture: Guest National HSR expert.

3. Submit EMRA newsletter article: “The Role of Health Services and Outcomes Research in EM.” The Health Services Research IG, chaired by Dr. Robert Rydman, approved a merger with the Outcomes Research IG, chaired by Dr. Larry Melnicker. Both chairs will continue as co-chairs for one year. A reciprocal decision was made at the Outcomes Research IG meeting. A discussion of the HSR IG didactic presentation at the 2000 conference in San Francisco

by Drs. Heidenreich, Zalenski, Lowe, and Rydman was conducted. The state of membership, objectives, and plans for more didactics at next year’s conference were discussed.

Approximately 10 members attended the meeting.

Injury Prevention Linda Degutis, MD, Chair: linda.degutis@yale.edu Objectives 1. To develop and present a didactic session at the 2001 SAEM annual meeting; 2. To develop and implement mechanisms for networking with other professional organizations and agencies that have an interest in the field of injury prevention. These include but are not limited to: ACEP, APHA (American Public Health Association), ACS (American College of Surgeons), ATS (American Trauma Society), NCIPC (CDC), STIPDA (State and Territorial Injury Prevention Directors Association), American Academy of Pediatrics (AAP), etc.

The meeting was attended by 14 members of the interest group. Discussion of the Didactic Session proposal for the 2001 SAEM meeting centered around the benefit of having the Director of the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention participate in a session. The potential topics for the session

Geriatric Lowell Gerson, PhD: lgerson@neoucom.edu Objectives 1. Develop a didactic session about innovations in geriatric education for residents, fellows and practicing physicians for the 2001 Annual Meeting.

2. Develop a research network to facilitate studies about elder ED patients.

3. Update the Elder Abuse Teaching Module.

C. Seth Landefeld MD, Chief Division of Geriatrics spoke with us about educational opportunities. After the talk we

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Interest Group Objectives and Report (Continued) included: injury prevention research priorities and opportunities; innovative methods in injury prevention research; and injury prevention program evaluation strategies. Linda C. Degutis, DrPH, Yale University, was elected to chair the interest group.

medicine in other countries.

Dr. Holliman then presented his lecture on academic and development aspects of international emergency medicine.

Medical Student Educators Jamie Collings, MD, Chair: jcolli@luc.edu Objectives 1. Start a web site for medical student educators that would be a resource for lecture/teaching information 2. Contact all medical school student rotation directors to determine what computer based teaching/skills materials they are using 3. Submit a didactic proposal to invite a speaker to help teach people how to make web based teaching materials and interactive computer teaching lectures for medical student rotations Approximately 25 members attended the Medical Student Educators Interest Group meeting.

Jamie Collings, MD, was elected chair and Dave Manthey, MD, was elected vice-chair. The interest group discussed what the SAEM Undergraduate Committee is working on.

We discussed the need to obtain accurate information about clerkship requirements at all medical schools and the difficulties getting the survey to those people who can and will accurately provide information for their medical school.

We also discussed starting a central database with links to individual websites. This database would be available to all medical student educators and would contain lectures, interactive computer modules, or whatever teaching materials people chose to provide. Our goal would be to allow medical student educators access to what other people are teaching and enhance their curriculum without having to produce it all themselves. We then discussed developing a project proposal that would involve computer informatics and innovative teaching approaches.

International Jeff Smith, MD, Chair: emdjps@gwumc.edu There were approximately 80 persons in attendance. The International Interest Group completed the long-term project of generating a series of published manuscripts which define and provide the academic framework for international emergency medicine development. The latest three of these publications are the “Observational” International Emergency Medicine Fellowship Curriculum manuscript which was published in the April issue of Academic Emergency Medicine. The article on International Emergency Medicine Journals and Web Sites was published in the Annals of Emergency Medicine in December 1999 and the manuscript on Planning Recommendations for International Emergency Medicine System Development was published in Academic Emergency Medicine in August.

Dr. Douglas Rund made a presentation on an emergency medicine development project he is working on in Brazil. Dr. Gary Green provided an update on the activities of the organization, Emergency International. A report on the activities of the ACEP International Section was made. The ACEP President has appointed a Special Task Force in International Emergency Medicine to plan and coordinate ACEP’s efforts in this field. Dr. Phil Anderson has been working on coordinating international emergency medicine information to be placed on the SAEM web site.

Dr. Kris Arnold has completed a major project involving placing on the web the information previously accumulated by the International Interest Group on emergency medicine rotations available in other countries for residents and students. Dr. Arnold encouraged attendees who might know of additional rotations to access the web site and send him information electronically on these new rotations. The web site address is www.ed.bmc.org/iem/search.cfm.

It was reported that the American Academy of Emergency Medicine is planning a conjoint conference with the European Society of Emergency Medicine in the year 2001. Dr. Antoine Kazzi of the University of California, Irvine is coordinating this project.

Elections for new officers of the Interest Group were held and Dr. Jeff Smith was elected Chair, Dr. Mark Davis was elected Vice-Chair, Dr. Kris Arnold was elected Secretary and Dr. Joseph Epstein and Dr. Kumar Alagappan were elected Members at Large. Dr. Mike Drescher was elected International Advisor to the Interest Group.

Dr. Jon Mark Hirshon will chair a committee which will develop a list of clinical opportunities in emergency medicine in which physicians from the U.S. can participate in other countries.

Dr. Joe Epstein, Dr. Kumar Alagappan and Dr. Gary Green will chair the development of a grid for recording provisions and features of the emergency medicine and EMS systems in different countries. This would utilized as a survey to start to be able to provide outcomes analysis of emergency medicine system effectiveness in different countries.

The SAEM office will be contacted to determine if rejected abstracts from international sources might be able to be accepted for presentation during one of the SAEM Interest Group business meetings to allow physicians from other countries to attend the meeting. A letter will be sent to the SAEM Board requesting consideration of reduced dues and meeting fees for international attendees. The goal of this would be to increase the interest in academic emergency

Neurological Emergencies Dexter Morris, MD, Chair: dmorris@med.unc.edu Objectives and a narrative report have not yet been submitted.

Pain Management James B. Jones, MD, PharmD, Chair: jbjones@clarian.com Objectives 1. Link all members of the interest group on listserv 2. Develop a “state of the art” session for 2001 Annual Meeting.

3. Develop an educational session on how to teach resident.

Approximately 10 members attended the Interest Group meeting and it was agreed that elections would be held at the 2001 SAEM Annual Meeting.

Pediatric Jill Baren, MD, Chair: jbaren@mail.med.upenn.edu Objectives and a narrative report have not yet been submitted.

Research Directors Michelle Blanda, MD, Chair: blandam@summa-health.org Objectives 1. New Research Directors Manual project.

2. Didactic proposals for 2001: If accepted, develop faculty and agenda.

Didactic proposals for 2002: Ideas for new proposals.

3. Development of an ED database. The Public Health Task Force has started to develop a new public health process where they collect data on screening for domestic vio-

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Interest Group Objectives and Report (Continued) lence, how many people are doing it, making it relevant to emergency medicine. Bob Rydman had talked about this and we may have him talk about it again here.

Approximately 20 members attended the meeting. Michelle Blanda was elected chair. The first item of discussion was the database of EM researchers. This has been assigned to the research committee to form a database of researchers that are used for industry. Many people have managed it before including Geoff Rutledge. SAEM has developed a task force that will look at this (Brian Zink, Larry Melniker).

There were concerns about the qualifiers, how it would be used and the information that was put in regarding funding.

This is an informational item only and no action was taken.

It was agreed there should be a research directors orientation, similar to what is given to new residency directors. We decided that we may do a type of workshop that is approximately 1/2 to 1 day long. Focus would be on precepting residents, teaching research curriculum, evaluations, time management and resources.

It was agreed that substance abuse is an area of considerable public debate with well funded, active research underway and a promise to improve EM training and the care we provide. Nationally, university based centers for alcohol and addiction studies, the NIAAA, NIDA, CDC, NHTSA and HCPQR have “discovered” the teachable moment in the emergency department. Opportunity abounds the academic emergency physicians who get involved now.

Toxicology Leslie Wolf, MD, Chair: leslie.wolf@wright.edu Approximately 10 individuals attended the SAEM Toxicology Interest Group meeting (STING). The chair is Leslie Wolf, and the secretary is Stewart Wright. The group will continue to revise the guidelines for Toxicology training for EM residents with a goal to submit a manuscript to AEM. We discussed developing an award and the fund for Toxicology training being developed through FAEM. The group agreed to develop guidelines for the fellowship. We discussed the didactic submission guidelines and possible topics for submission for the 2001 Annual Meeting. The group was also informed and given details about the Toxicology CPC and didactic session at the annual Toxicology meeting in Tucson this fall. The goals of the SAEM leadership (faculty development, national affairs, and research) were relayed to the group. The next meeting will be held in Tucson in September.

Substance Abuse Robert Woolard, MD, Chair: robert_woolard@brown.edu Objectives 1. Propose and conduct a training session at 2001 Annual Meeting on changing behaviors: Present innovative training strategies for physicians on advising or counseling patients.

2. Participate in the planning of and conduct an EM alcohol research conference (in conjunction with CDC).

3. Create an EM bibliography of substance abuse articles and make it available on the web site.

4. Seek approval for an abstract submission category in Substance Abuse.

Trauma Michael Gibbs, MD, Chair: mgibbs@carolinas.org Two didactic submissions were suggested for 2001. Dr. Bilkovski expressed an interest in developing a proposal regarding non-invasive hemodynamic monitoring of trauma patients. This proposal generated significant enthusiasm in the group since non-invasive hemodynamic monitoring is not commonly used currently. Dr. Bilkovski will speak with trauma researchers including Drs. Manny Rivers and Richard Summers who have experience in the use of these devices.

He will develop a protocol for a didactic session on the potential for future use of these devices and suggest several speakers. A didactic session on the use of cyto-protective agents in preventing secondary injury in trauma was also considered.

Donnie Baron gave a brief update on the status of the penetrating neck trauma study. Subjects are no longer being enrolled. 150 patients have been enrolled to date in the Shoulder Dislocation study. Boston Medical Center and Parkland in Texas are currently the two participating centers.

Patient enrollment will continue. Dr. Michael Gibbs was elected the new chair of the interest group.

There were approximately 10 participants. Substance Abuse Interest Goals were reviewed and new draft of goals follows: 1. Develop and promote a more comprehensive approach to Addiction Medicine within Emergency Medicine, including prevention strategies, an educational curriculum, and a research agenda.

2. Promote EM research in substance abuse, including defining appropriate topics and identifying funding sources.

3. Promote liaison with other organizations in the field of substance abuse research and treatment.

An update of current projects was presented. Dr. Woolard agreed to continue to press for the creation of a substance abuse abstract submission category at SAEM. Dr. Gail D’Onofrio reported that the educational materials for EM residents are available through the SAEM web site. Dr. Dan Pollock reported on planning a CDC sponsored conference which should set the research agenda for EM alcohol interventions. The 2-1/2 day meeting will be held in the Washington, DC area in April, 2001. Dr. Runge agreed to create a bibliography of Substance Abuse articles in the Emergency Medicine literature for distribution to the Substance Abuse Interest Group. Ultimately this bibliography can be appended to the resident alcohol educational materials on the SAEM web site.

There was discussion of the need for Emergency Medicine experts to bring the alcohol educational materials to residency programs and give grand rounds. It was generally accepted that no or little education is given to EM residents concerning addiction medicine. However, it was noted by Dr. D’Onofrio that the SAEM alcohol web site has been quite active. Dr. Woolard will seek requests from CORD through the CORD list. Requests for grand round speakers will be forwarded to Substance Abuse Interest Group members via e-mail.

Ultrasound Interest Group Michael Blaivas, MD, Chair: blaivas@pyro.net Objectives 1. Promotion of outcome research of emergency ultrasonography.

2. Establishment of an image bank on SAEM web site for ultrasound educators.

3. Joint ACEP-SAEM position statement on emergency ultrasound education.

4. Establishing training and credentialling criteria for the field.

Approximately 70 members attended. Elections for chair were held. Dr. Blaivas was elected.

Vivek Tayal discussed efforts to draw up credentialling guidelines for the field, as well as standardizing the education

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Interest Group Objectives and Report (Continued) may mandate or suggest uniform training in all residency programs.

that sonographers should receive. ACEP and SAEM will be putting forth a joint position document with the objective, “to prepare a joint document that will provide a comprehensive overview of the role of ultrasound in the practice of emergency medicine.” The outline is being submitted to the boards of SAEM and ACEP for approval. Larry Melniker discussed his work to the SOAP trial(s). A number of these studies will soon be under way. The prospective version of the first SOAP study has also begun. Approximately five other SOAP trials are in the works with a number of primary investigators involved. Anthony Dean discussed his work with a rigorous and standardized test of ultrasound skills, which is now comprised of almost 80 questions. Dr. Dean was elected to the chair-elect. Testing on the examination is now underway and consists of image recognition and interseparation as well as other knowledge questions. Work on the proposed image bank was discussed with a proposal to be submitted to the SAEM Board. The bank will initially consist of still images but may eventually include MPEG video clips. Mike Peterson discussed his survey of ultrasound program costs. The preliminary results show surprising breadth of answers on some issues with conformity on others. The “white paper,” a document requested by ABEM, was discussed by Mike Heller and the group working on it. This document will discuss the need for ultrasound training in emergency medicine. It will likely cover the extent of its applications and

Web-educators J. Stephen Huff, MD, Chair, jshuff@virginia.edu Objective 1. To serve as a resource and development tool for webbased educational projects for interest group members.

The organizational meeting was attended by 17 individuals and was convened for the purpose of forming an interest group to promote internet use as an educational tool for emergency physicians. The Web-educators’ interest group (WIG) was organized after 20 members expressed the desire to form an interest group. A listserve will be organized.

The objective of the group is to serve as a resource and development tool for interest group members. Possible activities discussed included forming a project gallery for members, linking to projects presented at SAEM meetings, and providing a forum for technical advice on web activities.

It was proposed that a web site be created for the group with links for educational related emergency medicine sites.

Youth Violence Prevention Karyn Cole, MD, Chair: kcole@fac.howard.edu Objectives and a narrative report have not yet been submitted.

President’s Message (Continued) have ever encountered – people like Michelle Biros, Scott Syverud, Brian Gibler, Dan Savitt, Susan Gin-Shaw, Mike Spadafora, and Jim Hoekstra. So, when I had an inkling to try out a research idea on alcohol and shock in the laboratory setting, I was pulled in by the faculty and residents and steered in the right direction. When I needed help with statistics, it was there. When my papers or book chapters needed a critical yet gentle review there were unconditional offers to help.

I went to my first national emergency medicine meeting as a second year resident, and had the chance to present my study as a fledgling investigator. At that point I became hopelessly hooked.

I had come to realize that while academic emergency medicine is a job, and a career, it is also a cause, based on a need. Emergency patients need better care, and the way to achieve that is through research and education. As a latecomer to the world of academic medicine, emergency medicine has a great deal of catching up to do. When I took my first job out of residency in 1988, I was compelled by the idea that the need for academic physicians who were true to the cause was greater in emergency medicine than in any other discipline. I think that is still the case.

So, the short answer to the first part of the question — why did you go into academic emergency medicine? Because I had exceptional role models, and I was needed.

I have no problem answering the

second part of the question in the affirmative — I think that academic emergency medicine is the best job in medicine. Am I happy? Well, not always deliriously so, but I am able to leave the medical center most days with a sense of contentment and satisfaction with the work I have done. Academic emergency medicine can be an immensely satisfying career for a number of reasons:

Clinical Care Academic emergency department patients are the most challenging cohort in medicine. The challenge comes from two ends of the spectrum. On the one hand, academic health centers, as tertiary medical facilities, care for the unfortunate patients who have complex, rare, or especially difficult diseases to manage. These patients — the liver transplant patient with fever, the lupus patient with altered mental status — present with complicated medical emergencies, where prompt diagnosis and treatment is crucial to a good outcome. On the other hand, many academic ED’s serve an urban, indigent population where common diseases are seen with their worst manifestations due to inadequate health care, neglect, or psychosocial factors. The academic emergency physician must have the expertise to handle, and to teach others how to handle, the complicated and the common. The progression toward this level of expertise has many humbling moments, but I believe the mastery of clinical care in an academic ED is one 19

of the highest achievements that can be made in American medicine.

Teaching I put teaching before research on this list, even though I am a huge advocate of the development of research in emergency medicine. The greatest academic emergency physicians are first and foremost great teachers. Is it paradoxical that the loudest, most hectic place in the hospital is the best teaching environment? Not when we think of the key elements of teaching — interesting subject matter, and the student’s role as an active learner. A medical student may hear an in depth discussion of diabetic ketoacidosis during ward rounds on an internal medicine rotation, but that same student will learn DKA better when she is drawing a blood gas on a DKA patient in the ED, feeling Kussmaul’s respirations blow across her forehead, and maybe catching a whiff of ketones. This medical student sometimes ends up as an emergency medicine resident, and the satisfaction that comes from helping a fresh, eager, scared intern develop into a confident, caring, competent senior emergency medicine resident is immense. The intense, direct contact that emergency medicine faculty have with their residents makes for a unique teaching relationship. Teaching an emergency medicine resident changes a three a.m. rendezvous with a combative, intoxicated trauma patient from a routine, and somewhat tiresome

(continued on next page)

President’s Message (Continued) case, into an opportunity to share experience and knowledge.

A lot of little guppies have the chance to swim in the big fishbowl that is the academic ED, and as a result, academic emergency physicians play a huge role in the education of American physicians.

This is reinforced when I travel around the country, and encounter physicians who remember me from their days as a medical student, when I taught them to suture, or when they were an internal medicine resident and we treated a patient with ethylene glycol poisoning.

Academic emergency physicians also serve as teachers of paramedics, EMT’s, nurses, and other health care professionals. The opportunity to have an impact on the education of so many people is probably the most rewarding part of academic emergency medicine.

The need for excellent teachers will not diminish in the future. Despite this great need and the prominent role that teaching plays in our lives, most current academic physicians have no formal training in education. I am hopeful that at least some of the current generation of medical students and emergency medicine residents who aspire to be academic emergency physicians can improve the quality of our teaching by obtaining formal training in education.

Research Providing clinical care and teaching in the ED are academically enriching activities that have strong elements of service to others. Research is a more selfish pursuit. While the ultimate goal is to improve patient care, for most academicians doing research is like scratching an itch. The itches are the research questions that keep one awake at night, and the scratching is the experiments or studies that will placate the itch. I have previously highlighted the great opportunities that exist for emergency medicine researchers, including the new emphasis on clinical research funding at a national level.

Residents who are entering academic emergency medicine have unprecedented options for funded research training fellowships, career development grants, and seed money for startup research projects. They also have a bigger core of qualified emergency medicine investigators to serve as mentors and role models. Ten years ago, emergency medicine research was on the fringes, but this is no longer the case. We now enjoy representation via funded research or administrative and advisory roles in every major research niche in both national research institutions and the biomedical industry. The future is bright for research, but, again, the issue of need arises. We need bright and motivated emergency physi-

cians to go out and seek research training, so they can take advantage of the plentiful resources that are currently available. And our patients need us as researcher leaders — no one else better understands how research can translate into improved care for emergency patients than academic emergency physicians.

Professional Interactions Just as the ED provides broad exposure to all types of trainees, it also provides opportunities for interactions with faculty in the other disciplines of medicine. The turf wars and adversarial relationships that were part of the assimilation of emergency medicine into the academic world are largely over. One of the best aspects of being an academic faculty member is the chance to collaborate with non-emergency medicine faculty who may have valuable expertise, insights, and resources. The ED, with its high patient volumes, and large number of trainees, may be the ideal site for joint research studies or educational projects. As front line providers, academic emergency physicians can contribute to collaborative efforts in areas such as public health, drug development, testing of medical devices, and patient safety. Especially in big academic centers, many investigators have no exposure to acute care, and greatly appreciate the broad-based, real world perspective of the academic emergency physician. This same perspective can be valuable in administrative roles.

Professional interactions are the part of sustenance of academic life, and the strength of these interactions promises to increase as academic emergency medicine matures and improves its educational and research efforts.

National Involvement and Advocacy While it is possible to become involved in the big picture of health care as a community emergency physician, an academic career provides more opportunities to serve at a national level.

Whether it is in the realm of research, education, public health, or governmental affairs, the chance to work on a national level for an important cause can be instructive and satisfying. Academic emergency physicians who work in busy teaching hospital ED’s have an unquestioned credibility when speaking on issues that concern emergency care. We can use this credibility to advocate for improved patient care, research and education in the field.

If variety is the spice of life, then academic emergency medicine is like a Thai curry. When people ask me how I spend my time, I have to laugh as I take them through a day of doing a morning 20

experiment in the lab, attending noon emergency medicine resident conferences, giving a medical student lecture, counseling some students on career choices, and then working an afternoon shift in the ED. It is not clear if the triquetrous career of clinical care, education and research will hold up in the world of academic medicine, but even as a two pronged attack, the job has amazing variety. Not everyone wants this amount of stimulation, but I would challenge anyone to find an academic emergency physician who is bored with his or her job. Because of this variety, something positive is almost always happening – my experiment may have failed that day, but I helped a medical student make a career decision, and a resident learned how to manage acute pulmonary edema.

Yes, I’m glad that I went into academic emergency medicine. Nowhere is the need greater. No other job in medicine has more variety or challenges than clinical care in the ED. In no other job is there the opportunity to teach so many people. In no other job is quality research needed more. And no other patients need our national involvement and advocacy more than emergency patients. To the residents and medical students who are contemplating their career choice, I invite you experience the challenge of the best job in medicine.

Brian Zink, MD SAEM President University of Michigan

Call for Proposals in Medical Education Research The National Board of Medical Examiners has announced a call for proposals (CFP) for the 2000-2001 Edward J. Stemmler, MD, Medical Education Research Fund. Grants of up to $70,000 will be awarded for research or development of innovative evaluation methodology in medical education. Pilot and more comprehensive projects will both be considered. Eligible applicants include all medical schools accredited by the Liaison Committee on Medical Education or the American Osteopathic Association.

The full CFP guidelines and application forms can be downloaded at http://www. nbme.org/new.version/CFPentry.htm.

The proposal deadline is November 12.

For more information, contact Deborah Kuhar, National Board of Medical Examiners, (215) 590-9657 or dkuhar@ mail.nbme.org.

FELLOWSHIP POSITIONS

Albany Medical College

ROCKY MOUNTAIN POISON AND DRUG CENTER: MEDICAL TOXICOLOGY fellowship program is recruiting applicants for two positions beginning July 1, 2001. Our two-year ACGME-accredited program provides extensive clinical (>150,000 poison center calls/year from four state region & in-patient service), research, publishing, and teaching experience under the supervision of ACMT and ABEM certified faculty. Affiliations include Denver Health Medical Center (level 1 trauma center) and University of Colorado Health Sciences Center. RMPDC is an Equal Opportunity employer. For more information contact Richard Dart, MD, PhD, Director, Rocky Mountain Poison and Drug Center, 1010 Yosemite Circle, Denver CO 80230 (phone: 303-739-1100; email: rdart@rmpdc.org).

Faculty Position Department of Emergency Medicine Open rank: The Albany Medical College Department of Emergency Medicine is seeking Board Eligible or Board Certified emergency physicians for an academic position with research, teaching and patient care responsibilities. Salary, rank and track commensurate with accomplishments and experience. The Emergency Department cares for 65,000 patients per year and serves as the primary teaching site for a fully-accredited emergency medicine residency program. Albany Medical Center is a level 1 trauma center with active air and ground transport programs. The Albany Medical College is an equal opportunity/affirmative action employer. Send CV to Vince Verdile, MD, Chairman, Department of Emergency Medicine, Albany Medical College, MC-139, 47 New Scotland Avenue, Albany, NY 12208, 518-2623773; Fax 518-262-3236.

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

Candidates must be board certified or prepared in emergency medicine.

Established emergency medicine residency program with eight residents per year. Spacious ED facilities. Childrenâ&#x20AC;&#x2122;s hospital and beautiful pediatric ED. Over 50,000 visits per year. Level I trauma center for pediatric and adult patients. Energetic young faculty with diverse academic backgrounds. Augusta is an excellent family environment and offers a variety of social, cultural, and recreational activities. Compensation and benefits are excellent and highly competitive. Please contact: Larry Mellick, MD, Chair and Professor, Department of Emergency Medicine, 1120 15th St. AF 2036, Augusta, GA 30912; 706-721-7144; e-mail: Lmellick@mail. mcg.edu EOE/AA NEW YORK CITY, Director of Clinical Operations: Exciting position for experienced board certified emergency physician to join the faculty, Department of Emergency Medicine, Mount Sinai School of Medicine; manage operations, informatics and fiscal issues during a time of significant departmental growth. Combined annual ED census over 80,000, EM residency program, 1100-bed tertiary center. Academic rank commensurate with qualifications. Please submit confidential letter and CV to Scot Hill, MD, Chair of Search Committee, Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029. Fax: 212-426-1946.

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

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

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or eligibility and California medical license or eligibility to apply required. Appointment level in the clinical series commensurate with experience/qualifications; salary per established UCAD salary scale. Reply to David A. Guss, MD, Director, Department of Emergency Medicine, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 921038676; 619-543-6217; email: dguss@ucsd.edu. AA/OE UNIVERSITY OF MISSOURI-KANSAS CITY/TRUMAN MEDICAL CENTER, Department of Emergency Medicine seeks academic faculty for a full-time appointment at the assistant or associate professor level.

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

UNIVERSITY OF NEW MEXICO, Albuquerque: Department of Emergency Medicine: Faculty positions, Clinician Educator or Tenure track, are available for board certified/board eligible Emergency Physicians, with strong clinical skills and demonstrated interest and experience in teaching and in research. Qualified applicants are invited to send a letter of interest, CV, & two letters of recommendation to David Sklar, MD, Chair, UNM Health Sciences Center, Department of Emergency Medicine, ACC 4-West, Albuquerque, NM 87131. Positions open until filled.

For best consideration, submit application materials before November 30, 2000. EEO/AA UNIVERSITY OF TEXAS MEDICAL BRANCH IN GALVESTON, TEXAS is seeking candidates for full-time faculty positions in emergency medicine.

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

OREGON HEALTH SCIENCES UNIVERSITY Department of Emergency Medicine is conducting an ongoing recruitment campaign for talented faculty members: 1) Entry-level clinical faculty members at the Instructor and Assistant Professor level. Preference given to those with Fellowship training (especially in Pediatric Emergency Medicine) or equivalent experience. 2) PhD or MD/MPH research faculty member experienced in collaborative clinical research, microcomputer database use, epidemiology, and statistics. Excellent research and writing skills are mandatory. Evidence of extramural funding potential is required. Knowledge of emergency medicine as a clinical discipline is expected. Please submit a letter of interest, CV and the names and phone numbers of 3 references to: Jerris Hedges, MD, MS, Professor & Chair, OHSU Department of Emergency Medicine, 3181 SW Sam Jackson Park Road UHN-52, Portland OR 97201-3098.

UNIVERSITY OF CALIFORNIA, San Diego: Department of Emergency Medicine is recruiting for full-time Research Director. The UCAD DEM includes a Comprehensive ED with a census of 38,000; a basic ED with a census of 18,000; clinical programs in Hyperbaric Medicine and Medical Toxicology; a node of the California Poison System; a busy Paramedic Base Hospital; an air medical service; a regional DMAT; a PGY 24 emergency medicine residency; and fellowship training programs in Hyperbarics and Toxicology. There are presently 15 full-time faculty in the department with plans to expand to 17 July 1, 2001. Will consider candidates with PhD or MD degree. Physician applicants must be EM board certified with California medical license or eligible to apply. Formal training and prior research experience required. Established extramural funding desirable. Appointment level and salary commensurate with qualifications and experience; salary per established UCAD salary scale. Reply to David A. Guss, MD, Director, Department of Emergency Medicine, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8676; 619-543-6217; email: dguss@ucsd.edu. AA/OE UNIVERSITY OF CALIFORNIA, San Diego: Department of Emergency Medicine is recruiting for full-time faculty positions starting July 1, 2001.

The UCSD DEM includes a Comprehensive ED with a census of 38,000; a basic ED with a census of 18,000; clinical programs in Hyperbaric Medicine and Medical Toxicology; a node of the California Poison System; a busy Paramedic Base Hospital; and air medical service; a regional DMAT; a PGY 2-4 emergency medicine residency; and fellowship training programs in Hyperbarics and Toxicology. EM board certification

UNIVERSITY OF CALIFORNIA, DAVIS is recruiting for a full-time faculty in Academic Emergency Medicine at the Assistant, Associate or Full Professor level. Eligible candidates must be board certified in Emergency Medicine, or anticipate graduation from an RRC-approved training program in Emergency Medicine. Individual must be eligible for licensure in the state training program in Emergency Medicine. Individual must be eligible for licensure in the State of California. Candidate must have a minimum of one recent publication in an Emergency Medicine journal and presented an abstract at a national scientific meeting. The UC Davis Emergency Department is located in Sacramento, California. It sees 65,000 patient visits per year, has 29 Emergency Medicine residents, an aeromedical program, and a critical trauma volume placing it in the top five busiest programs nationally. Responsibilities of the position include: Clinical care, teaching of medical students and residents, and a commitment to clinical research in the area of Emergency Medicine.

For consideration, send a letter outlining your research, teaching background and interests, administrative experience, curriculum vitae, and a list of five references to: Donna Kinser, MD,; Chair, Emergency Medicine Search Committee, University of California, Davis, Health System; 2315 Stockton Blvd., PSSG 2100; Sacramento, CA 95817. Position is open until filled, but not later than January 31, 2001. The University is an Affirmative Action/Equal Opportunity employer.

Emergency Medicine at Northwestern University School of Medicine Applications are invited for full-time faculty in the Division of Emergency Medicine (open rank). The Attending Physician, Emergency Medicine is responsible for clinical practice in the Emergency Department of Northwestern Memorial Hospital, for the teaching of residents and medical students, and for demonstration of academic productivity. The newly build (1999) Emergency Department serves over 60,000 patients/year and serves as a Level 1 Trauma Center for the city of Chicago. The residency program has enrolled its 27th class, currently accepting 7 EM residents/ year. The hospital is committed to service excellence and innovation. Applicants for this faculty position must have completed residency training in emergency medicine. Preference will be given to applicants with demonstrated research interest and to those who will serve as exceptional role models for residents and medical students. Women and minorities are encouraged to apply. Salary is commensurate with experience. Proposed start date is September 1, 2000. To ensure full consideration, please send a curriculum vitae, along with a brief description of career interests, prior to September 1, 2000, at: JAMES ADAMS, MD NORTHWESTERN UNIVERSITY SCHOOL OF MEDICINE DIVISION OF EMERGENCY MEDICINE 216 E. SUPERIOR STREET, SUITE 100 CHICAGO, IL 60611 Northwestern University is an Affirmative Action/Equal Opportunity Employer. Hiring is contingent upon eligibility to work in the United States.

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

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

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

EMERGENCY MEDICINE RESEARCH ASSOCIATE The Department of Emergency Medicine at Maimonides Medical Center in Brooklyn, New York is seeking a Research Associate.

The emergency department is advancing an academic and research theme based on operations research of clinical service delivery and evidence-based emergency medicine. We are exploring establishment of an emergency medicine residency program. Credentials appropriate to support academic appointment at our university affiliation are required.

The department serves over 75,000 patients annually from diverse cultural backgrounds in a unique community setting. PhD applicants with clinical research experience are preferred. The salary and benefits are competitive.

Mail CV to Daniel G. Murphy, MD, Vice Chairman and Medical Director, Department of Emergency Medicine, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, New York, 11219, or e-mail to dmurphy@ maimonidesmed.org.

UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS. BC/BE ED Physician for Level I Trauma Center with 33,000 visits/year. Clinical teaching responsibilities for Medicine, Pediatric, Family Medicine and Surgery housestaff. Clinical research opportunities. Flight physician opportunities on helicopter critical care transport service (>1,200 flights/ year). Premiere health care facility and tertiary referral center providing care to patients with the widest array of diagnoses providing a stimulating and challenging clinical environment. Superb living standard in a very desirable community with a highly respected University. Competitive salary, benefits and clinical workload. Phone: 608-263-1325; Fax 608-262-2641; jrc@medicine.wisc.edu

FACULTY POSITIONS Dept. of EM • Tufts University School of Medicine Baystate Medical Center • Springfield, MA 01199 www.baystatehealth.com Senior Emergency Medicine Researcher: Seeking an emergency medicine researcher with experience in clinical research and grant writing. The position includes significant protected time; minimal clinical and administrative responsibilities; competitive salary (AAMC Standards) not based on grant support; departmental research staff including a clinical nurse researcher, a team of EM research faculty; office space and secretarial support; an academic appointment with Tufts University School of Medicine consistent with experience and publications.

Pediatrics Emergency Medicine: Seeking BC/BE physician board certified or board eligible in Pediatric Emergency Medicine to join a regional trauma center with a fully-accredited Emergency Medicine Residency Training Program and a Children’s Hospital. Opportunities include a full unencumbered medical school academic appointment and an active clinical research program. You will serve as an attending physician in the Pediatric Emergency Department and develop and direct a Pediatric Emergency Medicine Fellowship Program.

Emergency Medicine Physicians: Seeking BC/BE emergency medicine physicians, residency trained in Emergency Medicine, for full-time positions (open rank) available with patient care, teaching, and clinical research responsibilities. Salary and academic rank commensurate with accomplishments and experience.

Baystate Medical Center is a Level 1 Trauma Center, 600-bed hospital with an annual ED census of 85,000 in Western Massachusetts, Baystate Medical Center has a PGY1-3 emergency medicine residency with 8 residents per year and was recently named one of the top 15 major teaching hospitals in the United States for clinical excellence and efficient delivery of care (HCIA and The Health Network).

Springfield is located in the beautiful Connecticut River Valley at the foothills of the Berkshires with convenient access to coastal New England, Vermont and metropolitan Boston and New York.

The area also supports a rich network of academic institutions including the University of Massachusetts and Amherst, Smith, Hampshire and Mount Holyoke Colleges.

Please send your letter of interest with curriculum vitae to: Philip Henneman, MD, Professor and Chair Dept .of Emergency Medicine, Tufts University School of Medicine c/o Don Rainwater • Baystate Health System 759 Chestnut Street, Suite S1578 • Springfield, MA 01199 Telephone: (800) 767-6612 • Fax: (413) 794-5059 • Email: Don.Rainwater@bhs.org

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

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

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

Baystate Health System is an Equal Opportunity Employer

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NORTH CAROLINA:

North Carolina: Opening for Director of

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

Salary and benefits are extremely competitive.

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

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

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

ACADEMIC EMERGENCY PHYSICIAN

WEST VIRGINIA UNIVERSITY EMERGENCY MEDICINE CHAIR

SOUTH CENTRAL PENNSYLVANIA

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

These materials should provide evidence of qualifications as noted above.

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

Women and minorities are encouraged to apply.

www.wellspan.org 24

D ISTRICT OF C OLUMBIA

T

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

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

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

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

FULL-TIME FACULTY ASSISTANT OR ASSOCIATE PROFESSOR LEVEL The Section of Emergency Medicine at Yale University School of Medicine is recruiting full-time faculty members at the Assistant or Associate Professor level. Our environment offers: • Academic growth with generous protected time to pursue research and scholarly activities.

• All clinical practice at Yale-New Haven Hospital, a Level 1 Trauma Center with over 80,000 ED visits per year • An accredited Emergency Medicine Residency program with 40 residents (PGY-1-4) • An EMS fellowship • Opportunities for collaboration with other faculty in the School of Medicine, School of Public Health and other professional schools in the University Applicants should be residency trained and board certified/ qualified in Emergency Medicine. Salary and academic rank is commensurate with experience and accomplishments.

Send letter of interest and curriculum vitae to: John A. Schriver, MD Chief, Section of Emergency Medicine Department of Surgery Section of Emergency Medicine 464 Congress Avenue, Suite #260 New Haven, CT 06519-1315 Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women and members of minority groups are encouraged to apply.

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2000-2001 SAEM Committee/Task Force Interest Form Deadline: January 15, 2001

Members interested in serving on a committee or task force in 2001-2002 should complete this form or send a letter responding to the questions on this form. Completed forms submitted as an e-mail attachment are preferred, however mail and fax copies are also acceptable. Members are encouraged to review the following materials on the home page at www.saem.org or upon request from the SAEM office: 1. Committee/task force orientation guidelines that detail the role and structure of SAEM committees/task forces.

2. Current 2000-2001 committee/task force objectives.

3. SAEM mission, vision statement, and five year goals and objectives.

The following guidelines will be used: 1. Completed interest forms must be received by January 15, 2001.

2. Members, whether currently serving, or wishing to serve, on a committee/task force must complete the form.

3. Due to the relatively small number of committees/task forces, preference will be given to those who offer thoughtful responses and suggestions on the interest form.

4. Typically, members will serve on one committee or task force at a time.

5. Committee/task force appointments and reappointments will be made by the President-elect by April 2001. The term of appointment is May 2001 to May 2002.

6. Committee/task force members are expected to attend the meetings and participate in the committee/task force activities. All committees/task forces meet at the SAEM Annual Meeting and many meet at the ACEP Scientific Assembly.

7. Individuals must be SAEM members to serve on a committee/task force.

8. Whenever possible, at least one resident will be appointed to each committee/task force.

1. Which description best characterizes you?

M EM resident, will finish in _____ (year) M Faculty member without previous SAEM committee or task force participation M Faculty member with previous SAEM committee or task force participation M Other: ____________________________________________________________________________________________ 2. Is there a particular committee or task force in which you are interested? M Yes M No Explain: _____________________________________________________________________________________________ ____________________________________________________________________________________________________ 3. Is there a particular objective in which you are interested? M Yes M No Explain: _____________________________________________________________________________________________ ____________________________________________________________________________________________________ 4. Do you belong to an SAEM interest group? M Yes M No If yes, which one(s):____________________________________________________________________________________ 5. What specific objectives or tasks do you think SAEM should pursue in the coming year? ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ 6. Have you previously served on an SAEM committee or task force? M Yes M No If yes, list name of committee/task force and time period served:_________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Name:_______________________________________________________________________________________ Institution:____________________________________________________________________________________ E-mail address:________________________________________________________________________________ Return to SAEM at 901 N. Washington Ave., Lansing, MI 48906, fax (517-485-0801), or e-mail at saem@saem.org 26

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

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

DO

PhD Other____________

Home Address_________________________________________________________ Birthdate____________________ Sex: M

F

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

Home

Business

Telephone: Home (_______)________________________________

Business (_______)________________________________

FAX: (_______)____________________________________________

E-mail:__________________________________________

Faculty Appointment and Institution _______________________________________________________________________________ Membership benefits include: • subscription to SAEM’s monthly, peer-reviewed journal, Academic Emergency Medicine • subscription to the bimonthly SAEM Newsletter • reduced registration fee to attend the SAEM Annual Meeting Check membership category:

□ Active

□ Associate

□ Resident

□ Fellow

□ Medical Student

Active: open to individuals (a) with an advanced degree who hold a medical school or university faculty appointment and actively participate in acute, emergency, or critical care in an administrative, teaching or research capacity; (b) with similar degrees in active military service or (c) who otherwise meet qualifications but who do not hold a faculty appointment and who petition the Membership Committee. Annual dues are $295 plus a $25 initiation fee payable when the application is submitted. The application must be accompanied by a CV and a letter verifying the faculty appointment.

Associate: open to health professionals, educators, government officials, members of lay or civic groups, or members of the public who have an interest in Emergency Medicine. Annual dues are $275 plus a $25 initiation fee payable when the application is submitted.

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

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

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

M domestic violence research M ems M ethics M evidence-based medicine M geriatrics M health services & outcomes research

M injury prevention M international M medical student educators M neurologic emergencies M pain management M pediatric emergency medicine

M research directors M shock/trauma M substance abuse M toxicology M ultrasound M youth violence prevention

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

Signature of applicant___________________________________________________________________ Date__________________ 27

NEWSLETTER

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

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

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

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

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

CALL FOR ABSTRACTS 2001 Annual Meeting May 6-9 — Atlanta The Program Committee is accepting abstracts for review for oral and poster presentation at the 2001 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/ out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obstetrics/gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The deadline for submission of abstracts is January 9, 2001 at 3:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted.

The abstract submission form and instructions will be available on the SAEM web site at www.saem.org by November 1, 2000. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Only reports of original research may be submitted. The data must not have been published in manuscript or abstract form or presented at a national medical scientific meeting prior to the 2001 SAEM Annual Meeting.

Original abstracts presented at other national meetings within 30 days prior to the 2001 Annual Meeting will be considered.

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

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