September-October 2001

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE Funding for Emergency Medicine Initiatives Emergency Medicine has come a long way in the past 25-30 years.

The number of residency programs has grown tremendously and academic departments have sprouted. Yet in comparison to other Marcus Martin, MD more established specialties such as Internal Medicine, Surgery and Pediatrics we still have a great distance to go in terms of funding.

All medical specialties need resources for continued development. Financial resources for emergency medicine are typically derived from revenues generated through patient care.

But generally patient care revenue in academic emergency medicine is not enough due to many reasons such as the payer mix, contractual adjustments, safety net factors leading to high volume of self pay, indigent and free care. Gross collection rates average around 50% for most emergency departments, with many struggling to attain that level. Improved documentation, accurate coding and appropriate levels of reimbursement by the third party payors can all help.

Department chairs, medical directors and business managers are challenged with the goal (at minimum) to obtain budget neutrality after compensating for salaries, benefits and all other expenses including; supplies, equipment, dean’s taxes, travel, billing and collection fees, etc. Beyond budget neutrality is the desire to obtain resources for salary raises, incentive pay, contributions to reserve and ample funds left to support various academic endeavors.

When patient care revenue alone is not enough to subsidize expenses, our operations may depend upon allotments from the hospital and the medical school to make ends meet.

We have been referred to throughout the history of emergency medicine as loss leaders for the hospital, although we know the downstream effect is very positive for hospitals. The emergency department evaluates, stabilizes and admits to the hospital and the hospital derives income from this process.

Patients treated and released from the ED, as well as those admitted, are revenue sources for the health system as the hospital bills for the patient encounter. There is also the downstream effect of revenue generation for clinics and ancillary services.

Academic emergency medicine must look to other sources of funding in addition to patient care revenue and hospital and (continued on page 18)

September/October 2001 Volume XIII, Number 5

Emergency Medicine Activities at the AAMC Annual Meeting The Association of Academic Chairs of Emergency Medicine (AACEM) and SAEM have developed a number of educational sessions to be held on November 4 during the AAMC Annual Meeting. The sessions will be held at the Omni Shoreham Hotel in Washington, DC. All emergency physicians are invited to attend any of the sessions described below at no charge. However, pre-registration for the lunch session is required. Please register for the lunch session via e-mail at saem@saem.org. Contact the SAEM office with any questions.

The sessions begin in the Senate Room at 9:00 am with a presentation entitled, “Preserving the Emergency Medicine Safety Net.” Panelists will include James Hoekstra, MD, James Gordon, MD, and Lynne Richardson, MD. At 11:00 am a session entitled, “NIH Funding Opportunities for Patient-oriented Research” will feature Belinda Seto, PhD, Director of the Office of Reports and Analysis (ORA) and Deputy Director of the Office of Extramural Research (OER). Dr. Seto is responsible for developing and maintaining the Computerized Retrieval of (continued on page 13)

AEM Call for Papers “Assuring Quality” The Editors of Academic Emergency Medicine announce the next AEM Consensus Conference on “Assuring Quality” to be held on May 18 in St. Louis. The conference will aim to describe means of defining, assessing, measuring, and researching the delivery of quality emergency care in the clinical setting. We believe the conference is a logical progression in our consensus series, which has included “Errors in Emergency Medicine,” and “The Unraveling Safety Net.” We therefore issue this call for papers related to the topic of Assuring Quality. Submitted manuscripts are due on March 1, 2002. Accepted papers will be published in the late fall of 2002, along with Proceedings from the consensus conference.

Please submit eligible papers to the AEM editorial office in Lansing at aem@saem.org. Electronic submission of the original and a blinded copy are preferred. Submit also a cover letter clearly indicating that your submission is for the Assuring Quality Consensus Conference. General instructions for authors appear at www.saem.org/inform/journal.htm.

Any questions regarding this call for papers on the AEM Consensus Conference can be directed to Michelle Biros, MD, at biros001@maroon.tc.umn.edu or Jim Adams, MD, at: jadams@nmh.org.

Tales . . . Better Early Than Not At All Marcus L. Martin, MD University of Virginia SAEM President This is another tale from the crib (home). Summer has quickly come to an end and we are squarely in the midst of fall activities. It is back to school, football, soccer and other activities of the season. I always enjoy this time of year as we harvest the fruits of our labor from seeds sown earlier during the year. The fall foliage colors of red, gold, yellow and orange are worn brightly by the flowers, trees and the pleasantly surprising plants which during the summer appeared as weeds. The pumpkins and gourds come alive.

Soon Halloween will be upon us. I had many opportunities to participate in Halloween outings with my children over the years. A lot of them quite memorable including the time we trooped around in the heavy snow in Pittsburgh on Halloween night. I have also had opportunities to attend many fun filled Halloween parties sponsored by the emergency medicine residents. My wife, although not fond of the ghoulish Halloween celebration due to the devilish representation generally would concede and allow me to take our children out "trick or treating". I was always sure to help choose the costumes and accompany my children around the neighborhood "trick-or-treating" when I could. Alternatively, I would be the one to stay at home and greet the neighborhood kids at the door who gleefully donned their scary and colorful costumes. Overdressed at times, my kids movements were impeded and they would run into mailboxes bumping their heads or take a tumble down the slippery hillside into the leaves spilling out all their candy and ultimately bringing more leaves home in their bags than candy. These mild traumatic and infrequent events were a result of the kids hurrying to the next neighbor’s house to get candy. We all experience a few hard knocks and spills from slippery slopes as we progress in life.

For some reason, while in Cincinnati during my first year as a resident, Halloween was celebrated in our neighborhood on October 30, not October 31.

The next year on October 30, we got the kids dressed in their costumes and me in my "Dr. Blood" outfit. We lit the candle in the pumpkin, whose face we had carved the night before and placed it at

the entrance of our front doorway. We took some photos and had some laughs and waited until it got dark. Usually the next door kids would be knocking on our door immediately upon dusk. However, the neighborhood was quiet. We went outside to get the "trick or treating" started. We looked out and there were no lights except the one glowing in our pumpkin. Before knocking on anyone’s door, we came suddenly to realize that we were celebrating one day too early.

Unlike the previous year, Halloween would not be celebrated on October 30 this time but on the traditional October 31. We were one day early but no one noticed our single family celebration.

Needless to say we got a great laugh out of it all and carried fond memories for many years thereafter. Of course, as my resident’s schedule would have it, I had to work the next evening so it was better to be one day early to have fun with the kids than not at all.

I had many opportunities to participate in Halloween outings with my children over the years. You may or may not celebrate Halloween activities but many children do. I hope it’s a safe one in your neighborhood. Have a great fall. Enjoy the foliage and let’s be early or on time in accomplishing the SAEM objectives.

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 2001 will receive membership benefits through January 15, 2003 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 Newsletter and can also be submitted electronically from the 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.

Examples include the continued development of Academic Emergency Medicine, increased funding for Society research grants (see the Call for Grants in this newsletter) an ever-increasing Annual Meeting and the research presented at it, 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.

From the Diary of a Virtual Advisor Wendy Coates, MD Harbor-UCLA Medical Center On a sunny Saturday afternoon in July, I hosted a pool party and barbecue for my medical school advisees. The goal was to develop a network so the students could look to each other for support on their journey to apply for an EM residency. What made it an especially interesting meeting was a surprise visit from my "virtual advisee" from Kansas who was passing through Huntington Beach, CA that afternoon.

She was on her way to an EM rotation in northern CA from San Diego where she had just won a triathlon. As she slipped into her place around the table, her concern for her new colleagues from southern CA turned into an exchange of ideas and proved to be a positive experience for all. As she stocked up on fruit for the 2

6 hour drive that lay ahead, we said good-bye to my "virtual advisee." As the gate shut, one local student remarked that he had never met anyone from Kansas before. Another commented that she felt lucky to have such easy access to an advisor nearby. There are many other "virtual advisees" waiting to be paired with someone like you. Won’t you consider giving them the gift of your wisdom by signing up to be a Virtual Advisor today? http://www.saem.org/advisor/index.htm

Visit AEM online at www.aemj.org

Call for Nominations Deadline: February 1, 2002 Nominations are sought for the SAEM elections which will be held in the spring of 2002 via mail or electronic ballot. 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, Committee/Task Force or President-elect) to consider the responsibilities and expectations of an SAEM elected position. Orientation guidelines are available 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 and should include the candidate's CV and a cover letter describing the candidate's qualifications and previous SAEM activities. Nominations are sought for the following positions: President-elect: The President-elect serves one year as President-elect, one year as President, and one year as Past President.

Candidates are usually members of the Board of Directors.

Secretary/Treasurer: The Secretary/Treasurer serves a three-year term on the Board. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces and are usually members of the Board.

Board of Directors: Two members will be elected to three-year terms on the Board. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces.

Resident Board Member: The resident member is elected to a one-year term and is a full voting member of the Board. Candidates must be a resident during the entire term on the Board (May 2002-May 2003) and 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: One member will be elected to a two-year term. The Nominating Committee selects the recipients of the SAEM awards (Young Investigator, Academic Excellence, and Leadership) and develops the slate of nominees for the elected positions. 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 term, the final year as the chair of the Committee. The Committee reviews the Constitution and Bylaws and makes recommendations to the Board for amendments to be considered by the membership. Candidates should have considerable experience and leadership on SAEM committees and task forces.

Faculty Development Conference:

AEM Call for Papers “Best Practices”

Navigating the Academic Waters

The Council of Emergency Medicine Residency Directors (CORD) is sponsoring a Consensus Conference to present and discuss “best practice” models in emergency medicine, residency education.

The conference will be held March 2-4, 2002 in Washington, DC. This conference will highlight models to incorporate the six new ACGME core competencies into educational programs, and will also explore “best practices” in other important areas of the emergency medicine curriculum. In addition, topics related to evaluation and assessment of the effectiveness of educational curricula will be discussed.

Manuscripts relevant to these topics are being solicited for consideration of publication in Academic Emergency Medicine. The deadline for receipt of manuscripts is December 15, 2001. Instructions for authors appear on the website at www.saem.org/inform/journal.htm. Send manuscripts, including one blinded copy, one original copy, and an author copyright and disclosure form to AEM (preferably electronic to aem@saem.org). Be sure to specify that the manuscript is for the Best Practices issue. Any questions can be directed to Michelle Biros, MD, at biros001@maroon.tc.umn.edu.

March 2-4, 2002 – 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, presentations skills, resident evaluation, mentoring and clinical teaching, as well as time and personal management. This course nicely augments the ongoing efforts made by SAEM in the area of faculty development. Young faculty or senior residents interested in an academic career should contact the CORD/AACEM office at 517-485-5484 or the CORD web site at www.cordem.org. Registration is limited to 125 people, so call today!

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University of Pittsburgh Secures AHRQ Grant to Study Heart Failure Clifton Callaway, MD, PhD University of Pittsburgh SAEM Research Committee Donald M. Yealy, MD, Professor and Vice-Chairman in the Department of Emergency Medicine at the University of Pittsburgh, recently received an investigator-initiated project grant (R01) from the Agency for Health Care Research and Quality (AHRQ) entitled "An Empiric Risk Stratification Rule for Heart Failure." The broad aim of the project is to derive a practical clinical decision rule that could identify patients presenting with heart failure who are at low risk of death or short-term medical complications. Theoretically, these low-risk heart failure patients, if reliably identified, might be candidates for discharge from the emergency department rather than admission to the hospital. Heart failure remains one of the leading diagnoses for hospital admission in the United States, and thereby accounts for a large proportion of healthcare expenditures.

The investigators at the University of Pittsburgh will capitalize on a Pennsylvania database of information about key clinical findings in all hospital admissions. Multivariate analysis of this database will seek to determine if information available to the physician at the time of initial evaluation could be used to

identify patients who did not die within 30 days. The second part of the project will determine whether the model derived in that step also predicts admission to intensive care, hospital length of stay and readmission to the hospital within 30 days. While the Pennsylvania database is large enough to allow validation of predictive models on subsets of retrospective data that were not included in model derivation, prospective validation of any derived rule will constitute the next logical step after this project.

Development of the heart failure project represented a logical progression of the group research interests from their prior work on community-acquired pneumonia. In the mid 1990’s, investigators in the Department of Medicine approached Dr. Yealy and the Department of Emergency Medicine faculty for input on how to implement a clinical decision rule for pneumonia patients. The rule that existed previously had been developed using similar statistical techniques by non-emergency physicians. Reflecting this fact, the rule required input data that were not always available or that could not be applied practically in the emergency department. Collaboratively, emergency medicine and medicine investigators, funded

by AHRQ grants in the Department of (continued on page 8)

Information on Federally Funded Grants Sought The SAEM Research Committee would like to list and highlight Emergency Medicine research that is supported by NIH or other federal agencies. The Research Committee will prepare articles about projects that demonstrate unique collaborations or innovative approaches. The primary purpose of these articles is to provide positive examples for other members on their way to achieving federal funding.

Projects that illustrate how a smaller endeavor matures into a research program that can be funded at the federal level are of particular interest.

Furthermore, we hope to list the titles/topics of ongoing projects as a resource for members seeking expertise in particular fields.

If you are a Principal or CoInvestigator for a current program or project grant supported by NIH, AHRQ, CDC or other federal funding, we invite you to notify the Research Committee of your project on an ongoing basis.

The Research Committee will try to publicize new projects in Emergency Medicine research and to point out resources for members seeking expertise in particular fields. Send any information to Clifton Callaway, MD, PhD, at callawaycw@msx.upmc.edu or to SAEM at saem@saem.org.

An Online Source for Research Funding Opportunities Robert N. Bilkovski, MD Christ Hospital SAEM Research Committee A number of internet resources can be used to remain up-to-date on current research funding opportunities. One example is the Community of Science (COS), an internet site dedicated to the research and development community throughout the world. More than 480,000 individual members utilize COS to find research funding opportunities, track currently funded research and collaborate with colleagues sharing similar research interests. The COS database represents universities, corporations and government agencies worldwide.

The COS funding opportunities are updated daily and contain in excess of 400,000 funding opportunities.

Subscribers can receive weekly updates reflecting funding opportunities in their area of expertise and interests.

Furthermore, COS members can track

information on recent funding based on institution, funding agency and/or theme. The funding opportunities are not limited to the field of medicine but include all of the sciences (i.e. math, engineering, medicine), social and behavioral sciences, arts and humanities as well as technology and computer sciences.

One feature of the COS site is a searchable database of funding sources. On a recent visit to the site, entering the search term "emergency medicine" resulted in 52 hits for potential funding opportunities. All of the EMF, ACEP, and SAEM grant programs were listed, but numerous less familiar research grant sources were identified as well. These included the non profit Medisan and Pharmalink organization in Sweden which funds research on vol4

ume replacement and small volume resuscitation and the International Trauma Anesthesia & Critical Care Society which provides pilot funding for research in the general fields of perioperative trauma, anesthesia, emergency medicine and critical care, including basic science or clinical research, clinical management, education, or administration.

Finally, special funding opportunities are listed for Federal agencies such as DHHS, CDC, and DOD. Membership to COS is free to members of academic institutions, which should include the majority of this journal's audience. For more information on the Community of Science, visit www.cos.com.

Letter to ACC/AHA on Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography Published below is the text of a letter that the SAEM Board of Directors sent to the ACC/AHA Task Force that has developed the document, “Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography”. The document is expected to be published in the December issue of the Journal of the American College of Cardiology. The SAEM Board of Directors agreed that it was important to distribute SAEM’s response to the document to the SAEM membership. The SAEM Board of Directors is also expected to approve an editorial on this topic that is currently under development. The editorial will appear in the emergency medicine literature in the next few months.

The Board of Directors of the Society for Academic Emergency Medicine recently received the final draft of the ACC/AHA Clinical Competence Statement On Electrocardiography. We understand that this document is to be published shortly, and that you have requested an endorsement by our organization. The SAEM Board of Directors does NOT endorse the document in its current state.

The Board acknowledges and thanks you for inviting our participation. Your gracious inclusion of the representation from Emergency Medicine no doubt reflects the recognition of the role emergency physicians play in ECG interpretation and patient care decision making each day across the United States.

There are over one hundred million patient visits per year to emergency departments throughout the country.

Many of these patients receive ECGs as part of their evaluation, with important clinical management decisions made by the emergency physicians who order the tracings. We feel that the ECG document has overlooked the important role of emergency physicians who interpret millions of ECGs annually and are trained during their residency to do so.

A more detailed analysis is required to establish the minimum education/training, experience, cognitive and technical skills necessary for competent performance of electrocardiogram interpretation in the emergency setting. The SAEM Board of Directors does not feel that the American College of Cardiology’s Task Force on Clinical Competence can define minimum competencies for emergency physicians.

Patient care treatment decisions are made in the emergency department on a real time basis. Although back up support is important for all types of patient care in the emergency department post care "overread" of ECGs by "experienced ECG interpreters" for quality assurance generally does not factor into the immediate care rendered to the emergency patient. ECGs are best interpreted in accordance with the clinical situation at hand. Emergency physicians are in the unique position to inter-

pret the ECG real time, both optimizing the patient care and likelihood of successful clinical outcome. The SAEM Board of Directors feels that "real time" ECG interpretation is more beneficial to patient care than secondary overreads after the opportunity for intervention has passed.

We recognize that emergency physicians must receive sufficient training to be considered competent to provide appropriate clinical interpretations of ECGs. Emergency Medicine residents learn ECG interpretation through didactic sessions, clinical case conferences and in the ED while caring for patients under direct supervision of board-certified emergency medicine attending faculty. Moreover, the certification examinations conducted by the American Board of Emergency Medicine, include questions based on correct interpretation of ECGs and rhythm strips. During the course of training, EM residents are involved in the interpretation of hundreds of ECG tracings. However, there has not been an established minimum number of ECG interpretations and hours of training necessary for emergency physicians to be considered competent to provide clinical ECG interpretations. On page 14 of the document it is stated "while there is no scientific study to rely upon, we estimate that most physicians can obtain competence after reading at least 500 tracings under supervision of an expert electrocardiographer". You admit there is no evidenced-based study to set a standard so your recommendation is only an opinion and not necessarily appropriate for emergency medicine.

According to the ACC/AHA ECG document "as the assessment of competency is complex and multidimensional, isolated recommendations contained herein may not necessarily be sufficient nor appropriate for judging overall competency". We agree with that statement.

It is further stated on page 5 of the document "it is recognized that other physicians not meeting these criteria may provide preliminary interpretations of ECGs in selected circumstances such as emergencies and settings where a 5

formally trained physician is not physically available". It further states, " in such circumstances a formally trained physician should be accessible to provide back up support". If by "formally trained physician" the committee refers to an "expert electrocardiographer", we would agree that such consultation should be readily available to the emergency physician 24 hours a day.

On page 16 in the document it is stated "however, as valid, reliable and widely available standardized ECG exams become more widely accepted, such as the ABIM ICE ECG exam, we recommend they become the primary pathway by 2005 outside of cardiology board certification to demonstrate competence for granting initial ECG overreading privileges to physicians not previously credentialed." The process of credentialing physicians to provide ECG ‘overreading privileges’ sets a different level of competence and mastery of electrocardiography. This standard does not apply to the set of skills needed to provide sound clinical decision making by physicians who interpret ECGs in the emergency department setting.

In summary, the clinical competency statement developed by the Task Force may be suitable to assist hospitals in the process of credentialing cardiologists and other physicians who seek recognition to provide ECG overreading privileges. However, the guidelines are not suitable for determining the competence of emergency physicians to provide clinical ECG interpretation and related patient care decisions. Competencies for the interpretation of electrocardiogram in the emergency department setting must be established by colleagues in our own specialty.

We appreciate the efforts of the Task Force in developing the clinical competency statement on ECG’s, but at this time SAEM will not endorse it as it is currently written. We request you remove any reference in the document to SAEM.

Call for Photographs Deadline for receipt: February 15, 2002 Original photographs are invited for presentation at the SAEM 2002 Annual Meeting in St. Louis. Photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data may be submitted. Submissions should depict findings that are pathognomonic for a particular diagnosis relevant to the practice of emergency medicine or findings of unusual interest that have educational value. Accepted submissions will be mounted by SAEM and presented in the "Clinical Pearls" session and/or the "Visual Diagnosis" medical student/resident contest.

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

Photo submissions must be accompanied by a case history written as an "unknown" in the following format: 1. Chief complaint 2. History of present illness 3. Pertinent physical exam 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 with at least one blank line between sections. The case history MUST be submitted as an email attachment to saem@saem.org. If accepted for display SAEM reserves the right to edit the submitted case history.

Submissions will be selected based on their educational merit, relevance to emergency medicine, quality of the photograph, the case history, and appropriateness for public display. Contributors will be acknowledged and photos will be returned after the 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, where necessary, must accompany submissions and include a release of responsibility.

All submissions will be considered for publication in Academic Emergency Medicine. In addition, SAEM reserves the right to post selected images and case histories on the SAEM website for teaching purposes. Submitters will be acknowledged. SAEM will retain the rights to use submitted photographs 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.

S A E M

Call for Nominations Young Investigator Award Deadline: December 15, 2001

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 mentor-trainee relationship.

3. Academic accomplishments which may include: a. postgraduate training/education: research fellowship, master’s program, doctoral program, etc. b. publications: abstracts, papers, review articles, chapters, case reports, etc. c. research grant awards d. presentations at national research meetings e. research awards/recognition The deadline for the submission of nominations is December 15, 2001. 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.

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

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Research Training Grant Recipients Report on Their Experiences Sabine Brouxhon, MD, and Craig D. Newgard, MD, were the 2000-2001 recipients of the Resident Research Year Grant (now renamed the Research Training Grant). Both have generously contributed articles outlining their experiences for the benefit of the SAEM membership, especially those considering submitting an application for the 2002-03 grant cycle and those SAEM members who have donated funds to the SAEM Research Endowment to help make the SAEM research grants program possible.

Craig D. Newgard, MD, MPH Harbor-UCLA Medical Center I am currently in the second year of a 2-year emergency medicine research fellowship at Harbor-UCLA Medical Center in Torrance, California. This training opportunity was made possible with the help of the SAEM Resident Research Award.

The following is a recollection of the events that led up to the fellowship and what has since transpired.

By the second year of residency, I knew I wanted to pursue a career in academic emergency medicine and had decided on a research fellowship. Although there were funded research fellowship opportunities within emergency medicine, these positions were uncommon. I had done research as a resident and wanted to remain at Harbor-UCLA for fellowship training to continue these projects and to continue working under my faculty-mentor, Roger J. Lewis MD, PhD. Opportunities seemed vast; however, I needed to find extramural funding to allow the fellowship to materialize. I spent the first six months of my last year of residency filling out grant applications, finalizing the preliminary data that would serve as the basis for my fellowship research, caring for my newborn son, and working as a resident, although not always in that order. I was fortunate to receive both the SAEM Resident Research Award and a F32 National Research Service Award Postdoctoral Fellowship Grant1,2 through the Agency for Healthcare Research and Quality. Two grants were necessary to secure funding for a 2year training period, as the Resident Research Award only provided a single year of funding at the time.

We organized the 2-year period to maximize the training opportunities. I spent the first year in a Master’s of Public Health program in Epidemiology through the UCLA School of Public Health. The MPH program provided a concentrated period of formal research training, embodied in a 12-month version of a 2-year Master’s program. Shortly after starting the graduate program, I realized how little I really knew about research. The experience was enlightening to say the least.

Although becoming a graduate student required an adjustment period, it was an incredible experience. I now recognize the benefit of a dedicated period of study towards methodology, design, analysis, and formal statistics. I can finally do much of my own data management and analysis on projects for which I previously spent months awaiting assistance. The program provided research tools that I plan to use throughout my career.

In addition to the graduate program, I spent the first year finishing a number of smaller projects, working clinical shifts in the ED, and building the infrastructure for the main fellowship project entitled, "Prospective Validation of a Clinical Decision Rule for the Triage of Pediatric Patients Involved as Passengers in Motor Vehicle Collisions." The project entails the validation of a clinical decision rule that we previously developed from a national database and includes 22 paramedic squads and 28 pediatric receiving hospitals. Being the principal investigator of such a project has provided a wealth of insight into the complexities of carrying out a multi-center study. Some of these challenges include working with many different Institution Review Boards, securing Federalwide

Sabine Brouxhon, MD University of Rochester My experience from the resident research fellowship has been challenging and immensely rewarding, full of hurdles and successes. Having been asked to share with you these experiences has prompted me to recollect 12 months of hard work that would have not come to fruition without the award from SAEM. On a November afternoon, I realized how little time there was left to prepare a competitive application, and I was filled by a myriad of questions with unknown answers.

Although the importance of research training is strongly advocated throughout academia, the majority of EM training programs include little research time in their curriculum. Their primary focus is on preparing physicians for a career in clinical EM with only a limited research project within the three or four year curriculum. However, personal dreams to pursue translational research, as well as the desire to strengthen basic science training in the field of Emergency Medicine, propelled me through a wall of fears and uncertainties.

In my opinion, the research fellowship objective is to invest in the future of the specialty by supporting dedicated residents with special interests and potential to gain training in areas far beyond the clinical field, and to bring this knowledge back to EM. As I mentally prepare myself now to sketch a future in academic EM, it has become clear that the benefits of the research year far outweighed the obstacles. This year has afforded me the time and post-doctoral training to obtain preliminary data necessary for additional research funding (EMF/NIH) so as to secure protected time away from clinical responsibilities. It has also enabled me to forge interdepartmental collaborations, learn an array of molecular techniques and gain insight into submitting grant proposals in compliance with UCAR (university committee on animal resources) and IRB (institutional review board for human research) regulations. These elements are invaluable for any resident considering a future in academic research. Indeed, the recently established two-year SAEM fellowship with a respectful stipend will provide young investigators the opportunity to enhance their research background by allowing adequate post-doctoral research training.

Another important aspect in pursuing an academic career is choosing an established mentor who will lay down a strong foundation from which one's research efforts will blossom. The mentor should have adequate NIH or ancillary funding to support the financial expenses, and the environment must be conducive to learning the appropriate laboratory techniques to obtain preliminary data competitive for future NIH funding.

When I initially submitted the fellowship application, I was unable to locate an academic mentor within the department of EM, but I circumvented this obstacle by finding a mentor with a comparable line of research within the Department of Dermatology. Although far from ideal, my line of research complemented her field of interest and provided an environment with all the molecular tools at my disposal and the structural framework to build a strong foundation for my future academic career.

My research project aimed at elucidating the role of the

(continued on page 8)

(continued on page 8) 7

Research Training Grant Recipients (Continued) Craig D. Newgard, MD, MPH (continued)

Sabine Brouxhon, MD (continued)

Assurances for hospitals, understanding the unique concerns of out-of-hospital research, and conceiving of the project design and methodology. Further, carrying out the project after graduate training allowed me to apply my newfound knowledge and skills while still under the auspices of the fellowship.

I must also mention the benefit of having an excellent mentor. Dr. Lewis not only helped organize the fellowship, but has also provided critical insight into research-related topics and the practical details of organizing and carrying out effective research, many of which are difficult to learn otherwise.

Having an experienced guide to provide feedback, critique, teaching, supervision, and support has been a key component of the fellowship.

I am thankful for the opportunity to allocate a training period dedicated to learning new skills and concepts. Further, I am grateful for funding sources such as the SAEM Resident Research Award and the AHRQ grant that have provided the opportunity to train as a future investigator in emergency medicine. The grants available for such training are becoming more available and more consistent with the amount of time required to complete an effective training program. The SAEM Research Training Grant (formerly the Resident Research Award) now provides $75,000 per year for a 2-year period of training. Although the thought of two additional years of training originally seemed excessive, I now understand the need to dedicate such time to a fellowship, as none of the above objectives would have been effectively accomplished in a single year.

inducible prostaglandin H2 synthase, recently known as COX2 (cyclooxygenase-2), in thermal skin burn injury. This idea began when I was rotating through the Trauma Surgery Department as a second year EM resident, and I was faced with the devastating scars and contractures that developed in patients with deep dermal burns. The idea of having an "inhibitor" of skin burn scaring appealed to me as a potential research project with direct clinical relevance to everyday emergency medicine practice: A relatively inexpensive drug administered early in the disease process could potentially alleviate the long-term sequelae of thermal injury. Although previous studies suggested only modest treatment outcomes from using non-steroidal anti-inflammatory drugs (NSAIDs) that block all forms of cyclooxygenase, such as indomethacin, recent reports indicated a distinct role of COX-2 in cellular homeostasis. Specifically, since COX-2 has been associated with mitosis and cellular proliferation in a number of different tissues and systems, it is possible that COX-2 is also implicated in the development of hypertrophic scars that results from excessive cellular proliferation and reduced apoptosis.

My work involved experiments utilizing human skin cell cultures from patients following reductive mammoplasties.

Furthermore, mice of a special laboratory strain were employed that totally lacked hair (SKh: hairless mice) that allowed for easy access of their skin. In brief, my work demonstrated that COX-2 is implicated in the development of a hypertrophic cellular state following skin thermal injury, as it was spatially and temporally localized within cells undergoing hyper-proliferation at the site of injury. The results, although preliminary, are very interesting as they open new avenues for the management of skin thermal injury in the acute medical setting.

Surprisingly, this year went too fast! It gave me a unique opportunity in my early steps in EM to come closer to the basis of our field, the pathophysiology of the disease at the molecular level. Although the SAEM Award may appear to have given me only a "year-out," in fact, it has changed my professional career by giving me the chance to fulfill my dream of pursuing translational research in EM.

References: 1. Grant # 0099400100.

2. Additional information on this grant program can be found at: http://www.ahcpr.gov/fund/99005.htm

University of Pittsburgh (Continued) Medicine, produced a landmark manuscript (N Engl J Med. 1997 Jan 23;336: 243-250) describing the derivation and validation of a clinical decision rule for community-acquired pneumonia.

Following this, collaboration continued.

A follow-up AHRQ RO1 was funded for $4.9 million beginning in July 1999 to implement the pneumonia decision rule in 32 hospitals, with ongoing collaboration between the two Departments and Dr.Yealy serving as Co-PI and other faculty serving as funded Investigators.

After several years, reports Dr. Yealy, the emergency medicine investigators were facile in the techniques for this type of research and had developed a

track record. The Department of Emergency Medicine had more narrowly focused the academic efforts of a subset of its faculty. Furthermore, the departmental administration was comfortable working with federally funded research after recruiting staff with experience and zeal.

With that background, it was natural to apply the acquired skills in developing clinical decision rules to a new disease.

Because of the potential to have an impact on a large number of hospital admissions and the absence of any other rational triage tools, heart failure was an obvious choice. This time, however, the emergency physicians took the 8

lead in submitting a proposal to AHRQ. Thus, while some of the original investigative team examines whether the decision rule for pneumonia is changing medical practice in the community, others have begun to develop the next decision rule for heart failure.

Letter to the Health Care Financing Administration The following is the text of a letter SAEM sent to the Health Care Financing Administration on August 27, 2001, in regards to the Five Year Review of the Work Relative Value Units Under the Physician Free Schedule (HCFA-1170-PN).

The Society for Academic Emergency Medicine (SAEM) appreciates the opportunity to comment on the Five Year Review of the Work Relative Value Units Under the Physician Fee Schedule published in the Federal Register on June 8, 2001 (HCFA-1170PN). SAEM represents 5000 academic emergency physicians, in teaching hospitals and academic medical centers throughout the United States.

Emergency medicine has been integrally involved in the Relative Value Update Committee (RUC), and has been pleased with the progress of the RUC and the results of the RVU review process. In general, we have relatively few substantial concerns regarding the RVU Five Year Review. Although SAEM is regrettably somewhat late in the game with our concerns, a new issue has surfaced in the practice of emergency medicine, which we believe represents an un-reimbursed physician service that has significant financial and operational implications for our members.

A number of factors have led to a relative shortage of inpatient beds nationally. The U.S. population is growing and aging, resulting in more patients per hospital bed and more need for hospitalization per capita. There is a severe nursing shortage, leaving many inpatient beds unstaffed. Due to financial pressures, many smaller hospitals have been closed, shifting patients to already overcrowded neighboring facilities, and decreasing the total available inpatient beds for many communities. Managed care, despite its best efforts, has not been able to decrease the need for hospitalization across the population. In fact, the financial pressures that managed care has applied to hospitals have limited hospital expansion to keep up with population growth, and limited the supply of nurses and other healthcare providers who often leave medicine to pursue more financial rewarding careers. The result is a relative paucity of inpatient beds nationally, with resultant hospital overcrowding.

Unfortunately, this paucity of inpatient beds has led to a backup of patients in the ED. Patients who are evaluated in the ED and subsequently admitted to the hospital are being forced to stay in the ED for prolonged periods of time due to a lack of inpatient beds.

This hospital overcrowding and subsequent "ED boarding" of admitted

patients has resulted in ED stays on the nature of 2-3 days in some institutions.

In many institutions, admitted patients are being discharged from the ED after their complete 2-3 day hospitalization.

The implications of this crisis of hospital overcrowding are formidable, with ambulance diversion from one hospital to another, separation of patients from their primary physicians, and loss of the ED as a safety net for those persons who are in need of critical, time-sensitive therapies.

This issue is especially important for the SAEM membership, emergency physicians who work in tertiary referral hospitals and emergency medicine residency training programs. These teaching hospitals represent the "last resort" in cities that suffer from overcrowded health care facilities. They tend to receive a large number of transfers from the EDs of private community hospitals, and subsequently suffer a disproportionate share of the hospital overcrowding and ED boarding. Patients with illnesses that require sub-specialty care, trauma patients, burn patients, and the uninsured often crowd the hallways and treatment rooms of these tertiary care EDs while they wait for inpatient beds to become available. Whereas this practice of "admitting and boarding" does not represent optimal care, and whereas SAEM does not support or condone its use in the ED, this practice has become a pervasive reality in the past six months. It is having substantial effects on our practice, and on our financial viability.

At present, patients who are admitted to the hospital, but boarded in the ED, represent a patient population which is un-reimbursed in the CMS physician fee schedule. These patients not only require continual intervention on the part of emergency physicians, but they also occupy ED beds which could be used for other patients who are in need of care. As such, these patients represent a true double-jeopardy situation from a financial standpoint. At present, there is no mechanism for billing for these patients, no CPT code, and no work RVU. Observation codes have been developed for patients who are observed in the ED for a prolonged period of time, but the "admitted and boarded" patients discussed above fall outside of the inclusion criteria for observational care charges. CMS facility fees 9

will reimburse the hospital for these "admitted and boarded" patients whether or not they reach a hospital bed. The emergency physician, however, cannot capture a professional fee for work rendered in the ED on these patients. In institutions where the ED physician is not compensated or subsidized by the hospital, there is no mechanism for reimbursement of these physician services.

SAEM proposes that CMS consider instituting an emergency medicine professional CPT code and RVU for patients who undergo prolonged ED stays after admission to the hospital.

This code would be for patients who are admitted to the hospital but fall outside of the guidelines for ED observational charges. In addition, these charges would not be incurred unless the patient is boarded in the ED for at least 8 hours after their admission to the hospital. It would only be applicable to patients who are admitted to the hospital, but are boarded in the ED due to the unavailability of hospital beds. As would be expected, appropriate documentation would be required to assure active participation on the part of ED physicians in the care of these boarded patients.

The leadership of SAEM has been reviewing and discussing this problem intensely for the past 6 months. The boarding of admitted patients in the ED represents what we believe is sub-optimal care for our patients. Asking for reimbursement for these patients should not be construed as supporting or condoning the activity of prolonged ED boarding. On the contrary, SAEM would encourage CMS or other governmental agencies to work together to limit the practice of ED boarding. Unfortunately, ED boarding is real, and has become a serious issue that has a significant impact financially and operationally in tertiary care EDs. It is limiting the ability of our EDs to provide the medical safety net that our patients require, and it is having a significant impact on our teaching programs.

We welcome the opportunity to discuss this issue with CMS or another appropriate governmental agency. The Society for Academic Emergency Medicine thanks you for your consideration of our views.

Activity Report – Under Represented Minority Mentorship/Research Task Force Glenn Hamilton, MD Chair, Under Represented Member Mentorship/Research Task Force Wright State University Since being given its charge by Marcus Martin, MD, last May, the Under Represented Minority Mentorship/ Research Task Force (URMM/RTF) has been making steady progress: 1. Assignment and expansion of its membership to include a cross country, cross cultural representation.

There are currently 25 members on the committee.

2. Establishment of 18 sites currently (more opportunities are certainly available) who are identified as resource and data sites for the specific projects assigned to the URMM/RTF. 3. Each site has three assignments for this academic year.

A. To identify two minority students who are currently or will have mentorship activity on their behalf relative to research and/or career choices in emergency medicine. These two students are to fall within the AAMC guideline for minority which includes African American, Puerto Rican American, Native American, and Hispanic or Mexican American.

B. Each mentor will work with the two medical students to establish and fulfill a focus group in the area of emergency medicine.

This group will follow several templates and complete survey instruments. The orientation of the focus group is to determine the attitudes and perceptions of these individual minority groups in regards to their thoughts about emergency medicine as a potential career choice.

C. Each site has been requested to create two or more cases following a specific format. Each case will demonstrate the benefit of cultural competency in clinical care. The mentor at the site may continue to work with the medical students or may include residents or faculty in this case development.

4. Each activity at the site has several goals.

A. The identification of mentees will establish a listing of minority indi-

viduals being supported by emergency medicine faculty. This will be important for current and future recruitment efforts.

B. The focus group information will be tallied and plans are being made to present this information at the SAEM Annual Meeting in 2002. In addition, a scholarly paper will be written on the subject and a monograph developed that will discuss how these attitudes and perceptions may be utilized to improve the recruitment efforts of emergency medicine programs toward minority medical students.

C. The cases will be assembled into a case based clinical competency curriculum. This curriculum will use a student workbook and instructor guide to present a variety of cultural insights. The curriculum is anticipated to be expanded over time to have utility as a teaching module in both emergency medicine training programs and potentially medical school curricula.

5. Dr. Martin and I, as well as potential other members of the Task Force, are planning to meet with representatives of the AAMC to present our current activities. We are hopeful this presentation may assist us in sharing our activities with other academic societies, and identifying funding sources for future development of the program.

This effort is built on the previous efforts of SAEM committees over the last several years. It should also create a number of new projects in the future. These may include: 1. A validation effort of the content of the case material. This case material would be presented to representative groups being represented by the case information for clarification and expansion into new areas.

2. Creation of a cultural competency curriculum similar to the SAEM geriatrics curriculum, with the potential for similar long term funding and expansion of projects related to cultural awareness.

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3. Development of other media to assist in cultural competency training such as videos and interactive internet based programs.

4. Establishing a continual series of minority resident and faculty mentorship programs in emergency medicine.

5. Continued brain storming for additional ideas for the future.

Our goal is to have several completed projects at the time of the 2002 Annual Meeting, and to make one or two presentations on the information attained.

This is a critical topic for the Society and the future development and expansion of emergency medicine. We are only at the beginning.

Policy for Non-SAEM Conferences on the SAEM web site On June 12, 2001, the Board of Directors approved a policy in order to post non-SAEM conference information on the SAEM web site. The policy is as follows: 1. In order to provide an opportunity for the SAEM membership to have access to a wide variety of educational opportunities, SAEM invites organizations to submit information on conferences and meetings for posting on the SAEM web site.

2. Conference should be consistent with the SAEM mission of research and education in emergency medicine and should be of interest to SAEM members.

3. SAEM is not responsible for the content of the meetings and does not review them for content, quality, or educational value.

4. Postings are limited to the title, dates, and location of the conference, along with a link to the organization’s conference web site or an e-mail address for informational inquiries.

5. Organizations that wish to submit their conferences for posting on the SAEM web site should send a request and the appropriate information to SAEM at saem@saem.org

Academic Announcements Louis Binder, MD, MetroHealth Medical Center, and Charles Brown, MD, Brody School of Medicine, have been appointed to the Residency Review Committee for Emergency Medicine.

Ann Chinnis, MD, has been appointed Chair of the Department of Emergency Medicine at West Virginia University. Dr. Chinnis has previously served as the Interim Chair.

David C. Cone, MD, has been promoted to Associate Professor at the Yale University School of Medicine. Dr. Cone is the Chief of the Division of EMS and EMS Fellowship Director.

Linda C. Degutis, DrPH, has been promoted to Associate Professor at the Yale University School of Medicine. She is Director of the New Haven Regional Injury Prevention and Control Program and Associate Research Director for the Section of Emergency Medicine, Department of Surgery. She holds a joint appointment in the School of Public Health. Dr. Degutis has also been awarded a Robert Wood Johnson Substance Policy Research Program grant to study Driving While Intoxicated (DWI) Policy in the U.S. and Canada.

Kurt R. Denninghoff, MD, University of Alabama at Birmingham (UAB), received a grant from the U.S. Navy in the amount of $600,000 on the topic of "Eye Oximetry for Trauma Care." This brings his total funding from the Department of Defense for this program to $3,176,000. Dr. Denninghoff is also the Deputy Director for the UAB Comprehensive Youth Violence Center that was recently awarded a $5.7 million dollar grant from the Centers for Disease Control and Prevention (CDC).

Gail D’Onofrio, MD, Yale University, is the principal investigator on a newly awarded three-year R01 NIH grant entitled, "ED Physician Screening and Brief Interventions for Harmful and Hazardous Drinkers."

Jason Haukoos, MD, Harbor-UCLA, has received a two-year National Research Service Award Fellowship.

His project is entitled, "Enhancing Compliance with HIV Testing from the Emergency Department."

Debra Houry, MD, MPH, a third year resident at Denver Health Medical

Center, has been selected by the editors of JAMA to serve on the advisory board of the journal’s newly created resident section. The new board totals eight members, including two medical students, and will develop the new resident section of the journal.

A full academic Department of Emergency Medicine has been established at the University of Arizona College of Medicine as of July 1, 2001.

Harvey Meislin, MD, has been named interim chair and was previously the chief of the Section of Emergency Medicine within the Department of Surgery.

As of July 1, 2001 a full academic Department of Emergency Medicine has been established at Temple University School of Medicine. Robert McNamara, MD, is the chair of the Department.

On August 3, 2001, Jeff Runge, MD, Carolinas Medical Center, was confirmed by the U.S. Senate as the Administrator of the National Highway Traffic Safety Administration. Dr. Runge is an expert in motor vehicle injury care and prevention. As Administrator of NHTSA Dr. Runge will oversee an agency of more than 600 employees and an annual budget of $403 million dollars.

Ellen Taliaferro, MD, Parkland Hospital, has received a $25,000 conference grant from the Agency for Healthcare Research and Quality (AHRQ). The conference will be on the topic of "Medical Care and Domestic Violence."

Robert Wears, MD, University of Florida, Jacksonville, has received a two-year National Patient Safety Foundation grant in the amount of $99,000 for a qualitative research investigation into factors associated with errors (and successes) in EDs. The title of the grant is, "Understanding Errors in Emergency Departments: A Convergence Approach." Dr. Wears has also received an Agency for Healthcare Research and Quality (AHRQ) conference grant for a project entitled, "Organization Factors in Patient Safety." The conference will bring organizational behavior experts and health care executives together to develop a research agenda on high level organizational contributors to safety.

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Many emergency physicians served as reviewers for JAMA in 2000 including: Stephen L. Adams, Paul Auerbach, William Barker, Bill Barsan, Nick Benson, Ed Bernstein, Thomas Brott, Frederick Burkle, Michael Callaham, Brian Cook, Charles Emerman, Michael Fossel, Marianne Gausche, Lewis Goldfrank, Jerris Hedges, Judd Hollander, Raymond Jackson, Andy Jagoda, Gabe Kelen, Ken Kizer, Roger Lewis, Ron Maio, Norm Paradis, James Roberts, Art Sanders, Dave Schriger, Robert Shesser, Jonathan Singer, Ian Stiell, Joe Waeckerle, Robert Wears, and Don Yealy. If SAEM has missed anyone, please contact SAEM at saem@ saem.org.

SAEM members are encouraged to submit academic announcements or promotions, research funding, and other items of interest to the SAEM membership. Submissions should be sent to saem@saem.org and will be edited for length.

Geriatric Emergency Medicine Resident/Fellow Grants Available SAEM, with sponsorship from the John A. Hartford Foundation and the American Geriatric Society, 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 $2,500 for each project.

Applications for the Geriatric Emergency Medicine Resident/ Fellow Grant 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 4, 2002 with notification of selections by May 7 and funding awarded by July 1.

SAEM Board of Directors Update The SAEM Board of Directors meets each month, usually via conference calls. However, face-to-face meetings are held in May during the SAEM Annual Meeting, in the fall at either the ACEP Scientific Assembly or the AAMC Annual Meeting, and in the winter, usually in conjunction with an SAEM Regional Meeting or the CORD Faculty Development Conference.

The next Board meeting will be held during the ACEP Scientific Assembly on Sunday, October 14 at 2:00-6:00 pm. in the Mississippi Room of the Sheraton Chicago Hotel. All SAEM members are invited to attend.

The last Board of Directors Update was published in the November/ December issue of the SAEM Newsletter. This article will highlight the Board’s activities during the period of November 2000 through August 2001.

Research Funding The Board agreed that SAEM should increase its efforts to fund research in emergency medicine. The Board agreed that the Resident Research Year Grant’s name should be changed to the Research Training Grant and that the grant should be expanded to a two year grant and funding should be increased to $75,000 per year. The Board approved the development of a two-year Institutional Research Training Grant with funding in the amount of $75,000 per year.

The Board agreed to discontinue use of the name "Fund for Academic Emergency Medicine" (FAEM) since it was not well known within SAEM. The Board agreed to focus its efforts on the Society’s Research Endowment through the Grants Committee and the Financial Development Committee, especially in regards to coordinating SAEM’s research funding.

Regional Meetings The Board of Directors revised the SAEM regional meeting guidelines and application form. The new regional meeting guidelines can be viewed at www.saem.org/meetings/regguide.htm.

The changes included discontinuing financial grants, but providing additional support including slide sets for medical student forums; financial support to fund Board members if requested by the regional meetings; online abstract submission; and advertising in the SAEM Newsletter, Academic Emergency Medicine, and the SAEM web site. The Board also approved 6 regional meetings in 2001 and is in the process of reviewing 4 applications that have

already been submitted for 2002.

Publications/Manuscripts The Board reviewed several versions of a manuscript on "Filming in the ED" developed by the Ethics Committee. The manuscript will be submitted to Academic Emergency Medicine for consideration of publication and the Board will consider the development of a policy statement on the issue.

The Board also approved the Ethics Committee manuscript, "Guidelines for Research in Cooperation with Biomedical Industry Organizations."

This manuscript was published in the July 2001 issue of AEM and is posted on the SAEM website at www.saem.org/ publicat/ethics.htm.

The Board did not approve the proposed Scope of Training Task Force manuscripts on observation medicine and ultrasound. The Scope of Training Task Force also did not approve of the manuscripts. The Task Force has recommended that the manuscripts be published in the peer-review literature as contributions from the individual authors.

The Board decided not to endorse the proposed ACEP/SAEM manuscript on ultrasound.

The Board approved the development of a 2001-02 Salary Survey to be coordinated by Steve Kristal, MD. The Board agreed to include questions regarding extramural funding. The results will be submitted for consideration of publication in Academic Emergency Medicine.

The Board approved a request from John Gallagher, MD, President of the Association of Academic Chairs of Emergency Medicine (AACEM) for AACEM to cosponsor the SAEM Faculty Development Handbook. The Faculty Development Handbook is posted on the SAEM website at www.saem.org/ facdev/index.htm.

The Board approved a letter to the Health Care Financing Administration on the issue of Relative Value Units. The letter was developed by the National Affairs Task Force, chaired by Jim Hoekstra, MD, and is published in this issue of the Newsletter.

The Board approved the publication of the 2001-02 Membership Directory.

The Board approved a policy on posting non-SAEM conferences on the SAEM website (published in this Newsletter).

The Board endorsed the ACEP policy on Mandatory Report of Disaster-related Injuries and Illnesses.

The Board reviewed and commented on the "Report and Recommendations 12

Regarding Psychiatric Emergency and Crisis Services" which was submitted by the American Psychiatric Association (APA). Dr. Sandra Schneider coordinated the effort to submit comments to the APA. Academic Emergency Medicine The Board approved a funding request from Michelle Biros, MD, Editorin-Chief of AEM, to revise the AEM manuscript tracking database. The database was originally developed about 8 years ago and the proposed revisions are expected to cost approximately $4,0007,000. The Board approved a request from Dr. Biros to revise the AEM mission statement. The Board approved revised AEM Policies and Procedures.

The Board approved a request from Dr. Biros to increase AEM administration funding by $10,000, and to fund a halftime administrative assistant to help Dr. Biros with the administration of the journal. The half-time assistant will be located in Dr. Biros’ office in Minneapolis.

The Board approved funding of up to $5,000 for the 2001 AEM Consensus Conference on the topic of the Unraveling Safety Net. Proceedings and other manuscripts will be published in a special issue of Academic Emergency Medicine in November 2001.

2001 Annual Meeting The Board approved a budget, as proposed by the Program Committee, of $371,500 in revenue and $331,190 in expense for the 2001 Annual Meeting in Atlanta.

The Board approved an increase of $20 in the active and associate member registration fee to attend the 2001 Annual Meeting. The Board agreed to discontinue the FAEM fundraising dinner during the Annual Meeting and discontinued the Kennedy Lecture.

A budget for the 2002 Annual Meeting will be approved in the fall of 2001.

The Board approved three satellite symposia applications submitted for presentation at the 2001 Annual Meeting in Atlanta. The Board approved the educational agendas of three interest groups that submitted agendas for publication in the Annual Meeting on-site program. The Board approved the Geriatric Interest Group’s request to fund a speaker at the Geriatric Interest Group meeting. The Board approved the request to provide expanded space and time for the International Interest Group meeting.

The Board agreed to continue to provide free meeting space at the Annual Meeting for non-SAEM affiliated meetings and organizations. The Board agreed to encourage non-SAEM affiliat-

ed meetings to be held such that they do not conflict with SAEM educational sessions.

Other Activities The Board agreed to waive the fees for all Emergency Care Center Categorization applications received in 2001 and 2002.

The Board approved the 2001-2002 recipients of the Resident Research Year Grants, the Neuroscience Fellowship, the EMS Research Fellowship, the Scholarly Sabbatical Grant, the SAEM/EMF Medical Student Grants, the SAEM/EMF Innovation in Emergency Medicine grant, the Geriatric Emergency Medicine grant, and the Medical Student Interest Group Grants. The Board also approved the recipients of the Young Investigator Awards, the Academic Excellence Award, and the Leadership Award. The Board agreed to consider the development of a Humanitarian Award in 2002.

The Board conducted an informal survey by assigning Board members to contact pediatric emergency physicians and ask for input on what SAEM can do to increase the participate of pediatric emergency physicians in SAEM. (See Roger Lewis’ article on page 6 of the May/June issue of the SAEM Newsletter).

The Board approved the 2001-02 committee and task force objectives as submitted by incoming SAEM president, Marcus Martin, MD. The Board approved four slide sets to assist regional meetings in developing educational sessions for medical students at regional meetings.

The Board approved a series of constitution and bylaws amendments that were proposed to the membership via mail, and subsequently approved by the membership. The most important of these changes allowed the SAEM elections to take place by mail ballot, rather than at the Annual Business Meeting.

The Board approved the slate of nominees as submitted by the Nominating Committee and developed ballots for distribution to the active and resident members of the organization.

The Board approved the development of a long range planning session, including a survey of CAS organizations, in order to assist in projecting SAEM in 2010.

Nominations The Board agreed to nominate Jim Hoekstra, MD, for consideration as a nominee to the Administrative Board of the Council of Academic Societies

(CAS) of the Association of American Medical Colleges (AAMC). The Board submitted a slate of nominees to the Residency Review Committee for Emergency Medicine. As a sponsor of the American Board of Emergency Medicine, the Board submitted a slate of nominees for an open position on ABEM. The Board agreed to submit emergency physician nominees to the Center for Scientific Review.

Representation The Board approved a report on the Task Force on Weapons of Mass Destruction submitted by Mel Otten, MD, who represented SAEM on the Task Force. Dr. Otten’s report is published in this issue of the Newsletter.

The Board received a report from Jim Adams, MD, and Carey Chisholm, MD, who attended a June 28 meeting with representatives of ACEP and ABEM to discuss the Emergency Medicine Continuous Certification program. The major topic of discussion was the development of the Lifelong Learning and Self-Assessment program.

The Board approved Robert Wears, MD, and Jim Adams, MD, to attend a Patient Safety Conference in Chicago.

The Board reviewed and commented on the Rand Report on Pediatric Asthma.

The Board approved the First Monday project dedicated to ending gun violence, as requested by the Physicians for Social Responsibility.

The Board approved a proposal from the Public Health Task Force to collaborate with the USPSTF in regards to ED evidencebased prevention and screening. The Board did not approve a proposal to develop an SAEM Annual Meeting award for the research presentation that best addressed the Healthy People 2010 objectives.

Funding The Board approved a proposal from the Ultrasound Interest Group to develop an ultrasound image bank and approved funding of up to $6,945.

The Board approved funding Board members for travel expenses to attend all SAEM Board meetings, except for meetings held at the SAEM Annual Meeting. The Board approved the purchase of a dedicated server for the SAEM website at a cost of $1,000 plus $440 per month.

The Board approved funding of up to $1,500 to complete the Virtual Adviser Program and post it on the SAEM web site. The Board also approved funding to submit the Virtual Advisor Program as an Innovations in Medical Education 13

exhibit at the AAMC Annual meeting.

The Board approved funding in the amount of $12,000 for regional meetings held in 2001.

Emergency Medicine Activities (Continued)

Retrieval of Information on Scientific Projects (CRISP), a central database of NIH grant and contract awards, and providing data and analyses of extramural awards and trends. She is also responsible for developing and coordinating policies and programs related to NIH-sponsored clinical research and clinical trials.

At 12:15 a lunch session will be held in the Congressional A Room and the topic will be “Emergency Medicine and the AAMC.” The featured speaker will be Tony Mazzaschi, Associate Vice President for Biomedical and Health Sciences Research and Director of the Council of Academic Societies Affairs at the AAMC. Mr. Mazzaschi assists in developing AAMC’s research policy initiatives. He provides support to the AAMC Advisory Panel on Research and has been instrumental in organizing the Group on Research Advancement and Development.

AACEM will convene a membership meeting in the Chairman’s Room at 1:30-3:00 pm. The SAEM National Affairs Task Force is also expected to meet and the exact date and time will be announced when confirmed.

SAEM Salary Survey Underway The SAEM Salary Survey has been mailed to all emergency medicine residency programs and approximately 25% of programs have responded so far. The SAEM Salary Survey is coordinated by Steve Kristal, MD, who has developed the previous salary surveys. The Salary Survey is approved by the Board of Directors for development every 2-3 years and the last survey was done in 1998-99 and the results were published in the December, 1999 issue of Academic Emergency Medicine and are posted on the SAEM web site at: www.saem.org/services/educ.htm.

ACADEMIC RESIDENT News and Information for Residents Interested in Academic Emergency Medicine Edited by the SAEM GME Committee

PREPARING A DIDACTIC PRESENTATION Carey D. Chisholm, MD SAEM Board of Directors Indiana University Preparing a formal presentation to deliver to your peers and attendings can be a very intimidating task for the resident, especially the first time.

Public speaking remains one of the most anxiety provoking activities that we face. The following reflects a philosophy about approaching the mandated "lecture" activity and using it as an opportunity for personal growth while providing an invaluable educational experience to your audience. Life is too short to sit through hours of poorly developed or presented information.

The Product Your goal should be to develop a high quality interactive presentation that provides a state of the art update on the topic. This includes the 3-5 critical "take home" points that you’d like your audience to remember 6 months later.

A brief hand-out will reinforce these points for the audience. The delivery is interactive (talking with, not at the audience) to increase attentativeness, retention and allow tailoring to learner needs.

The Process ● Become "the expert". If you have any impact in the selection of a topic, consider taking one that makes you feel uncomfortable. This will maximize your potential for personal growth. Start by reviewing text information on the topic.

Perform a "learner’s needs assessment" by asking your colleagues and EM faculty what areas they would like to hear about ("What makes you most uncomfortable about x?" or "What are the biggest dilemmas you’ve faced with this problem?"). Contact non-EM faculty who specialize in the area of your topic and pick their brain ("What problems or mistakes have you seen in the ED

●

●

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management of a patient with X" or "How can we best assist you in caring for one of your patients who presents to the ED with Y?"). Finally, contact EM community practitioners and elicit their perspective about these patients and how they are cared for outside of the academic ED. Perform a literature search and cross reference it with the bibliography in the text chapters. If you missed a sizable number of the text chapter citations, ask the search librarian for assistance in your search. Review these references and critically appraise any that will be used in your presentation. If the information appears to conflict with that you’ve heard from one of the folks above, contact them again and request clarification ("3 of the studies suggested that diagnostic test Z doesn’t assist in managing the patient acutely…I was curious if you agree with their recommendations").

Investigate costs and charges for diagnostic tests, therapies and medications. I call local pharmacies to ascertain charges to patients for medications, and our inpatient pharmacy for inpatient/ED costs and charges. Your medical director of the ED should be a valuable asset in obtaining this information.

Create a lesson plan. This is not an outline of the topic, or a reprint of power point slides. It is a description of what you will teach over your allotted time and how you will teach the information. Decide what the key 3-5 "take home" points are and build your lesson plan around these.

Ask yourself: "if I was sitting in the audience, would I care about hearing such and such". If the answer is "no", why inflict it on your peers? EM is a clinical specialty and practical in its approach. Any discussion about pathophysiology, epidemiology, etc. must be placed in a clinical context. If it can’t be, it’s extremely unlikely your audience will 14

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remember it 6 months (2 minutes...) later. Paradoxically, it may actually lessen your overall effectiveness as members drift into daydreaming from disinterest and distraction.

Caveat: since you’ve now become an "expert" there will be aspects about your subject that you now find really interesting: unfortunately your audience will not share your zeal. Be realistic and stick to the take home messages.

Develop a delivery method: will you use PowerPoint, overhead, dry erase board or nothing? Will special AV resources be needed? If so, arrange months ahead of time. How will you make your presentation interactive and conversational?

Seek guidance from a faculty mentor whose delivery style you respect.

Practice: even before the "dry run" you should be able to do 80% of your presentation without reading extensively from your notes. Ask a friend, spouse or colleague to listen to 15 minutes of your presentation, tracking your use of "space-fillers" such as "uh", "uhm", or "OK".

Delivery Arrive early and assure the AV program is ready (practice setting it up ahead of time on the same computer that you will use). Dress comfortably but business like.

Speak loudly and slowly, projecting your voice to the back of the room.

In larger venues or if you speak softly, ask for a volunteer (in the back of the room) to raise their hand if they cannot hear you (be sure to glance back there about once a minute). ● Introduce yourself and your topic.

Do not apologize for your topic…find a "hook" to show them why paying attention will reap rewards for them ("statistically, 1 in 5 of you will be successfully sued within 5 years of graduation for failing to make this diagnosis"). ●

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Get out from behind the podium and mingle…speak with the audience, rather than carrying on a monologue. Ask leading questions, solicit perspectives, and use "real life" vignettes.

After asking a question to the audience, use a pause to force interaction (17 second rule).

AV aids should enhance rather than detract from your message (be careful that they don’t "become" your message). Be very careful with builds, clip art, or vacation or family photos (the latter 2 increase audience day dreaming as it sparks them to think of their own kids or last vacation). Humor is great if it ties into the presentation, is not used excessively and is tasteful (you’re there to inform, not entertain…think long term message). An offended audience will remember none of your take home messages...thus you have failed in your endeavor.

Repeat questions or solicited responses to the entire audience.

Otherwise many will not hear what was said, and interest will drift.

Provide literature citations for more controversial or cutting edge recommendations, or to emphasize a point. "Landmark" articles should be listed in your hand-out.

Summarize! Go back over the 3-5 points that you wish the audience to remember.

Have fun.

You’ve spent hours preparing for this, so why not enjoy the fruits of your labor?

Dealing with stage fright: public speaking remains one of the most feared tasks. A good controlled rush of adrenaline at the start of a presentation may enhance your skills, but too much can cause your presentation to unravel. Practice is the best preparation. Rehearse your opening 2-5 minutes so that it’s an unconscious process. Remember that it’s not a hostile crowd that you’re addressing…it’s your peers and friends and they wish you success. If you’ve prepared, you have become "the expert" … as such draw strength. Beta blockers have been effective for those who are paralyzed by public speaking, but be certain to trial these ahead of time if you choose to use them.

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Speaking to an unknown audience: When speaking at national meetings, I always assess the composition of the audience prior to beginning my presentation. This will better allow me to tailor my comments (e.g. if 80% of the audience are RN’s versus 80% attending faculty physicians) to the interests and expertise of the audience. I also take a moment to find out what their expectations of the presentation are so that I can be certain to address those issues (or tell them right up front that I will be unable to do so).

Major Mistakes ● Reliance on text material (not becoming the "expert") ● Attempting to cover too much information

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Podium hugging Speaking too softly or too rapidly Not repeating a question (or solicited answer/observation) from 1 audience member to the entire group.

Failure to keep eye contact with the audience Reading to the audience Lacking enthusiasm Excessive space fillers ("uhm", etc.)

Losing the message in the presentation (too many bells and whistles) Poor Power point slide colors/font detract from presentation (addressed in a future article)

Nominations Requested for Resident Member of the SAEM Board of Directors Nominations are sought for the resident member of the SAEM Board of Directors. The resident Board member is elected to a one-year term and is a full voting member of the Board. The deadline for nominations is February 1, 2002.

Candidates must be a resident during the entire one year term on the Board (May 2002-May 2003) and be a member of SAEM. Candidates should demonstrate evidence of strong interest and commitment to academic emergency medicine.

Nominations should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter.

Nominations should be sent to

saem@saem.org or 901 N. Washington Ave., Lansing, MI 48906. Candidates are encouraged to review the Board of Directors orientation guidelines on the SAEM web site at www.saem.org or from the SAEM office.

The election will be held via mail ballot in the Spring of 2002 and the results will be announced during the Annual Business Meeting in St. Louis.

The resident member of the Board will attend four SAEM Board meetings; in the fall, in the winter, and in the spring (at the 2002 and 2003 SAEM Annual Meetings). The resident member will also participate in monthly Board conference calls.

Password Required to Receive AEM Online SAEM members must now use a password to access their online subscription to Academic Emergency Medicine. All SAEM members are entitled to receive a free subscription of both the print copy and online version of AEM. To activate your subscription go to the website: <www.aemj.org>, Click on the subscriptions button. Click on the link “activate your member subscription.”

Enter your membership number (which is printed above your name on the mailing label of this Newsletter) and click the submit button. You will then be asked to select a user name and password. If you need assistance or do not have a member number, send an email to saem@saem.org or call 517-485-5484.

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Preparing and Presenting an Emergency Medicine Clinical Pathologic Case Conference Douglas L. McGee, DO Albert Einstein Medical Center Terry Kowalenko, MD Wayne State University The Clinical Pathologic Case Presentation (CPC) Conference is a teaching tool that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients in the emergency department (ED). Cases for presentation must be relevant to emergency medicine practice, solvable and discussible. Critical to success is an effective presentation by both the case presenter and the case discussant. Cases are discussed using logical consideration of their salient features and measured consideration of the suggested differential diagnosis. This article reviews the preparation and presentation of the CPC Conference for Emergency Medicine.

Introduction The CPC Conference can be an effective teaching tool. Not only does this conference format teach the clinical aspects of the presented case; it illustrates the logical, measured consideration of a differential diagnosis that typifies a rational approach to the ED patient. The inclusion of the CPC Conference during EM meetings is testament to its educational value. The CPC Conference can also be an effective way to teach medical students and residents, particularly when the learner is given the opportunity to prepare and present the discussion for a case from the faculty who present the case.

The CPC Conference format mirrors the typical ED patient encounter. The presenter describes the patientâ&#x20AC;&#x2122;s chief complaint, history of present illness, past medical/surgical history, social history, allergies, and medications. The vital signs and physical examination are presented in sufficient detail.

Diagnostic data usually available in the typical ED are presented. This might include pulse oximetry, basic laboratory tests, radiographs, electrocardiograms and other studies. The discussant then describes the differential diagnosis, logically narrowing the list to a few selected probable diagnoses and often offers a final diagnosis. The first presenter then reveals the final diagnosis, discusses how the diagnosis was confirmed, provides details regarding the case outcome, the applicability to EM, and may briefly discuss the final diagnosis.

Selecting a Case Given the variety of cases seen in a typical ED, the spectrum of potential CPC cases is broad. Cases that are unusual presentations of common diagnoses or typical presentations of unusual diagnoses make the best cases for CPC presentation.

The best cases for CPC conference have several elements in common: "relevance", "solvability", and "discuss-ability".

Cases in which the final diagnosis is deduced, or highly suspected, based upon information available in the ED are considered "relevant". Although diagnostic evaluations not usual to the ED may be required to confirm the diagnosis, they should not be required to place the diagnosis at, or near, the top of the list of probable diagnoses. "Relevance" is linked to a critical element of an appropriate case: "solvability". The discussant must have a reasonable opportunity to make, deduce, or highly suspect the final diagnosis. Enough discriminating information must be available to allow a thoughtful, logical discussion of the differential diagnosis. Cases that are highly complex, contain multiple primary diagnoses, or are laden with many extraneous facts are difficult to solve and should be avoided. Finally, the case must be "discuss-able". Cases that

do not allow a demonstration of the deductive process used to reach a diagnosis do not afford the opportunity to teach the audience to think logically. Select cases that have interesting and educational differential diagnoses.

Preparing and Presenting the Case After the case is selected, prepare it for presentation. The case must be provided to the discussant well in advance of the Conference. Include the chief complaint, the history of present illness, past medical and surgical histories, social histories, medications, and allergies. Provide the vital signs and physical examination. If diagnostic studies were obtained, present the results. Do not interpret data. Let the discussant interpret the EKG, read the chest x-ray or calculate the anion gap. The contextual interpretation of data is an important part of the CPC discussion. It is customary to present all information obtained in the ED, usually in the order in which it was collected. Let the discussant decide which bits of information are relevant and which are "red herrings". Incomplete and irrelevant historical and physical examination data are part of the practice of EM. On rare occasion, it may be appropriate to withhold a confirmatory test obtained in the ED as long as the case is solvable based upon the other information provided. The goal of this academic exercise is not to "stump" the discussant but to present an interesting and educational conference.

The case information sent to the discussant is presented in the CPC Conference. Present to the audience the information given to the presenter. For the sake of time, normal diagnostic data may be described as such without listing each result.

Do not provide information to the audience that has not been given to the discussant. Do not interpret data for the audience; allow the discussant to interpret data. Present the case, clearly, concisely, and succinctly. Conclude the case presentation and offer the floor to the discussant. This should take no longer than five minutes.

Discussing a Case Discussing an unknown case in front of an audience can be stressful, but exciting and challenging. Adequate preparation for the discussion will make the presentation enjoyable.

Remember the main goal of the CPC Conference: illustrating the measured, logical progression from a patient presentation to a narrowed differential diagnosis. Do not focus on making a final diagnosis. Focus on the process by which a final diagnosis is derived. The process that led the discussant to the final diagnosis is illustrated in the CPC Conference.

Review the case and consider each data point to be potentially relevant. Seemingly inconsequential information may prove to be pivotal. Determine which features of the case are the most relevant. These salient features may include historical and physical data, diagnostic data, and the interpretation of diagnostic data. Each salient feature prompts a differential diagnosis. Consider a complete differential diagnosis for each feature. The old saw "If you donâ&#x20AC;&#x2122;t think of it, youâ&#x20AC;&#x2122;ll never diagnose it" applies to CPC discussions. After outlining the potential diagnoses, narrow the list.

As in clinical medicine, one of two approaches often leads to a reasonable approximation of the final diagnosis. The first approach is to recognize the data as part of a syndrome. A (continued on next page) 16

Clinical Pathologic Case Conference (Continued) syndrome is a constellation of signs, symptoms and diagnostic data related to another by some anatomic, physiologic or biochemical abnormality. Compare the differential diagnosis lists developed for each salient feature with each other.

Occasionally, a common thread, or syndrome, is discovered.

The table below illustrates this process: Differential diagnosis A Disease A Disease B Disease C Disease D Disease E

Differential diagnosis B Disease F Disease I Disease P Disease R Disease B

Differential diagnosis C Disease B Disease Q Disease T Disease O Disease K

• Potential confirmatory studies • Final diagnosis (if possible).

• The discussion should take no longer than 20 minutes.

Presenting the final diagnosis and case discussion After the discussant offers a potential solution to the case, the conference is returned to the presenter. The goals of this portion of the CPC Conference are to: reveal the final diagnosis, present diagnostic data that confirms the diagnosis, discuss the diagnosis and its applicability to EM, and summarize the features of the case which allow a reasonable guess at the diagnosis.

Some may prefer to reveal the final diagnosis first and then offer data that confirmed the diagnosis. Others may prefer to describe the diagnostic test results before the final diagnosis is revealed. A brief discussion of the ED or hospital course and case outcome is informative and interesting. The order in which this information is presented is a matter of personal preference. Present a brief discussion of the final diagnosis that reviews the salient features of the diagnosis. Briefly summarize the ED stabilization and treatment. Since important aspects of the selected case were relevance and solvability, the presenter should reiterate the case’s relevance and solvability to the audience. Accomplish this by pointing out the historical, physical or diagnostic data points that would prompt a practicing emergency physician to suspect the final diagnosis.

This part of the conference provides an important summary of the educational value of the CPC Conference and should take no longer than 10 minutes.

Presentation skills Participants must be well prepared and well rehearsed.

The time of each segment of the CPC conference is often restricted. Always adhere to the time limits. Speakers must be dressed appropriately and present themselves in a professional manner. If audiovisual equipment is used, it must work properly. Presenters should be comfortable with the equipment. If slides are projected, they must conform to accepted guidelines. Avoid crowded slides, irrelevant artwork, spelling errors, and distracting color schemes. The audience expects the participants to avoid monotonous speech, mumbling, distracting mannerisms, meaningless phrases and interjections, and a motionless presentation. The speakers must be engaging and enthusiastic. Humor may be a useful adjunct to the presentation but should be used with caution. Do not tell inappropriate jokes or offend members of the audience.

Summary The CPC Conference can be a valuable education tool that accomplishes two distinct educational tasks. The first is to review and discuss the historical, physical and diagnostic data points of an emergency medicine case. Second and most importantly, the logical, deductive process used in clinical emergency medicine to winnow a long list of potential diagnoses to the most probable diagnosis is demonstrated. This is also a wonderful opportunity for residents and faculty to make a presentation during a national meeting. Presenters and discussants are encouraged to collaborate and submit cases for publication to Academic Emergency Medicine.

Differential diagnosis D Disease W Disease Z Disease M Disease X Disease B

In this example, diagnosis "B" is on each list and may represent a syndrome. Most cases will not be so straightforward.

Disease "B" may not be contained on every list or a second syndrome may be common to many lists. When more than one syndrome is possible, weigh each diagnostic possibility with respect to the presence of "syndrome defining" features.

Successive approximation will suggest that one diagnosis is more probable than another is.

The second approach weighs each potential diagnosis in terms of supporting or refuting data. Create a differential diagnosis list for each salient feature. Compare each list to find diseases common to one or more of them. The second example illustrates this process: Differential diagnosis A Disease A Disease B Disease C Disease D Disease E

Differential diagnosis B Disease D Disease E Disease P Disease R Disease B

Differential diagnosis C Disease B Disease Q Disease P Disease O Disease E

Differential diagnosis D Disease E Disease Z Disease D Disease X Disease B

In this example, diseases "B" and "E" are on every list, disease "D" is on three lists, and disease "P" is on two lists. All other diseases are found only one time. The diseases common among several lists represent the most probable diagnoses. Consider clinical and diagnostic data that increases or decreases the probability that a diagnosis is correct. This table illustrates that process: Disease B Disease E Disease D Disease P

Data supporting The diagnosis ++++ + +++++ ++

Data not supporting The diagnosis ++++++++ +++ ++ ++++++++

In this example, disease "D" seems more probable than other diseases. Although disease "B" and disease "E" appeared on every list, the weight of the data does not make the diagnosis probable. Some data is more specific and may weigh more than other softer data. The discussant logically weighs each potential diagnosis in terms of the data available to estimate a probability. The most probable diagnosis will be at the top of the final differential diagnosis list, the least probable at the bottom.

Various presentation formats are effective and must suit the style of the discussant. Close attention to time guidelines is critical. The presentation format for the discussion could follow this outline: • Review of the salient features • Differential diagnosis of the salient features • Logical discussion of the potential diagnoses • Presentation of the most likely diagnoses

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President’s Message (Continued) medical school allotments. We face the economic realities of the present and should anticipate that those of the future will be similar unless we find more resources.

The total money available for emergency medicine through Emergency Medicine Foundation (EMF) and SAEM research fund (roughly 4 million dollars) is a nice resource but not enough, in my opinion, to sustain the development of academic emergency medicine for the future. The SAEM Research Fund has total capital assets of about two (2) million dollars. The grant awards are as follows: 1. Medical Student Interest Group grants – recipients receive up to $500 and the number of recipients varies each year, usually 3 to 5.

2. EMS Fellowship – just increased to $60,000, it is a one-year grant that is provided to one recipient.

3. Neuroscience Fellowship – $50,000, one-year grant provided to one recipient.

4. Research Training – $75,000 per year for two years; currently 1 or 2 recipients per year.

5. Institutional Training – $75,000 per year for two years, probably one recipient.

6. Scholarly Sabbatical – up to $60,000 per year; currently 1 recipient per years.

In addition, SAEM co-sponsors two grants with EMF: 1. Medical Student Research 2. Innovations in Emergency Medicine Education The Emergency Medicine Foundation has a corpus (total capital assets) of roughly 2.2 million dollars with anticipated total annual awards of around $425,000. EMF awards range from the directed cardiac arrest survival award funded by Wyeth-Ayerst, at $100,000 over two years, to the $2,400 medical student awards SAEM and EMF jointly fund. In addition, there are $50,000 established investigator and career development awards, $50,000 award for research in neurological emergencies, $35,000 research fellowships, $10,000 physician/nurse research team grants and $5,000 resident research grants.

Other resources available may be money earned through medical director contracts, medico-legal consults, research grants, corporate and private

funding. Emergency medicine has had low visibility for NIH grants. There are approximately 14 emergency medicine NIH grants awarded. This information was personally relayed by John Gallagher, President of the Association of Academic Chairs of Emergency Medicine, who researched the computerized retrieval of information on scientific projects (CRISP) database of federal funds. There are likely other EM NIH grants out there but unidentified through CRISP because of limitations in the search engine. NIH grant funding is a major source by which academic departments and medical schools have derived prized rankings in such publications as US World and News Reports. However, grant funding for research and education come from many other sources in addition to NIH such as CDC and AHRQ. Corporate funding has been a long time available source also. Individual giving through grateful patients, our colleagues and ourselves and private donors is another category of available funding.

Children’s Medical Centers have run telethons and annual giving campaigns for many years and have been successful. For the most part emergency medicine has not run a similar type of campaign. Some departments of emergency medicine have endowed chairs. Many departments of emergency medicine have no endowed chairs and I think the maximum number at any one institution is two or three. In contrast, some older medical specialties at a single institution may have more endowed chairs than the total of all of emergency medicine.

In the successful $1.1 billion campaign recently completed by the University of Virginia, I had the good fortune of being a member of the Faculty Campaign Task Force for the School of Medicine. I contributed to the campaign from both a planning and financial standpoint. I am proud to say that all of the Emergency Medicine faculty made gifts to this campaign.

Through my involvement I learned a lot about fund raising particularly as it relates to restricted gifts. It has been an eye opener for me to learn about the planning and organization that goes into these campaigns in order to effectively tap into all of the potential resources available for academic development. These types of cam-

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paigns have occurred through universities and medical schools for many years. Unfortunately, emergency medicine for the most part has not been a part of these campaigns. The charitable gifts contributed through alumni, corporations, private entities and research foundations typically are directed to scholarships, fellowships, endowed chairs, programmatic designations, and capital projects such as biomedical centers/buildings.

Generally donors do not provide unrestricted support.

University financial investment teams advance endowment income through expertise in financial advising, research, global investment, private equity, and venture capital. Investment rules are held sacred. Never touch the endowment principal. Plow most of your investment returns back into the endowment, keep your spending focused on your educational mission, and don’t stray far from the convention that limits endowment spending to no more than about 5% of annual returns in the investment. Strong endowment returns can free up money or make more available for the operating budget. Most college endowments are fairly young. The idea, centuries old took root in US higher education during the 1960’s and 1970’s during which time many schools were struggling financially. 2 3 Universities across the United States have accrued much wealth through development efforts. Many of the best endowed colleges and universities are enjoying remarkably good fortune in recent years. Thanks to stock market returns that soared in recent years (until 2000) and record setting fund raising campaigns.2 Harvard is at the top with an 18.8 billion dollar endowment. More than 40 colleges now report endowments of 1 billion dollars or more.2 Of the top 25 colleges/universities with $1.5 billion dollars endowment or more, 75% have academic departments or a division of emergency medicine.

Emergency medicine will need more resources than we currently have to develop our programs, research and training agendas for the future. Some departments have established annual fund drives to generate support from individuals for their research and educational missions. We can increase opportunities for private support for (continued on next page)

President’s Message (Continued) EM particularly if we seek community input and research private funding sources. The ultimate goal is to obtain resources, to free operational funds, to continue to develop our programs and to free our scholars/researchers and educators to develop themselves, their academic agendas and the future providers, educators and researchers of emergency medicine so we can better serve our patients. Other contribution possibilities are deferred gifts, which may be gift annuities, charitable remainder trusts, life insurance policies or bequests. Planned gifts may be outright gifts of assets such as stocks, real estate, tangible personal property, retirement plans, life insurance or business interests. These assets may be converted into deferred gifts. Many people give contributions of outright gifts and planned gifts.4 We must know who are the philanthropists. Don’t discount women. Most people associate major gift philanthropists with men. That assumption is changing. Forty-one percent of IRS-listed top wealth holders are women.

Today, women and the issues they deeply care about represent some of the most significant new faces in philanthropy. Women are more likely to invest inherited wealth in charitable funds and foundations than men who tend to put money into business ventures. Women like many new donors are motivated by making a difference. 5 Nearly 48% of American women make charitable bequests compared to 35% of men. It is estimated that today American women own 60% of the nation’s wealth.

We in emergency medicine, at the local, state and national levels organizationally must improve our awareness of funding opportunities. Some academic emergency departments may have the opportunity to organize, operate and assume the risk in such business ventures as freestanding emergency centers and/or managing additional hospital-based ED’s. Other ventures include managing poison centers, hyperbaric medicine, occupational toxicology, sports medicine and procuring various contracts, (i.e., prehospital transport, medical direction, mass gathering medical coverage, training). The above are examples of entrepreneurial opportunities and not all inclusive. Obviously, when we approach entrepreneurial opportunities, we must consider the merits before proceeding.

Opportunities may appear wonderful yet

not be right!

Some departments of emergency medicine have developed their own centers, foundations or funds. I will not attempt to describe them here. At the May 2001 Association of Academic Chairs of Emergency Medicine meeting, I described my experience with the development of the Emergency Medicine Center for Education, Research and Technology (EMCERT) recently established at the University of Virginia. I indicated to the chairs at that meeting that I would share this experience in a newsletter.

EMCERT was created on advice from a prominent corporate leader in the region, a member of the board of the UVa Health Services Foundation (billing and benefits arm) and the PR director from the Department of Emergency Medicine. Our first priority was to obtain the blessing of the School of Medicine leadership. Once secured, we worked for over a year to research and recruit potential Advisory Board members. The Board consists of community leaders, business leaders, and former health care professionals from the community we serve. The role of the Advisory Board is to help support our priorities, by giving their time and expertise to advance our mission and achieve our goals, using their influence to raise the profile of the UVa Department of Emergency Medicine in the region, and financially through their personal support and by helping to raise funds from the community.

Working with our board, we created a mission statement and developed a business/strategic plan for EMCERT. In establishing EMCERT, we benefited from the insight provided by Dr. Janet Williams, Director of the Center for Rural Emergency Medicine in our neighboring state at the University of West Virginia. So far establishment of the EMCERT Advisory Board has been a successful venture and we are moving forward with pursuit of priorities as established in our strategic/business plan. The community stands to benefit from such activities and there is much enthusiasm on the part of the board members to help.

One of our first orders of business was to establish a gift fund through which we could receive gifts to the department. The priorities of EMCERT include seeking private support to forward the education, research and technological advances including ultrasound 19

machines, patient care simulators, endowed chairs, grant writers, faculty positions and fellowships.

The Development Office also helped with a business plan and strategic approach to increase faculty in an area of potential new business.

The development office associated with your university or medical school can help in many ways. They can advise you on how to seek funds from the private sector from individuals, corporations, or foundations. In addition, they may be able to help your department with an income generating venture that falls within the strategic goals and mission of the medical school/health system.

The SAEM Board and Financial Development Committee are working on the objectives of establishing a research/academic development mission statement and goals with a business plan to include fund raising efforts directed towards the various opportunities described in this newsletter. I also believe SAEM could eventually benefit from the help of a development officer (part-time or full-time) who could help maximize the generation of funds to support the mission of the SAEM research fund.

References 1. Gallagher John.

President Association of Academic Chairs of Emergency Medicine. Executive Committee Minutes. July 2001.

2. Marklein MB. Elite Colleges Pressured to Use New Wealth. USA Today. Page 1, Tuesday, May 8, 2001.

3. UVa, Tech, VCU Funds Rise Fourfold. Richmond Times Dispatch.

May 3, 1998.

4. The Medical Faculty Campaign Brochure. University of Virginia Health System Development Office.

5. Pulse, Vol. 4 No. 2, Spring 1998. The Campaign for the University of Virginia Health Sciences Center.

Pages 1,2.

The complete EMF and SAEM grant programs are published in this issue of the Newsletter

FACULTY POSITIONS

University of Cincinnati Medical Center

ANN ARBOR, MICHIGAN: FACULTY/CLINICAL STAFF and RESEARCH DIRECTOR (academic setting) Seeking BC/BP EM physicians to join St. Joseph Mercy Hospital. Clinical research experience required for Directorship. Level II Trauma Center with on-site Medflight air ambulance service that sees 92,000 patients annually between the ED, adult and pediatric ambulatory care centers, and chest pain observation unit.

Approved EM Residency program sponsored by hospital and U of M Medical Center. Employed positions offer excellent remuneration, faculty stipend, paid malpractice, relocation allowance, cafeteria-style benefits, 401(k), long term disability, flexible scheduling and more. Director position offers dedicated protected time. Contact Nancy Ely@ 800-4663764, ext. 337; nely@epmgpc.com; or visit us @ EPMGPC.com.

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.

OHIO STATE UNIVERSITY: Assistant/Associate or Full Professor.

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

OREGON: The Oregon Health Sciences University Department of Emergency Medicine is conducting an ongoing recruitment of talented entry-level clinical faculty members at the assistant professor level.

Preference is given to those with fellowship training, experience in collaborative clinical research, and writing skills, Please submit a letter of interest, CV, and the names and phone numbers of three references to: Jerris Hedges, MD, MS, Professor & Chair, OHSU Department of Emergency Medicine, 3181 SW Sam. Jackson Park Road, UHN-52, Portland OR 97201-3098.

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

PENNSYLVANIA: Seeking EM Residency-trained physician. Join cohesive faculty of 30 BC physicians evaluating 100,000 patients at Lehigh Valley Hospital in Allentown. New EM residency program. LVH is academic, tertiary hospital and Level I trauma center with 11 residency programs, and member of Council of Teaching Hospitals (COTH). Eligibility for faculty appointment at Penn State/Hershey. Opportunity for resident teaching and clinical research. Located in beautiful valley with 800,000 people, excellent schools, safe neighborhoods, 10 colleges and universities. Philadelphia 60 miles South; Manhattan 75 miles East. Email CV c/o Michael Weinstock MD, Chair EM, to carol.voorhees@lvh.com Fax (610) 402-7014. Phone (610) 402-7008.

UNIVERSITY OF MICHIGAN: The Department of Emergency Medicine at the University of Michigan is seeking a Residency Program Director for the Emergency Medicine Residency Program. The residency program is a joint program between the University of Michigan and St. Joseph Mercy Hospital both located in Ann Arbor. The residency program is a four-year program with 56 approved residents. Candidates at the Associate Professor level (either clinical or tenure track) preferred. Excellent fringe benefit package. If interested, please send curriculum vitae to: William G. Barsan, MD, Professor and Chair, Department of Emergency Medicine, UMHS, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0303. The University of Michigan is an equal opportunity affirmative action employer.

RESIDENT EMS COORDINATOR The Division of Emergency Medicine at Duke University Medical Center is working to develop an Emergency Medicine Residency Program.

We are currently seeking a faculty member with a strong interest in EMS. This position offers opportunities for community EMS involvement, clinical practice in the ED, teaching, and research. Residency training and BC in EM required. Duke University Medical Center Emergency Department is a Level I Trauma Center in Durham, North Carolina, with an annual volume of 65,000 patient visits.

Competitive salary and benefits.

Faculty with EMS fellowship training are especially invited to apply.

UNIVERSITY OF NEBRASKA MEDICAL CENTER: Section of Emergency Medicine, seeks an ABEM board eligible or -certified individual for a fulltime academic position. This is an exceptional opportunity to be a part of a young, dynamic group in an outstanding tertiary referral environment.

Generous salary, benefits and CME. Respond in confidence to: Robert M. Muelleman, M.D., Professor, Director of Emergency Medicine, University of Nebraska Medical Center, 1150 UNMC, Omaha, NE 68198-1150.

(402-559-6705) The University of Nebraska is an affirmative action/equal opportunity employer. Minorities and women are encouraged to apply.

Please contact: Kathleen J. Clem, MD, FACEP Chief, Division of Emergency Medicine DUMC 3096, Durham, NC 27710 email: clem002@mc.duke.edu

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

Faculty Development Fellowship The Wright State University School of Medicine, Department of Emergency Medicine is pleased to announce the second year of its new Faculty Development Fellowship. Must have completed Emergency Medicine Residency and be Board Prepared. Starting dates are flexible. The Fellowship has an 18 hour / week clinical commitment at one of our several practice sites (30,000 to 95,000 patient visits.) There are planned instructional sessions in didactic and clinical teaching, curriculum design, research project planning, grantsmanship, writing and publishing in the medical literature, use of media, administrative skills, international emergency medicine and several other topics. Each segment is linked to the expertise of a specific faculty members, combined with written materials. A portion of the program can be tailored to the needs and interests of each fellow. Stipend is $50,000 plus generous benefits and travel support. We are currently accepting applications for 2002. Please include a CV, letter of interest and two letters of reference. If you have an interest in academic emergency medicine and would enjoy a year of focused training in the skills necessary to establish your career, contact: Glenn C. Hamilton, MD, MSM Department of Emergency Medicine 3525 Southern Blvd., Kettering, OH 45429 Phone: (937) 296-7839 • Fax: (937) 296-4287 email: glenn.hamilton@wright.edu Consideration of applications begins September 15, 2001 and will continue until the positions are filled. Wright State University is an AAEO Employer.

WASHINGTON HOSPITAL CENTER (WHC) AND GEORGETOWN UNIVERSITY HOSPITAL (GUH) in Washington, D.C. are seeking physicians board certified or residency trained in emergency medicine to join their faculty. Our Department of Emergency Medicine is both traditional and cutting edge: traditional in that we believe that the provision of medical care is a sacred trust; cutting edge in that we are committed to using the most advanced information technology to improve clinical care. Contact Mark Smith, MD, FACEP, Chairman, at (202) 8770808, fax (202) 877-2468 or write to him at Washington Hospital Center, Department of Emergency Medicine, 110 Irving Street, NW, Washington, D.C. 20010-2975.

We are increasing our faculty again! These are all new openings. The Brody School of Medicine at East Carolina University has immediate openings available for emergency physicians at the rank of assistant professor or above, depending upon the candidate’s qualifications. Physicians must have emergency medicine residency training or ABEM/AOBEM certification. The emergency medicine residency program has been fully accredited since 1982.

Many faculty are extensively involved in state and national activities. Pitt County Memorial Hospital is a 740-bed Level I trauma center, with 55,000 ED visits per year and a new Urgent Care facility will open in the fall of 2001. Our residency has 12 positions per year. Greenville has the benefits of being a very family-oriented community and a college town.

Compensation is competitive and commensurate with qualifications; an excellent fringe benefits program is provided.

Screening begins summer of 2001 and will remain open until filled. This is an excellent opportunity to join a rapidly-growing emergency department in the coastal plains of eastern North Carolina, just ninety minutes from the Atlantic Ocean.

RESIDENCY DIRECTOR

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

The residency program is based at Bellevue Hospital Center, New York University Medical Center, and New York University School of Medicine. The active emergency departments at both sites offer a broad exposure to all aspects of Emergency Medicine.

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

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

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

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

Please submit letter of interest and curriculum vitae to: Nicholas Benson, MD, MBA Professor and Chair Department of Emergency Medicine The Brody School of Medicine at East Carolina University 600 Moye Boulevard Greenville, North Carolina, 27858-4354 Phone 252-816-4757; Fax 252-816-5014 ECU is an EEO/AA employer and accommodated individuals with disabilities. Applicants must comply with the Immigration Reform and Control Act. Proper documentation of identity and employability required at the time of employment. Current references must be provided upon request.

www.ecu.edu/med

www.uhseast.com

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University of Cincinnati Medical Center

ANNOUNCING The University of Cincinnati Department of Emergency Medicine has established a second Endowed Chair in Emergency Medicine. We are seeking an established clinician scientist to hold the Endowed DISTINGUISHED CHAIR FOR CLINICAL RESEARCH IN EMERGENCY MEDICINE The University of Cincinnati Department of Emergency Medicine established the first Residency Training Program in Emergency Medicine in 1970. We have a long history of productive research with special emphasis on Cardiovascular, Neurovascular, Toxicology/HBO, and Outcomes investigation. This Endowed Chair offers a special opportunity for an individual to pursue a leadership position in Emergency Medicine.

Individuals interested in this opportunity are encouraged to contact: W. Brian Gibler, MD Richard C. Levy Professor of Emergency Medicine Chairman, Department of Emergency Medicine University of Cincinnati College of Medicine 231 Albert Sabin Way Cincinnati, OH 45267-0769 513/558-8086 FAX: 513/558-4599 e-mail: Diane.Shoemaker@uc.edu

Associate Director- Division of Pediatric Emergency Medicine/Medical Director- Emergency Department Children’s Hospital The Ohio State University/Children’s Hospital Columbus, Ohio

Academic Emergency Medicine

The Ohio State University and Children’s Hospital in Columbus, Ohio seek an Associate Director for their Pediatric Emergency Medicine Division. The division has 24 faculty members and is responsible for the medical care for both the Emergency Department at Children’s Hospital and the Urgent Care program. The Emergency Department is a designated Level I Pediatric Regional Trauma Center with 80,000 visits in 2000. The Division is actively involved in training and teaching with four fellows per year (12 total) and approximately 20 residents per month who rotate through the Emergency Department. The Associate Director will be responsible for assisting the Chief of the Division in managing and developing the division and will function as Medical Director of the Emergency Department. Qualifications for the position include BC in Pediatrics and Pediatric Emergency Medicine, 3-5 years clinical experience in an Emergency Department and demonstrated commitment to education and research. Prior experience in management or a leadership role highly desirable. For additional information please contact: Barbara Fahey, (630) 545-2470 or Email: bfahey@faheyassociates.com.

The Department of Emergency Medicine, Wright State University School of Medicine seeks a faculty member at the Instructor, Assistant or Associate Professor level. Faculty rank and salary are commensurate with the candidate’s professional qualifications and School of Medicine standards. Faculty activities include medical education at all levels, curriculum coordination, administration and patient care. An interest and ability in clinical and classroom education are preferred. Requirements for appointees include: Instructor, Board prepared; Assistant, Board Certified; Associate, board Certified and 5 years Emergency Medicine experience. All must be graduates of Emergency Medicine Residency and eligible for Ohio license. Applicants should send curriculum vitae and names of three references to: Glenn C. Hamilton, MD, MSM Department of Emergency Medicine 3525 Southern Blvd., Kettering, OH 45429 Phone: (937) 296-7839 • Fax: (937) 296-4287 email: glenn.hamilton@wright.edu Consideration of applications begins September 15, 2001 and will continue until the positions are filled. Wright State University is an AAEO Employer.

The Ohio State University is an Equal Opportunity/ Affirmative Action Employer. Qualified women, minorities, Vietnam-era veterans, disabled veterans, and the disabled are encouraged to apply.

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LOS ANGELES COUNTY HARBOR-UCLA MEDICAL CENTER —EMS DIRECTOR—

FACULTY POSITION

The Department of Emergency Medicine (DEM) at Harbor-UCLA Medical Center is seeking a full-time academic emergency physician to fill the position of EMS Director. The institution is a public hospital committed to serving the underserved of Los Angeles County, a Level 1 Trauma Center, and a major teaching affiliate of the UCLA School of Medicine. The DEM has an annual census of approximately 70,000 and supports a fully accredited Emergency Medicine residency program. As a paramedic base hospital, Harbor receives 550 calls per month, serves as a clinical site for paramedic training, and is a Physiocontrol site for EMS fellowship training. Candidates should be residency trained and board certified in Emergency Medicine. Ideal candidates will have EMS fellowship training or previous EMS experience in the areas of administration, teaching and research.

Academic rank and salary are commensurate with experience and accomplishments. For further information, contact:

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

Residency training and BC in EM required.

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

Robert S. Hockberger, M.D. Chair, Department of Emergency Medicine Harbor-UCLA Medical Center 1000 W. Carson Street – Box 21 Torrance, CA 90509 (310) 222-3504

Please contact: Kathleen J. Clem, MD, FACEP Chief, Division of Emergency Medicine DUMC 3096, Durham, NC 27710 email: clem002@mc.duke.edu

Harbor-UCLA Medical Center is an equal opportunity and affirmative action employer.

WEST VIRGINIA UNIVERSITY Department of Emergency Medicine Open Rank: The Department of Emergency Medicine at West Virginia University has a full-time physician faculty position available. The qualified emergency physician will have patient care and teaching responsibilities. The WVU Hospital System includes a Level 1 Trauma Center with 38,000 annual patient visits, a well-established Emergency Medicine residency and an active aeromedical transport program. The Department has eighteen EM residents involved in a 1, 2, 3 program and twenty-six Physician Assistants from throughout the country enrolled in a graduate program in Emergency Medicine.

Duties include direct patient care and the supervision of medical students, physician assistants, and residents. Significant research opportunities with an emphasis on injury control are available through the affiliated Center for Rural Emergency Medicine.

Morgantown offers both scenic beauty and low cost of living that is within commuting distance of Pittsburgh, PA. The area offers lakes, hiking trails, skiing, whitewater sports, and numerous other outdoor activities. Preferred candidates will be residency trained in emergency medicine and board certified/eligible. Salary and rank commensurate with accomplishments and experience. This position will remain active until filled. Applicants should forward a letter of interest, curriculum vitae, and names and addresses of three professional references to Ann S. Chinnis, M.D., Chair, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, P.O. Box 9149, West Virginia University, Morgantown, WV 26506-9149.

West Virginia University is an Affirmative Action/Equal Employment Opportunity Employer.

DEPARTMENT OF EMERGENCY MEDICINE 5 NEW POSITIONS! The Emory Dept. of EM has been allocated five additional full-time attending physician positions. Our department staffs Grady Memorial Hospital, Atlanta’s Level I trauma center and the base hospital for our residency program and two additional teaching EDs — Crawford Long and Emory University Hospital. Program strengths include an outstanding EM residency program, medical student teaching, EMS, toxicology, tox fellowship with CDC, clinical and laboratory research, injury control, and health policy.

Very competitive salary and benefits. Residency-training and/or board certification in EM required. Emory is an equal opportunity/affirmative action employer — women and minorities are encouraged to apply. For more info, check our web site at www.emory.edu/em or contact: Arthur Kellermann, MD, MPH, Professor and Chair Department of Emergency Medicine 1365 Clifton Rd., Suite B-6200 Atlanta, GA 30322 Phone: (404) 778-2600 Fax: (404) 778-2630 Email: akell01@emory.edu

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2002 Regional Meetings Being Planned The Department of Emergency Medicine Announces The Research Scholarsâ&#x20AC;&#x2122; Program In Emergency Medicine

Watch for additional information on the 2002 SAEM Regional Meetings in the November/December issue of the SAEM Newsletter. Meetings already being planned include:

The Dept. of Emergency Medicine, in collaboration with the Dept. of Epidemiology of the Grace C. Rollins School of Public Health, invites applications for the new Research Scholars Program in Emergency Medicine. The goal of this two-year program is to provide rigorous methodological training for emergency physicians seeking careers in academic research settings. The program is designed for individuals who hold doctoral degrees of MD or MD/PhD. Successful applicants will have a demonstrated commitment to clinical research and will have shown that they will benefit from a formal didactic curriculum. Year One: Research Scholars will receive formal instruction for the Masters of Science in Clinical Research degree (MSCR) within the School of Public Health. This NIH funded initiative is designed for physicians to learn the fundamentals of research methodology, statistics, and clinical trials design in order to develop into successful independent investigators. The tuition for this degree is funded by the NIH. Applicants must meet the regular entrance requirements of the Department of Emergency Medicine, the Emory Graduate Division of Biological and Biomedical Sciences, and the Rollins School of Public Health. Year Two: Research Scholars will conduct their thesis research at one of the three Emory EDs under the mentorship of basic science and physician researchers. Current areas of emphasis include neuroscience, medical toxicology, injury control, disaster medicine, clinical research, international health, and public health surveillance.

Both Years: Scholars will present their research to the Dept. of Emergency Medicine and participate in EM resident education, particularly in their area of research expertise. Other Requirements: Residency trained, and Board eligible or certified in Emergency Medicine. Appointment: Scholars will begin July 1, 2002 with appointment as Clinical Instructors in the Dept. of Emergency Medicine.

Because of the rigorous nature of the Masters of Clinical Science program, there will be significant protected time from clinical duties. Initial Application Process: Submit letter of interest, current CV, a letter of recommendation from current Program Chair of Division Chief, and two additional professional letters of reference to: Dr. Arthur L. Kellermann, Chair, Dept. of EM, Emory University, Suite #B-6200, 1365 Clifton Road, NE, Atlanta, GA 30322. For a Complete Description of the MSCR Program, see http:/www.sph.emory.edu/CRCA/

Western Regional Meeting April 6-7, 2002 San Diego, CA Contact Steve Hayden, MD: shayden@ucsd.edu New England Regional Meeting April 10, 2002 Hoagland Pincus Conference Center Shrewsbury, MA Contact Richard Dart: rdart@bu.edut Mid-Atlantic Regional Meeting April 11-12, 2002 First USA Riverfront Arts Center Wilmington, DE Contact Brian Burgess, MD: tbburgess@home.com Southeastern Regional Meeting April 12-14, 2002 Sea Turtle Inn Jacksonville, FL Contact Andy Godwin, MD: andy.godwin@jax.ufl.edu

Emory is an Equal Opportunity/Affirmative Action Employer. Women and Minorities are Strongly Urged To Apply.

The Top 5 Most-Frequently-Read Contents of AEM During the Month of August 2001 Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articles archived on AEMJ.org.

1 2 3 4 5

Children with First-time Simple Febrile Seizures Are at Low Risk of Serious Bacterial Illness Acad Emerg Med Aug 01, 2001 8: 781-787. (In "CLINICAL INVESTIGATIONS") Initial Experience of Emergency Physicians Using the Intubating Laryngeal Mask Airway: A Case Series Acad Emerg Med Aug 01, 2001 8: 815-822. (In "CLINICAL PRACTICE") The Intubating Laryngeal Mask Airway: Suggestions for Use in the Emergency Department Acad Emerg Med Aug 01, 2001 8: 833-838. (In "SPECIAL CONTRIBUTIONS") Predicting Postconcussion Syndrome after Minor Traumatic Brain Injury Acad Emerg Med Aug 01, 2001 8: 788-795. (In "CLINICAL INVESTIGATIONS") Effects of Biphasic vs Monophasic Defibrillation on the Scaling Exponent in a Swine Model of Prolonged Ventricular Fibrillation Acad Emerg Med Aug 01, 2001 8: 771-780. (In "BASIC INVESTIGATIONS")

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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 • Fax: 517-485-0801 • www.saem@saem.org • saem@saem.org Name ______________________________________________________________________ Title: MD DO PhD Other _________ Home Address _______________________________________________________________ Birthdate_________________ Sex: M F ___________________________________________________________________________________________________________ Business Address ______________________________________________________________________________________________ ___________________________________________________________________________________________________________ Preferred Mailing Address (please circle): Home Business Telephone: Home ( ______ ) ______________________________ Business ( ______ ) ______________________________ FAX: ( ______ ) _____________________________________ E-mail: ____________________________________________________ (Required for Active Membership) Medical School or University Faculty Appointment and Institution____________________________________________________________ Membership benefits include: • subscription to SAEM’s monthly, peer-reviewed journal, Academic Emergency Medicine • subscription to the bimonthly SAEM Newsletter • reduced registration fee to attend the SAEM Annual Meeting Check membership category:

❒ Active

❒ Associate

❒ Resident

❒ Fellow

❒ Medical Student

Active: open to individuals (a) with an advanced degree who hold a medical school or university faculty appointment and actively participate in acute, emergency, or critical care in an administrative, teaching or research capacity; (b) with similar degrees in active military service or (c) who otherwise meet qualifications but who do not hold a faculty appointment and who petition the Membership Committee. Annual dues are $295 plus a $25 initiation fee payable when the application is submitted. The application must be accompanied by a CV. Associate: open to health professionals, educators, government officials, members of lay or civic groups, or members of the public who have an interest in Emergency Medicine. Annual dues are $275 plus a $25 initiation fee payable when the application is submitted. The application must be accompanied by a CV. Resident/Fellow: open to residents and fellows interested in Emergency Medicine. Annual dues are $90 plus a $25 initiation fee payable when the application is submitted. The application must be accompanied by a letter from the director verifying that the applicant is a resident or fellow and the anticipated graduation date. (A group discount resident member rate is available. Contact SAEM for details.)

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

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

❒ EMS ❒ ethics ❒ evidence-based medicine ❒ geriatrics ❒ health services & outcomes research ❒ injury prevention

❒ international ❒ medical student educators ❒ neurologic emergencies ❒ pain management ❒ pediatric emergency medicine ❒ research directors ❒ simulation

❒ substance abuse ❒ toxicology ❒ trauma ❒ ultrasound ❒ web-educators ❒ 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 ________________

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Emergency Medicine Foundation Research Grant Program Overview All funding periods are July 1, 2002-June 30, 2003 unless otherwise noted. Contact EMF at 800-798-1822 or www.acep.org.

EMF Career Development Grant Description: 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: January 11, 2002 Notification: March 20, 2002 EMF Creativity and Innovation in Emergency Medicine Grant Description: 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: December 12, 2001 Notification: March 20, 2002 EMF Research Fellowship Grant Description: 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: January 11, 2002 Notification: March 20, 2002 EMF Resident Research Grant Description: A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level.

Deadline: December 12, 2001 Notification: March 20, 2002 Riggs Family/EMF Health Policy Research Grant Description: 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: December 5, 2001 Notification: March 20, 2002 EMF/FERNE Neurological Emergencies Grant Description: This grant program is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE). The goal of this directed grant program is to fund research based towards acute disorders of the neurological system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 will be awarded in this program annually.

Deadline: January 16, 2001 Notification: March 20, 2002 EMF/SAEM Medical Student Research Grant Description: This grant program is sponsored by EMF and SAEM. A maximum of $2,400 over 3 months for a medical student to encourage research in emergency medicine.

Deadline: January 18, 2002 Notification: March 20, 2002 EMF/SAEM Innovation in Medical Education Research Description: This grant program is sponsored by EMF and SAEM. A maximum of $5,000 to support projects related to educational techniques pertinent to emergency medicine training.

Deadline: November 14, 2001 Notification: March 20, 2002 EMF Directed Research Cardiac Arrest Survival Award Description: This grant program is sponsored by the EMF and Wyeth-Ayerst. The goal of this directed grant program is to fund research proposals specifically targeting research that is designed to improve the outcome of patients who suffer cardiac arrest.

Potential proposals can include basic science, translational or clinical science investigations. A maximum of $100,000 over 2 years (July 1, 2002-June 30, 2004) will be awarded in this program.

Deadline: November 21, 2001 Notification: March 20, 2002 EMF/ENAF Team Grant Description: 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: January 11, 2002 Notification: March 20, 2002 EMF Established Investigator Award Description: A maximum of $50,000 to established researchers.

Deadline: December 19, 2001 Notification: 26

March 20, 2002

S A E M

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

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

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

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

Scholarly Sabbatical Grant This grant provides funding of $10,000 per month for a maximum of six months to help emergency medicine faculty at the level of assistant professor or higher obtain release time to develop skills that will advance their academic careers.

The ultimate goal of the grant is to increase the number of independent career researchers who may further advance research and education in emergency medicine. The grant may be used to learn unique research or educational methods or procedures which require day-to day, in-depth training under the direct supervision of a knowledgeable mentor, or to develop a knowledge base that can be shared with the faculty memberâ&#x20AC;&#x2122;s department to further research and education.

Deadline for applications is November 1, 2001.

SAEM Emergency Medical Services Research Fellowship This grant is sponsored by Medtronic Physio-Control. It provides $60,000 for a one year fellowship for emergency medicine residency graduates in EMS at an approved fellowship training site. The fellow must have an in-depth training experience in EMS with an emphasis on research concepts and methods. The grant process involves a review and approval of emergency medicine training sites, as well as individual applications from potential fellows. Deadline for applications is November 1, 2001.

SAEM Neuroscience Research Fellowship This grant is sponsored by AstraZeneca. It provides one year of funding at $50,000 for an emergency medicine resident, graduate, or junior faculty member to obtain a mentored research training experience in cerebrovascular emergencies.

The research training may be in basic science research, clinical research, or a combination of both, and the mentor need not be an emergency medicine faculty member. Completion of a research project is required, but the emphasis of the fellowship is on the acquisition of research skills. Deadline for applications is November 1, 2001.

EMF/SAEM Medical Student Research Grants This grant is co-sponsored by the Emergency Medicine Foundation and SAEM. It provides up to $2,400 over 3 months for a medical student to encourage research in emergency medicine. More than one grant is awarded each year. The trainee must have a qualified research mentor and a specific research project proposal. Deadline for applications is January 18, 2002.

EMF/SAEM Innovations in Medical Education Grant This grant is co-sponsored by the Emergency Medicine Foundation and SAEM. It provides up to $5,000 to support projects that use novel techniques, programs, or products to improve emergency medicine education. Deadline for applications is November 14, 2001.

SAEM Geriatric Emergency Medicine Resident/Fellow Grants This grant is made possible by the John A. Hartford Foundation and the American Geriatric Society. It provides up to $2,500 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. Deadline for applications is March 4, 2002.

Please note, the above descriptions may be subject to modification by the Board of Directors and Grants Committee.

Please check the SAEM website, or call the SAEM Office at (517) 485-5484 for official grant instructions, application materials, and confirmation of deadlines.

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

S A E M

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

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

CALL FOR ABSTRACTS 2002 Annual Meeting May 19-22 — St. Louis, Missouri

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

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

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

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