September-October 2002

S A E M

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE Investing in SAEM’s Resident Members Of SAEM’s 5456 members, 1870 (34%) are residents. Resident members are therefore both a substantial fraction of our current membership and they represent the pool from which future academicians and leaders in emergency medicine will be drawn.

When considering how SAEM Roger J. Lewis, MD, PhD can best serve the needs of our resident members, it is useful to consider the different ways in which emergency medicine residents may be involved in academics. First, all residents are involved in academics in that they are being taught the clinical practice of emergency medicine in an academic setting. In addition, however, some fraction of our resident members are also planning or contemplating pursuing academic careers. For these residents, residency training (and hopefully fellowship training afterwards) serves a dual purpose: first to ensure the resident has the clinical skills necessary to provide high quality patient care and clinical instruction and; second, to ensure the aspiring academician gains the academic skills required for long-term academic productivity and success.

SAEM supports the clinical education of emergency medicine residents in numerous ways, including providing forums through which faculty members can exchange ideas on best practices in resident education and present research on educational methodology. SAEM supports the development of academic and research skills by residents through its journal, Academic Emergency Medicine, the Annual and Regional Meetings, and the SAEM website. This support includes publication of articles on academic skills and research methodology, the presentation of didactic lectures at the Annual and Regional Meetings and, of course, the presentation of numerous examples of outstanding emergency medicine research at our meetings. In addition, the Annual and Regional Meetings provide excellent opportunities for networking by residents, so that they can develop contacts with more experienced investigators and academicians within the emergency medicine community. Finally, the vast majority of SAEM Committees and Task Forces include SAEM resident members and a resident is elected to serve on the Board of Directors.

Despite SAEM’s products and activities supporting the clinical education of emergency medicine residents and the development of academic skills among the subset of resi(continued on page 16)

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

September/October 2002 Volume XIV, Number 5

Call for Expert Reviewers for Annual Meeting Abstracts

The SAEM Program Committee is currently accepting nominations for individuals to serve as expert reviewers for scientific abstracts submitted to the Annual Meeting. Individuals wishing to nominate themselves should submit an abbreviated CV that includes current academic position and area(s) of expertise (see list below). For each area of expertise the nominee should provide a list of peer-reviewed original research publications, review articles, textbooks chapters, and prior scientific abstract presentations. Priority will be given to individuals with demonstrated expertise based upon demonstrated research productivity. Nominations must be submitted to saem@saem.org by November 1, 2002, including an abbreviated CV and area(s) of expertise from the list below. Due to the expected response, the Program Committee cannot review full curriculum vitae of nominees.

Areas of expertise: abdominal/GI/GU, Administration/HCP, Airway/Analgesia, CPR, Cardiovascular (non-CPR), Clinical Decision Guidelines, Computer Technologies, Diagnostic Technologies/Radiology, Disease and Injury Prevention, Education/Professional Development, EMS/Out-of-Hospital, Ethics, Geriatrics, Infectious Disease, Ischemia/Reperfusion, Neurology, Ob/Gyn, Pediatrics, Psychiatry/Social Issues, Research Design/Methodology/Statistics, Respiratory/ENT, Shock/Critical Care, Toxicology/Environmental Injury, Trauma, and Wounds/Burns/Orthopedics.

New Residency Programs Approved During the September meeting of the Residency Review Committee for Emergency Medicine two new EM programs were approved. This brings the number of approved programs to 127. Congratulations to both new programs.

New York Presbyterian The New York-Presbyterian Hospital Emergency Medicine Residency Program will be a PGY 1-4 format with ten residents per year. New York-Presbyterian, the University of Columbia and Cornell, is the largest tertiary care hospital in New York City with 2200 inpatient beds on two campuses.

Residents will divide their time between the two campuses. Dr. Neal Flomenbaum and Dr. James Giglio are the chairs of Emergency Medicine and Wallace Carter is the program director.

University of South Florida The University of South Florida Emergency Medicine Residency Program will be a PGY 1-3 format with six residents per year. The program is based at Tampa General Hospital, which is a level-one trauma center with an annual ED volume of approximately 65,000 visits. Dr. David Orban is the chair of Emergency Medicine, and Dr. Kelly O'Keefe is the program director.

We woulda if we coulda …….

Ellen Weber, MD Chair, 2003 Annual Meeting Program Committee University of California, San Francisco Thanks to all of you who took the time to complete an evaluation of the 2002 Annual Meeting in St. Louis, and those of you who stopped us in the hallway, or cornered us in an elevator, or later wrote an email, to make suggestions. You have some great ideas. We really do consider many of these suggestions, although many simply do not come to pass. I thought this might be a good time to let you know about the ideas we have received that we’re considering and the dilemmas we are facing, and most importantly, ask you what you think about them.

Fewer tracks? More tracks?

Your responses fit a bell-shaped curved. Most of you say the current schedule is right on target, some say there are too many tracks going on at once, others want even more choice. We understand this to mean that the choice is good, but conflicts are bad. There were suggestions to stagger sessions more so that individuals can see the science and the didactics as well. One option we are considering is to have shorter didactic (or oral) sessions, so there are more “breaks” between them and you go to see something else during that time. Another is to have more of the scientific presentations as posters (as a number of societies are doing) with fewer oral abstract sessions. Since the poster sessions are longer, and you can see them in any order, you could attend that must-see didactic and then visit the science. You might also have the added advantage of a real discussion with the presenter (and vice-versa).

Raise the bar Several of you wrote that we need to raise the bar on the science presented.

In principle we heartily agree with this.

We want to put our best foot forward at this meeting, presenting the kind of research our colleagues in other disciplines, and our junior faculty members and residents, will admire and emulate.

However, some will argue that this is an opportunity for those who are just getting started to obtain feedback and enjoy the exhilaration of acceptance and presentation, and that this opportunity will keep our residents and junior faculty doing research and will encourage them to publish the resulting manuscript. We

do in fact have data, from our own meeting, that acceptance at the meeting is correlated with future publication. 1,2 As of this writing, we have not resolved this conundrum, and we will be discussing it further. Your input is welcome.

Poster sessions Confusion reigns. We’re going to rename them because an interactive session is supposed to (but obviously does not) imply that you simply interact with other members, while moderated sessions are those with, well, moderators. Many of you, particularly the presenters, said you were disappointed that there were not more posters being moderated. Some of you expressed fondness for the walk-around moderated sessions that were axed because of the fact that no one except the moderator, the presenter, and a few people in the front of the group could see the poster or hear the presenter. This regime, at least, will not re-attempt that logistical nightmare. However, we are devising a plan to make sure that every presenter has a chance to get feedback and suggestions from at least one expert commentator. We’ll let you know more about this as we finalize our plans.

Data splitting Both in the evaluations, and verbally, we have noted concerns about projects being split into multiple presentations.

Sometimes it is difficult to identify true data splitting because abstracts may (legitimately) be submitted under separate categories and are reviewed by different people. At least three members of the committee read all the abstracts to prevent these from slipping through, but even here, we—and we think you too— do not always agree on what is data splitting. One of our goals this year is to define for our reviewers the concept of data-splitting and to let our members know what definition we are using.

Again, your input is welcome.

Integrate the CPC into the main meeting We loved the suggestion we received to hold the CPC sessions during the main meeting, perhaps in the evenings.

We all jumped up and down (figuratively) in cyberspace, then landed with a (digital) thud when we realized that the 2

CPC allows 50 different programs to compete, and involves five sessions that run simultaneously for an entire day.

There is simply no way we could get it all done in a few evenings, even if we canned the banquet, the Pops, and your visit to Fenway Park. To quote Roger Lewis, “Reality strikes again.”

Daily Plenary sessions Another member (or maybe the same great thinker) suggested that we hold daily plenary sessions, perhaps as a way to decrease the conflicts and highlight the “better” science. This is in active discussion by the scientific subcommittee. The pros are as just noted.

The cons: because we don’t hold any other sessions during the time of the plenary, it would decrease the total number of other sessions at the meeting (both scientific and didactic). Another worry: will this deter individuals from attending the other paper presentations, thinking that the best stuff is only in the plenary?

Finally, a few words on the overall response to the meeting. Shamelessly ignoring the fact that our response rate of under 20% would make this data completely unpublishable, I am happy to conclude that the meeting was a success. Overall, the meeting was rated excellent by 25%, very satisfactory by 56%, satisfactory by 16%, and somewhat satisfactory by 2%. The majority of responses indicated that the selection of didactic topics, quality of science, number of didactic and scientific sessions, and keynote speaker were good or excellent. Suggestions for improvement, in addition to the ones above, included a different city (sorry), a different hotel, a greater variety of speakers (we’re working on this one too), and warmer rooms (amen).

I welcome your guidance in our planning and deliberations, and, as always, any other suggestions you would like to offer to improve your experience at the Annual Meeting. We can’t promise you that we will be able to pull them off, but at least you now know we try.

Ellen Weber: weber@medicine.ucsf.edu Cathy Custalow, Didactic (continued on next page)

Emergency Medicine Activities at the AAMC Annual Meeting The Association of Academic Chairs of Emergency Medicine (AACEM) and SAEM have developed a presentation and panel discussion to be held on Sunday, November 10, 2002 during the AAMC Annual meeting. The sessions will be held at the San Francisco Hilton Hotel.

All emergency physicians are invited to attend any of the sessions at no charge. However, pre-registration for lunch is required. You can register for

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lunch via email at saem@saem.org.

Contact the SAEM office with any questions.

The sessions begin at 8:00 am in the Franciscan A Room with a presentation entitled “The Effects of Overcrowding on Resident and Medical Student Education,” sponsored by SAEM. Speakers will include Mr. William Petasnick, Chair-elect of the Council of Teaching Hospitals and president of Froedtert Memorial Lutheran Hospital,

Brent Asplin, MD, Robert Derlet, MD, and Mark Henry, MD. At 9:45 am, John Moorhead, MD, will speak on “Workforce Issues in Emergency Medicine”.

Dr. Moorhead is a pastPresident of ACEP and currently heads their Workforce Taskforce. At 10:45 am, AACEM will hold its Business meeting and from 11:30 am to 1:00 pm, lunch will be provided in the Mason Room.

Once again, all emergency medicine physicians are welcome to attend.

Call For Nominations Young Investigator Award Deadline: December 13, 2002

In May 2003, 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 13, 2002, and nominations should be submitted electronically to saem@saem.org. Nominations should include the candidate’s CV and a cover letter summarizing why the candidate merits consideration for this award. Candidates can nominate themselves or any SAEM member can nominate a deserving young investigator.

Candidates may not be senior faculty (associate or full professor) and must not have graduated from their residency program prior to June 30, 1996.

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.

We would if we coulda…

(Continued) Subcommittee: cbc3d@virginia.edu Jeff Kline, Scientific Subcommittee: jkline@carolina.rr.com Diane Gorgas, Resident/Medical Student Subcommittee: gorgas.1@osu.edu Brian Euerle, Resident/Medical Student Subcommittee: beuerle@surgery1.umaryland.edu

CORD/AACEM Faculty Development Conference: Navigating the Academic Waters February 22-24, 2003 - 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 References 1. Callaham ML, Wears R, Weber EJ, et al. develop needed personal, management, teaching, and research skills Positive outcome bias and other limitations required for successful career in the selection of research abstracts for a advancement. CORD and AACEM scientific meeting. JAMA. 1998;280:254-57 have conjointly developed a seminar 2. Weber EJ, Callaham ML, Wears RL, et al. entitled: "Navigating the Academic Waters: Tools for Educators of Unpublished research from a medical specialty meeting: why investigators fail to pub- Emergency Medicine. This conference was first held in November 1996 lish. JAMA. 1998;280:257-59. and received high praise from attendees. The conference is designed 3

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, bedside teaching, negotiating 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!

AEM Consensus Conference on Disparities in Healthcare Planned David Cone, MD Senior Associate Editor, AEM Yale University Although health in the United States continues to improve overall, racial and ethnic minorities and certain other population groups generally have not experienced the same level of improvement.

Reports suggest that racial and ethnic minorities have higher rates of morbidity and mortality, and there is a growing body of evidence supporting concerns that racial and ethnic minorities experience a lower quality of health services, and are even less likely to receive preventative and routine medical procedures.

While moral and ethical reasons to create equality in health care are important, there are also public health advantages to eliminating disparities in health care. The disparity in health care contributes to higher health care costs and difficulties in improving the nations health overall. The impact of disparities on the health of the nation is so important that eliminating health disparities has become the second major goal of Healthy People 2010.

While the presence of disparities in medicine is not controversial, the best strategy to address this issue is unresolved. According to a recent IOM report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care�, access related factors are likely the most significant barriers to equitable care. There are many access related factors contributing to disparities including insurance status, insufficient transportation, and scarcity of healthcare providers and facilities in minority com-

munities. Even after adjusting for access related problems, however, disparities in health care exist for a number of populations in our nation.

The issues surrounding disparities are complex and multifactorial. As access to care is one of the major factors in disparity in health care, the emergency department may be the ideal location to identify those suffering poor health due to disparities and initiate interventions, and to initiate interventions and outcomes research for those suffering from disparities in health care.

Although some emergency department research has been done, more research is needed to help resolve the disparities that exist in health care. Accordingly, Academic Emergency Medicine is planning a consensus conference on May 28 (the day before the SAEM Annual Meeting) in Boston to address health care disparities in emergency department patients. The conference will first focus on providing a general overview of health care disparities with attention to the emergency department setting.

Issues such as defining what disparities exist in emergency medicine, how health care disparities outside emergency medicine impact us, and current research will all be discussed. Working groups will then discuss epidemiology, causes, relevant methodologies to research disparities, educational issues, clinical implications, areas for focused research, and outcome assessment of research into disparities.

This consensus conference will be

the fourth such meeting sponsored by the journal, following on successful conferences on errors, the unraveling safety net, and quality held at the 2000, 2001, and 2002 SAEM Annual Meetings. It is hoped that a conference such as the one proposed will help raise awareness and direct appropriate research towards interventions and subsequent outcomes to help resolve the disparity that many emergency medicine patients suffer.

At this time, the conference planning committee is asking for assistance in identifying people who can help us plan and execute the conference, whether it be as speakers, small group facilitators, or general participants. Names of noted experts from outside SAEM who might be able to bring a particular perspective are welcome along with those of SAEM members. Those committees and task forces with particular interest in or focus on this topic are also invited to participate more broadly as we develop this conference. Lasty, a Call for Papers has been published (see back cover of this issue of the Newsletter). The deadline for submission is March 1, 2003.

Please contact the SAEM office at saem@saem.org or Dr. Michelle Biros, Editor-in-Chief, at biros001@maroon. tc.umn.edu with any suggestions or contact information. Information will be published in future issues of the Newsletter as it becomes available. Registration information will be published in late 2002.

Resident Research Grant Report Roland C. Merchant, MD Brown Medical School Let me begin this report by saying how grateful I am to SAEM for providing me with financial backing for the first year of my research fellowship at Brown.

This funding was provided through the SAEM Resident Research Grant (now expanded and renamed the Research Training Grant). I’d also like to thank Dr. Bruce Becker and Dr. Kenneth Mayer, my research mentors, for their expert guidance; the members of Section of Emergency Medicine at Brown Medical School for their strong support; and Dr.

Lynne Richardson of Mount Sinai and Dr. Carlos Camargo of Harvard for their helpful encouragement when I applied for the grant. Without such help there would not have been a first year of research training.

My fellowship has included both practical and didactic training in research methods and concepts. This has involved a primary research project of my own and some smaller projects with other researchers while pursuing a Master of Public Health degree from the

Harvard School of Public Health. The fellowship has also entailed attending seminars in grantsmanship at the Center for Behavioral Medicine at Brown and lectures on HIV and AIDS at the Center for AIDS Research and the Brown AIDS Program, and participating in weekly meetings with the Preventive Health Research in Emergency Medicine Group at Brown.

My chief research project has been to examine HIV post-exposure prophylaxis provision at the Rhode Island (continued on next page)

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Resident Research Grant Report (Continued) Hospital and Hasbro Children’s Hospital emergency departments prior to and since the release of the Centers for Disease Control and Prevention’s 1996 occupational HIV post-exposure prophylaxis guidelines. This project has comprised a retrospective review of all patients presenting to the ED’s with possible HIV exposures, such as after a needle stick injury or sexual assault.

Although the final reports of this work are in progress, my colleagues and I did present some of our preliminary findings at the SAEM Annual Meeting in St. Louis and at the regional meeting in Worcester, MA. It is our hope that we will be able to delineate areas of improvement for our department on this type of secondary HIV prevention.

I have also had the good fortune to work with other members of our Preventive Health Research group on other subjects such as tobacco-related illnesses, human bite injuries, sexually transmitted diseases, and other preventable sources of human misery. Our multidisciplinary group, under the leadership of Drs. Bruce Becker and Beth Bock, meets weekly to discuss our common projects, review their progress, and create new ones. These meetings have provided me with networking opportunities and peer review for my work. In addition, I have been able to attend grantsmanship seminars produced for post-doctoral fellows by the Center for Behavioral Medicine. At these seminars, where fellows present sections of their

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grant applications for critique by the center’s research mentors and the other fellows, I’ve acquired extremely helpful grant-writing pointers from their sweatand tear-laden efforts.

In terms of didactic instruction, I’ve spent the past year pursuing a Master of Public Health degree with a concentration in quantitative methods, which emphasizes research methods. So far in my degree track, I have taken several basic and advanced courses in biostatistics and epidemiology. Through my studies I now finally know that logistic regression is not something that is creeping in the back of my uncleaned refrigerator. I’ve also had the good fortune to learn more about HIV and AIDS from international experts in the field through seminars and lectures offered by the Brown AIDS Program and the Center for AIDS Research at Brown.

In addition to my research training, I’ve had the uncommon and truly rewarding opportunity to work with Dr. Kenneth Mayer as well as members of the Brown AIDS Program and the Rhode Island Department of Health to create a set of guidelines on non-occupational HIV post-exposure prophylaxis for healthcare practitioners in our state.

We’ve composed a set of practice guidelines that address management of possible HIV exposures sustained by people who were not injured in the healthcare setting—which is a much larger group of patients not covered by the Center for Disease Control’s guide-

lines. We are the first state to offer comprehensive guidelines on this subject and are optimistic that they will positively influence provider practice in Rhode Island.

Probably the biggest benefit--or misery, depending upon one’s viewpoint--of receiving research funding is its (hopefully positive) impact on applying for more funding. I’d have to say that I’ve been doubly lucky this past year. For the next two years I will be able to continue my research training because of the support of a National Institutes of Health T-32 post-doctoral training grant through the Center for AIDS Research at Brown.

In addition, the Rhode Island Foundation provided my colleagues and me with a grant to continue research in HIV post-exposure prophylaxis provision. Because of this grant we will expand our investigation to every ED in the state of Rhode Island.

With continued good luck and with the sound guidance of my research mentors, I will be able to advance my research endeavors beyond the next two years of my fellowship. I’ll soon be looking forward to applying for a K-type award for support of my future work. I am deeply appreciative to SAEM for the opportunity to establish a foundation in research that will permit me to produce both better grant applications and higher quality research. I thank you again for your support.

Call for Submissions Innovations in Emergency Medicine Education Exhibits 2002 Annual Meeting Deadline: February 17, 2003

The Program Committee is accepting applications for review for the Innovations in Emergency Medicine Education (IEME) Exhibits at the 2003 SAEM Annual Meeting, May 29-June 1 in Boston. Submitters are invited to complete an application describing an innovative new educational methodology that they have designed, or an innovative educational application of an existing product. The exhibit should not be used to display a commercial product that is already available and being used in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teaching setting. Commercial support of innovations is permitted but must be disclosed. IEME exhibits will not be published in Academic Emergency Medicine with other abstracts, but will be publshed in the on-site program. However, if submitters have conducted a research project on or using the innovation, the project may be written up as a scientific abstract and submitted for scientific review in the appropriate subject category by the January 7 deadline.

The deadline for submission of IEME Exhibit applications is Monday, February 17, 2003 at 5:00 pm Eastern Time. Only online submissions using the form on the SAEM website (www.saem.org) will be accepted. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

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Academic Announcements SAEM members are encouraged to submit Academic Announcements on promotions, research funding, and other items of interest to the SAEM membership. Submissions should be sent to saem@saem.org by October 18 to be included in the November/December issue.

Brooks F. Bock, MD, has assumed the presidency of the American Board of Emergency Medicine. He has been a member of the ABEM Board of Directors since 1995 and has been involved in the examination process of the Board since 1985. Dr. Bock is the Dayanandan Endowed Professor and Chair of the Department of Emergency Medicine at Wayne State University School of Medicine and Specialist-in-Chief, Emergency Medicine for the Detroit Medical Center.

Scott Cameron, MD, has been appointed assistant director of the Emergency

Medicine residency program at Regions Hospital. His position began on July 1, 2002.

The American Geriatrics Society, the John A. Hartford Foundation, and the Atlantic Philanthropies have announced the winners of the first ten Dennis W. Jahnigen Career Development Scholars Awards. These two-year faculty development awards of $200,000 each provide a foundation on which individuals can initiate and sustain a career in geriatrics-oriented research and education.

Ten young researchers from anesthesiology, general surgery, emergency medicine, ophthalmology, physical medicine and rehabilitation, orthopedic surgery, and urology were selected this year.

Kennon Heard, MD, of the University of Colorado Health Sciences Center in Denver, has received one of the Jahnigen Awards for his project, “Acute Drug Toxicity in Elderly Patients: A

National Study of Overdoses, Adverse Drug Reactions and Poisoning.”

Stephen Meldon, MD, of Case Western Reserve University at MetroHealth Medical Center, received an award for “An ED-based Falls Prevention Screening and Referral Program.”

On August 23 HHS Secretary Tommy G. Thompson named the 21 members of the Secretary’s Council on Public Health Preparedness, which will advise the department on appropriate actions to prepare for an respond to public health emergencies, including acts of bioterrorism. Paul B. Roth, MD, dean of the School of Medicine and associate vice president for clinical affairs for the Health Science Center at the University of New Mexico was one of the appointees.

University of Massachusetts Receives NIDA Grant to Study Internet and Drug Abuse Robert Wright, MD Children's Hospital, Boston SAEM Research Committee Edward Boyer, MD, PhD is the principal investigator for an R21 grant funded by the National Institute of Drug Abuse (NIDA) entitled: Examining the Relationship Between the Internet and Illicit Drug Use. An R21 is an Exploratory/Developmental Grant that is designed to foster initial research and to develop a body of data upon which future research may be built. This project, a surveillance study linking modern information based technology with an important public health issue, is designed to gather data to be used in a subsequent larger epidemiologic study of internet use and substance abuse.

The study’s specific aims are: 1) to determine the proportion of persons using the internet to obtain information about the use of “club” drugs and other drugs; 2) assess the association of knowledge, attitudes, and behavior toward drugs with ways in which the internet is used; and 3) to determine the characteristics of persons whose selfreported drug-using behavior has been

altered by information obtained from the internet. The study will consist of a cross-sectional survey of subjects presenting to emergency departments. A multivariate analysis will be used to determine community and host factors that predict use of the internet to obtain illicit drugs .

This is one of the first projects to examine the public health implications that the internet has had on illicit drug abuse, overdose, and death.

Preliminary evidence suggests that the internet may not only be a source of information but may also encourage drug experimentation thereby increasing drug abuse. Understanding the complex relationship between internet use and drug abuse requires a sophisticated epidemiological approach . For example, internet use may influence drug abuse in different ways. It may be a risk factor on the causal pathway to drug abuse, or it may be a modifier of behavioral or community based risk factors associated with drug abuse. Because 6

the internet is widely available, is global in nature, and can disseminate information rapidly, it represents a potentially significant source of drug information that can be accessed by increasing numbers of young people. By understanding the multi-level factors which pre-dispose to drug abuse, public policy decisions regarding internet use will be more informed and the development of interventions targeting particular subgroups can be scientifically developed.

Dr. Boyer completed his Emergency Medicine Residency at the Hospital of the University of Pennsylvania in Philadelphia and a fellowship in Medical Toxicology at Children’s Hospital, Boston. He is currently an Assistant Professor at the Department of Emergency Medicine of the University of Massachusetts Medical School, where he is director of the Division of Medical Toxicology, and the Medical Toxicology Fellowship program director.

Sentinel Event Alert Advisory Group and its Recommendations Robert Schafermeyer, MD Carolinas Medical Center Chair, SAEM National Affairs Committee Recently, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) released a Sentinel Event Alert Advisory (Issue 26 - June 17, 2002) which will be reviewed and approved by their Board of Directors. Hospitals were notified that they should develop a response plan to reduce delay in treatment and implement the plan this year.

Many readers are aware of the sentinel event process and may have participated in one of the reviews that your hospital is required to undertake once a member of the hospital task force decides it is a sentinel event. This action is usually prompted by a perceived untoward event stemming from patient care, and the task force is usually composed of members of senior management.

The JCAHO appointed a group of physicians, nurses, pharmacists, and other patient safety experts to advise in the development of its first set of National Patient Safety Goals in April 2002. These were posted on the JCAHO website and sent to hospitals.

The Sentinel Event Alert Advisory Group conducts reviews of all Alert recommendations referred from hospital sentinel event committees and selects recommendations for inclusion in the annual National Patient Safety Goals.

The Goals recommended by the Advisory Group are forwarded to JCAHO's Board of Commissioners for approval.

In July 2002, the first set of six National Patient Safety Goals was announced. Each goal included one or two evidence- or expert-based recommendations. Beginning January 1, 2003, health care organizations will be surveyed for compliance with the recommendations or implementation of an acceptable alternative, while non-compliance will result in Accreditation with Requirements for Improvement.

We should commend the JCAHO for working on patient safety and analyzing sentinel events to reduce errors and bad outcomes for the patients we serve. No one can deny that we are in business to provide quality patient care. The JCAHO can also be commended for working with emergency medicine and hosting a recent forum, “Overcrowding and the Emergency Department” where key stakeholders continued the hard work to

address this national crisis. However, the advisory group did not include the most important recommendation that would help the emergency departments reduce delays in treatment – get admitted patients moved out of the ED. The JCAHO Sentinel Event Alert reviewed the sentinel events reported to them and noted that delays in treatment caused a significant amount of morbidity. “While hospital Emergency Departments (EDs) are the source of just over one-half of all reported sentinel event cases of patient death or permanent injury due to delays in treatment, Joint Commission sentinel event data reveal that such serious problems can occur in any hospital unit, as well as in other health care settings”1. There were 55 reported cases of delays in treatment, with 29 ED-related cases and 26 cases originating in hospital intensive care units, medical-surgical units, and other parts of health care facilities. Of the 55 cases of delays in treatment, 52 resulted in patient death.

There were many reported reasons for the delays in treatment with the most common factor being misdiagnosis (42%). Other reasons for delays included: “delayed test results (15%); physician availability (13%); delayed administration of ordered care (13%); incomplete treatment (11%); delayed initial assessment (7%); patient left unattended (4%); paging system malfunction (2%); and unable to locate ER entrance (2%).”1 The most common missed diagnosis (23 cases) was meningitis (7); six of the seven cases involved children. Other missed diagnoses included cardiac disease, pulmonary embolism, trauma, asthma, neurologic disorder, and four cases of unknown diagnosis due to the patient leaving without being evaluated.

Multiple root causes contributed to each sentinel event, with most organizations (84%) citing a breakdown in communication, most often with or between physicians (67%). Other cited problems included patient assessment process (75%); continuity of care issues (62%), most often relating to discontinuity of care across settings or shifts; orientation and training of staff (46%); availability of critical patient information (42%); staffing levels (25%); and availability of physician specialists (16%).”1

With the ED cases, the most commonly cited root causes were staffing (34%) and availability of physician specialists (21%); overcrowding was cited as a contributing factor in 31% of the cases. No surprises here. We have been trying to get administrations to recognize the problem, put the resources in place to fix the problem and, most importantly, to get patients out of the ED as soon as the emergency physician determines that the patient requires admission.

An April 2002 an American Hospital Association survey of Hospitals2 noted that the majority of hospital EDs perceive they are at or over operating capacity, with more than 90 percent of large hospitals (300 plus beds) reporting EDs at or over capacity. According to the survey, capacity constraints translate into longer waiting times for treatment, longer stays in the ED, and longer waiting times to get admitted to a general acute, critical care, or psychiatric bed.

Again, no surprises here. Issues of overcrowding are a threat to emergency departments everywhere, frequently stemming from insufficient staffed inpatient beds.

JCAHO suggests that multiple and varied risk reduction strategies be implemented to reduce delays in treatment and miscommunication. Many health care organizations have implemented a variety of strategies, including redesign of orientation and training processes, transfer procedures, staffing plans, on-call specialist contact procedures, triage procedures, and physical space. “Other strategies include the implementation of formal oral communication procedures, revised specialist oncall procedures and the revision or redesign of various other procedures such as initial assessment processes, patient information retrieval processes, credentialing and privileging processes, communication of abnormal lab or radiology results, and the implementation of voice recognition transcription software.”1 While these are helpful, where are the strategies to identify and to solve the real root causes? The lack of staffed inpatient beds, the prompt movement of patients to inpatient beds, and the investment in adequate staff and technology would be the “diagnosis” of most (continued on page 8)

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Sentinel Event Alert Advisory Group (Continued) practicing emergency physicians.

Other JCAHO recommendations include: “In light of the number of organizations experiencing delays in treatment that cite problems with communication, JCAHO recommends that organizations: 1. Implement processes and procedures designed to improve the timeliness, completeness, and accuracy of staff-to-staff communication, including communication with and between resident and attending physicians.

2. Implement face-to-face interdisciplinary change-of-shift debriefings.

3. Take steps to reduce reliance on

verbal orders and require a procedure of "read back" or verification when verbal orders are necessary.

4. That hospital EDs implement strategies to maintain a high index of suspicion for meningitis.”1 Recommendations for SAEM members: 1. We must strongly support and continue to provide quality patient care and promote patient safety.

2. We must continue making our case to JCAHO and our hospital administrators that ED crowding is due to boarding of inpatients in the ED, and that such practices must stop.

3. We need to continue our efforts to work with JCAHO to ensure that

appropriate standards are adopted and enforced.

References 1. Sentinel Event Alert Advisory Group Issue 26, June 17, 2002.

2. Emergency Department Overload: A Growing Crisis. The Results of the American Hospital Association Survey of Emergency Department (ED) and Hospital Capacity, April 2002.

Source http://www.jcaho.org/about+us/news+ letters/sentinel+event+alert/sea_26.htm

ACEP's 911 Legislative Network Continues to Make an Impact In an effort to further the interests of academic emergency medicine and emergency medicine teaching programs, SAEM has assumed a more active role in influencing and educating legislators and regulatory bodies in their deliberations over policies affecting the practice of emergency medicine. The National Affairs Committee has worked with the SAEM Board of Directors to produce position papers and letters to legislature that represent the interests of academic emergency medicine. These efforts are often undertaken in cooperation with our partners in the AAMC, AMA, ACEP, AAEM, and other national organizations that share SAEM’s views. SAEM also encourages its members to become more informed of national and local issues affecting academic emergency medicine. One opportunity for SAEM members to become more politically informed and politically active is the ACEP 911 Network, described below.

If you are interested in advocating for legislation and challenging public policy that affects your practice and your patients, ACEP's 911 Legislative Network wants you. The Network provides the advocacy tools necessary for you to raise awareness and garner support for emergency medicine initiatives in your community.

Launched in 1998, the 911 Legislative Network encourages ACEP members to cultivate relationships with their federal legislators for long term, ongoing lobbying and educational efforts. With the federal government increasingly involved in every aspect of healthcare, from physician reimbursement to the funding of medical research, these relationships are more important than ever. The goal is to have emergency physicians across the country available as healthcare issue experts to federal legislators and their staffs. As "citizen lobbyists," 911 Network members carry ACEP's concerns directly to policy makers. They educate lawmakers about the effects of legislation and regulation on emergency medical care.

Participants in the 911 Legislative Network are the voice of emergency medicine and, ultimately, the emergency patient.

The Network has grown significantly, from 341 members in 1998, to 874 today. ACEP has at least one 911 Network member in 341 congressional districts. With important mid-term elections looming in 2002, more help - especially in key congressional districts - is needed.

"Along with strategic use of the National Emergency Medicine Political Action Committee (NEMPAC) and direct lobbying by ACEP Washington staff, member involvement in the 911 Network is a critical link in ACEP's advocacy efforts," said Keith Ghezzi, MD, chair of the Federal Government Affairs Committee. "Members of Congress will respond to a person who lives in their district, especially if that person is a physician - someone with a prominent role in the community."

"We are especially interested in adding members in districts with leaders in the Democratic and Republican parties, and those districts that have legislators who are members of committees that handle health care issues," says Marilyn Heine, MD, a member of ACEP's Federal Government Affairs Committee and Chair of the 911 Network Subcommittee. "Our goal is to have at least one 911 Network member 8

in each congressional district, so we need to recruit about one-hundred more."

Network members have successfully persuaded members of Congress to support legislation. During the current Congress, 911 Network members contacted their Senators and Representatives to ask their support on healthcare legislation affecting physician Medicare reimbursement, bioterrorism preparedness and training, medical liability insurance, and patients' bill of rights legislation.

Individuals who join the 911 Legislative Network can participate in a number of ways, but at a minimum they should be prepared to: • Contact their members of Congress; • Develop a relationship with their Representative or Senators; • Participate in ACEP legislative activities, such as responding to an alert that calls for 911 members to contact a legislator by phone, fax, or e-mail; • Serve as the "eyes and ears" of emergency medicine and provide feedback to ACEP staff on issues or concerns from legislators. (continued on page 9)

911 Legislative Network (Continued) Along with establishing Network members in each congressional district, ACEP is looking for highly motivated ACEP members to act as Team Captains. "Team Captains take a leadership role in coordinating legislative and political activities in their congressional district or state," said Dr. Ghezzi.

One of the most important roles of the Team Captain is the recruitment of new Network members. "There is no one better than a politically active ACEP member to find and recruit other interested physicians for the Network," said Dr. Heine.

Team Captains help organize meetings with legislators in their district, help deliver NEMPAC checks to the members of Congress supported by NEMPAC, and may also be asked to host a congressional visit to an emergency department.

"Inviting your representative or a senator to visit your emergency department is the best way to educate legisla-

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tors about emergency medicine specific issues first hand, including patient access, crowding, ambulance diversion, rural or inner city health issues and quality of care," said Dr. Heine. "With 2002 being an election year, we anticipate that more legislators will want to visit their local ED to learn about these issues."

The 911 Legislative Network supports ACEP's legislative and regulatory advocacy program and has proven to be a powerful voice for conveying its messages to Capitol Hill. "Member involvement has been instrumental in our success," says Dr. Ghezzi. "Through the Network we find members who are interested in legislative advocacy and our grassroots lobbying efforts. We then give them the information and tools they need to be successful 'citizen lobbyists' and to communicate effectively with their legislators."

Each fall at Scientific Assembly, ACEP's Public Affairs department offers

the School of Political Advocacy to help ACEP members master the skills necessary to be effective citizen lobbyists.

This year, the school has been incorporated into the course titled "Why Vote?

How This Election Will Affect the Way You Care for Your Patients." Participants will learn how recent Washington actions affect the practice of emergency medicine, the best ways to become involved in the political process, and how the upcoming election may affect the practice of medicine. CME credit will be awarded for the course. The school takes place on Monday, October 7, in the Convention Center, Room 613-614, from 9:00 a.m. - 9:55 a.m.

If you'd like to join the 911 Legislative Network, or if you want more information, contact Mark Cribben in ACEP's Washington office at 800-320-0610, ext., 3013, or mcribben@acep.org. For additional information, visit the ACEP government and advocacy web page http://www.acep.org/1,6,0.html

Call for Photographs Deadline: February 17, 2003

Original photographs are invited for presentation at the SAEM 2003 Annual Meeting in Boston. 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 of at least 640 x 48).

Radiographs should be submitted as glossy photos, not as x-rays. For EKGs 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 brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding, 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.”

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

SAEM will retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

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

Submitters must attest that written consent and release of responsibility have been obtained for all photos EXCEPT for isolated diagnostic studies such as EKGs, radiographs, gram stains, etc. The attestation statement is included in the submission template.

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Local Sources of Research Support David Milzman, MD SAEM Research Committee Providence Hospital While many experienced researchers devote a large part of their effort to obtaining funding from federal or foundation sources, there is good reason to seek support from alternative sources and use local resources for research support. This short review will highlight the use of often-overlooked research aids that are usually present on your own campus or that can be found locally.

One way to find research funds may be to ‘hitch a ride’ with local faculty on an existing grant in an area where you have either expertise or strong interest.

However, be careful about choosing a mentor. Young investigators may promise more than they are capable of completing while senior researchers may not have time or interest to spend with new and inexperienced faculty.

Spending quality time with successful and active mid-level researchers may be the most productive. Use contacts within your department, or seek out researchers in your hospital, school, or campus that are involved in your research topic. Certainly, the closer the affiliation or more you can provide in terms of expertise or research time the more effort a mentor may invest in you.

After doing work on another investigator’s grant, look toward broadening the research into your own area of expertise. Develop local contacts to form a working group of researchers within a focused research area. For instance, if one has an interest in alcohol use, you may recruit faculty from departments as diverse as business and public policy (to explore costs to hospitals and the local jurisdiction), sociology or psychology (for studies on the societal and cultural costs of alcohol abuse), and biochemistry, neuroscience, psychiatry, and neurology (to investigate mechanisms of liver and brain damage). Developing affiliations with faculty members on a research area can bring you broader involvement in the general area and improve your future grant applications through the use of multi-disciplinary approaches.

The research offices of most medical schools have indexes of faculty research areas. This can be a time saver in developing your work/consultant group.

Another use of the local campus lies in the provision of cheap or free manpower. EM researchers have made excellent use of both undergraduate students and medical students as research assistants, thereby providing an educational opportunity and obtaining research assistants in a very cost effective manner.

Hollander and Singer1,2 describe their program of medical research courses which include a didactic curriculum on clinical research concepts, course examinations, and practical experience serving as active departmental research aides for both patient recruitment and data collection in research trials. Offering undergraduates the opportunity to earn college credit while participating in projects supports the research infrastructure with minimal financial start-up costs and results in high productivity of the clinician-educator faculty member with limited protected time. A good source of interested students is the local EM interest group at your medical school. While the time spent getting the students oriented to the research project and the oversight may seem great, the payoff in research productivity is usually greater.

Whether or not you have affiliations with a mentor or other local faculty, you may be able to start your research with a demonstration project that can be funded on either departmental (if primary EM) or institutional small grants for young researchers. Another useful resource for small grant funding is at the medical student, resident, or post-doctorate level. Both SAEM and ACEP fund these grants through EMF (http://www. acep.org/1,4003,0.html). These grants may provide stipend support for the student or resident and some funds for expenses. First time applicants have outstanding success rates for funding; however, some demonstration of past research productivity typically is necessary.

There are web sites such as ClinicalTrialFinder.com and www. controlled-trials.com that provide a matching service for investigators who are available to join phase III and IV trials in need of additional research sites.

Also, there are a number of corporate research organizations and more local recruitment sites that may provide an introduction to the research grant

process. Many foundations or publicly funded associations such as the American Heart Association (http:// www.americanheart.org/presenter.jhtml ?identifier=182), have funding mechanisms that vary from one local affiliate the next, but most programs are designed to assist students in training and other beginning investigators who are developing research careers in the broad field of cardiovascular function and disease and stroke. Awards are made in basic and health sciences and clinical studies. The American Lung Association, American Cancer Society, and many other foundations now utilize one site for grant information called proposalCENTRAL (http://pc.ecgrant. com/index.htm). This is a web-based ‘grant management solution’ for government, non-profit, and private grant-making organizations. This single web site has small start-up grants and special funding categories for students and training programs. The NIH may be more easily navigated through the site: http://www.grantsnet.org/ which is an outstanding “one-stop resource’ to find funding sites for all level of investigators, but especially helpful for those looking to initiate research funding.

Additionally, in a recent article by Mulholland3, funding sources are reviewed and sources of support identified on the internet.

Finally, local representatives of pharmaceutical companies and device manufacturers may have information regarding opportunities to test an approved drug or device for study of a nonapproved use or in an innovative trial.

These funds usually are non-competitive and without specified funding cycles or formal requests for proposals.

To summarize, there are many sources and resources for new or experienced investigators in need of new direction. All one has to do is ask, and spend some face time beginning in your own shop. Odds are very good that expertise is closer than you think. If not, web sources are plentiful and these sites all have extremely helpful humans on the other end to assist in applying for their funds. Taking the time and effort to ask is the all important step.

(continued on next page) 10

Jahnigen Career Development Scholars Awards A call for proposals has been issued for the 2003 Jahnigen Career Development Scholars Awards, an online version of which may be found on our website at http://www.american geriatrics.org/hartford/scholars_award. shtml. The awards (of $100,000 each year for two years) are designed to support young faculty (within 8 years of completing training) in the specialties of anesthesiology, emergency medicine,

S A E M

general surgery, gynecology, ophthalmology, orthopaedic surgery, otolaryngology, physical medicine and rehabilitation, thoracic surgery, and urology.

The deadline for filing applications is December 3, 2002. Up to ten awards will be given in 2003.

For further information, please contact Marina Shaykevich, by email, at mshaykevich@americangeriatrics.org.

Call for Nominations Deadline: February 3, 2003

Nominations are sought for the Hal Jayne Academic Excellence Award and the Leadership Award. These awards will be presented during the SAEM Annual Business Meeting in Boston. Nominations for honorary membership for those who have made exceptional contributions to emergency medicine are also sought. The Nominating Committee wishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or any SAEM member. Nominations should include a copy of the candidate’s CV and a cover letter describing his/her qualifications.

Nominations must be sent electronically to saem@saem.org. The awards and criteria are described below:

Academic Excellence Award

B. Other research publications (e.g., review articles, book chapters, editorials) C. Research support generated through grants and contracts D. Peer-reviewed research presentations E. Honors and awards

The Hal Jayne Academic Excellence Award is presented to a member of SAEM who has made outstanding contributions to emergency medicine through research, education, and scholarly accomplishments. Candidates will be evaluated on their accomplishments in emergency medicine, including: 1. Teaching A. Didactic/Bedside B. Development of new techniques of instruction or instructional materials C. Scholarly works D. Presentations E. Recognition or awards by students, residents, or peers 2. Research and Scholarly Accomplishments A. Original research in peer-reviewed journals

Leadership Award The Leadership Award is presented to a member of SAEM who has demonstrated exceptional leadership in academic emergency medicine. Candidates will be evaluated on their leadership contributions including: 1. Emergency medicine organizations and publications.

2. Emergency medicine academic productivity.

3. Growth of academic emergency medicine.

Keep Your Membership Mailings Coming!

Local Sources of Research Support (Continued) References 1. Hollander, J Valentine S. and Brogan G. Academic associate program: Integrating clinical EM research with undergraduate education. Acad Emerg Med 4:225-30, 1997.

2. Hollander JE, Singer AJ. An innovative strategy for conducting clinical research: The academic associate program. Acad Emerg Med 9:134-7, 2002.

3. Mulholland MW. Further thoughts on research funding. Ann Emerg Med 1998;31:308-11 11

Be sure to keep the SAEM office informed of changes in your address, phone or fax numbers, and especially your e-mail address.

SAEM sends infrequent e-mails to members, but only regarding SAEM issues or activities. SAEM does not sell or release its mailing list or e-mail addresses to outside organizations. Send updated information to saem@saem.org

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

Ways To Get the Most Out of Your Residency Michael S. Beeson, MD, MBA Summa Health System Chair, SAEM GME Committee As you have learned by now, emergency medicine residency training is an extremely busy time. There are many competing interests for your time, including your family, residency, and outside interests. The goal of this article is not so much to give advice on time management, as it is on successful strategies to maximize the training you are receiving.

When you embarked on a career path in emergency medicine, you carefully chose the residencies you applied to and interviewed at, as well as your ultimate rank list. As you consider how to maximize the training and education you receive, remember the qualities of the residency that you are at, and why you chose that particular residency program. Ultimately, the strengths of that program will help guide you through your residency training. The components of emergency medicine residency training can be broken down into: • Clinical Care • Academics • EMS • Research • Political interest/involvement • Camaraderie • Rest/wellness Before each of these components are discussed, try to envision the kind of emergency physician that you want to be.

Will you be a purely clinical emergency physician? Do you envision research or academic pursuits to be a component of your practice? How will EMS fit in? Do you have any interest in furthering the cause of emergency medicine as a specialty and the care of our patients through political involvement? Consider these questions in the context of five years after residency. The answers to these questions will help focus you into the areas you will be involved with in your career.

As each of these components is discussed, consider developing a mentoring relationship with one of the attending physicians at your program. Mentors are an extremely valuable way to further develop your knowledge in specific areas, develop modeling behaviors, and develop collegial relationships with others in your interest areas. Many residencies have mentoring relationships formalized within their program.

Take advantage of this! If your program does not, try to identify an attending with whom you would like to develop a mentoring relationship. If you are undecided as to an area of emergency medicine in which to focus, consider a mentor who provides an excellent example of patient care and communication.

Clinical Care In order to be successful in emergency medicine, the cornerstone is providing excellent care of patients. Whether you

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go into an academic environment, focus on EMS, research, or other areas, your success and reputation will be significantly affected by the quality of care you provide to your patients. There are several strategies that can be used to maximize this education. Be aggressive in seeing patients in the emergency department.

For those patient illnesses/injuries that you do not have a good handle on, make it a point to read about that illness/injury. There is nothing like reading about a disease or injury, and comparing it to the presentation of a patient you have recently taken care of, to emphasize learning points and help with retention.

On off-service rotations, be interested in that service. Your residency program has determined that a particular rotation is worthwhile for a number of reasons–RRC-EM requirements, the quality of the rotation, etc. Take advantage of what the rotation has to offer. As an example, when you are on an orthopedic rotation, observe or assist in the surgeries for hip fractures. Being able to explain the type of surgery that a patient is likely to have based on type of hip fracture can be very helpful to the patient and their family. Each off-service rotation has many things to offer, and they should be taken advantage of.

During your residency, try different methods of the same procedure. Residency training is a protected environment in which you have higher level residents and attending staff standing by to help. If you have only intubated with a Macintosh curved blade, for the next intubation, try using a Miller straight blade. The next time that you put in a chest tube, if there is time, consider an intercostal nerve block for pain control. The point is that you will be less apt to try new things once you graduate, and arguably the place to try new procedures and methods is during your formal residency training.

Academics To summarize, read, read, and read! Each rotation has readings assigned to it. Try to keep up with the assigned readings. Reading is one of the first things that is sacrificed as the demands on time increase, such as during difficult rotations. However, make reading a priority. Try to set aside time every day for some amount of reading. Everyone has a calendar that they put their scheduled shifts on. On that same calendar put down reading times, and even what you want to read. This will force you to recognize the importance of reading. Scheduling reading times ahead of time makes it a priority.

Conferences should always be attended. Prior to each conference, look at the conference topics. If possible, read about the topic, and find an article directly related to that conference topic. Just like reading about a disease/injury after having seen a patient with it, there is better retention of a topic if some preparation occurs prior to listening to the lecture.

If your career interests lie in academic emergency medi-

cine, make sure that you develop a mentoring relationship with your program director or other individual involved in the academics of your residency program.

EMS EMS is an area of emergency medicine that we can claim as our own. In some emergency departments, EMS will be responsible for nearly 50% of the patients seen. It is important to develop a thorough grounding in the components of EMS, including medical direction, protocol development, Medical Director duties, etc. If you are really interested in EMS, consider taking a medical directors’ course.

Many graduates of emergency medicine residency programs find that they are assigned to an EMS squad at the hospital in which they end up working at. The knowledge gained during residency will serve you well in this role.

Research The RRC-EM requires that every resident “participate in the development of new knowledge, learn to evaluate research findings, and develop habits of inquiry as a continuing professional responsibility.” Most residency programs require a research project of some kind. Try to become involved in a project that fits with your long-term goals as well as the program’s. As an example, if you have a strong interest in EMS, consider a research project with the EMS director. If you have a desire to pursue research following residency training, it is essential that you develop a mentoring relationship with a faculty member who is involved with research, and who can shepherd you through this academic development.

tions. Get your sleep. Schedule time with your friends and family. Talk to others who know your area and surprise your significant other on that rare day off with a trip to a local attraction.

Finally, from a Program Director’s Perspective Every program has requirements in each of the above areas. Understand that you will be measured as a resident at least partially by how well you complete your residency requirements. Make your life easier–complete the requirements! Document your procedures, resuscitations, and patient follow-ups. Prepare your assigned lectures.

Complete your program’s EMS requirements. If you are responsible for completion of your rotation evaluations, complete them! Do your readings.

Summary There is a tremendous amount of time, energy, and effort that must be expended during residency training.

Know your program’s requirements, and be diligent in completing them. Keep in mind your overall goal of the type of emergency physician you want to be five years after residency completion. Use the resources of your residency to help you achieve that goal.

Political Interest/Involvement There are many opportunities for involvement in organized emergency medicine. This pursuit will benefit you by learning that there is a lot of energy and effort that is occurring behind the scenes. All emergency physicians and all emergency patients benefit from this activism. In order to see this activism, you must at the least attend a state chapter meeting, or a national meeting of one of the major organizations. EMRA has significant influence in residency training as well as patient care. In addition, there are many important opportunities for residents in SAEM, ACEP, AAEM, etc.

Nominations Sought for Resident Member of the SAEM Board of Directors The resident Board member is elected to a oneyear term and is a full voting member of the SAEM Board of Directors. The deadline for nominations is February 3, 2003.

Candidates must be a resident during the entire one-year term on the Board (May 2003-May 2004) and must be a member of SAEM. Candidates should demonstrate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter. Nominations must be sent electronically to saem@saem.org. Candidates are encouraged to review the Board of Directors orientation guidelines on the SAEM web site at www.saem.org or from the SAEM office.

The election will be held via mail ballot in the Spring of 2003 and the results will be announced during the Annual Business Meeting in May in Boston.

The resident member of the Board will attend four SAEM Board meetings; in the fall, in the winter, and in the spring (at the 2003 and 2004 SAEM Annual Meetings). The resident member will also participate in monthly Board conference calls.

Camaraderie Some of the most successful graduating classes as a whole have the most camaraderie. Characteristics of these classes include meeting away from the hospital, doing things recreationally, and involving significant others with other residents/significant others. This camaraderie results in helping each other out, including during times of personal illness or family emergency. The result is less stress during your residency training.

Wellness Speaking of stress during residency, wellness is an issue that every program director is concerned about. If you are having problems during residency that are affecting your well-being, approach your program director or mentor and let them know. Use the camaraderie of your class to help you through any rough times, including difficult rota-

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Opportunities Available Through the SAEM Consult Service Glenn Hamilton, MD Wright State University Chair, SAEM Consulting Service The SAEM Consult Service has a long history beginning with the Society of the Teachers of Emergency Medicine (founded by Gus Roussi in the late 1970s). Its greatest activity was under the guidance of Steve Dronen, MD, who chaired the Consulting Service for many years and provided over 70 consultations during the 1990s. The SAEM Consult Service is well prepared to offer its considerable capabilities to interested parties in our specialty.

Although a variety of services are available, the primary foci have been the following: 1. Establishment of an EM residency – this consult is in advance of application to the ACGME and RRC-EM for consideration of a new EM residency. The consultation will assess the suitability and potential of the site for residency training and assist in the development of the program information forms required by the ACGME. This service has been successfully offered to more than 40 programs in the last two decades.

2. “Mock” survey prior to RRC-EM site survey – this service serves as a preparatory guide to residencies preparing for their official site survey by the RRC-EM. This is a useful process for making sure the issues of potential concern by the RRC-EM are addressed, and convincing institutional administration of the benefits of EM and its continued support.

There have been more than 40 of these consults in the last 20 years.

3. Research Consultation – this relatively new aspect of the service helps programs develop a research program suitable to their environment. Several sites have participated in this type of consultation with appropriate guidance and net gains in their research activity.

4. Faculty Development – EM remains one of the few specialties that requires faculty development as part of its program requirements.

Programs who are initiating or having difficulty in this area may request a faculty development consultation

to assist in planning effective programs for their faculty.

Consultations are done by experienced individuals who are Program Directors, Academic Chairs, and/or RRC-EM Site Surveyors. Usually 1-2 individuals participate in the consultation depending upon the needs of the institution. The individuals are selected with input from the institution and the consult service. Fees are $1,250 per individual per day plus expenses. An additional $500 is paid to SAEM to support the administrative aspects.

The 1980s and 90s were a time of tremendous growth for EM residencies.

The Consult service played a significant role in sustaining the quality of these residencies and assisting numerous Program Directors in developing and creating solutions to their problems.

The SAEM Consult Service looks forward to assisting in residency or academic development needs. Please contact me directly or through SAEM for further information and assistance.

The Top 5 Most-Frequently-Read Contents of AEM – August 2002 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

Guidelines for the Management of Severe Head Injury: Are Emergency Physicians Following Them?

Acad Emerg Med Aug 01, 2002 9: 806-812. (In "CLINICAL PRACTICE") Ultrasound Guidance versus the Landmark Technique for the Placement of Central Venous Catheters in the Emergency Department Acad Emerg Med Aug 01, 2002 9: 800-805. (In "CLINICAL PRACTICE") Are Intubation Conditions Using Rocuronium Equivalent to Those Using Succinylcholine?

Acad Emerg Med Aug 01, 2002 9: 813-823. (In "CLINICAL PRACTICE") Manual Measurement of QT Dispersion in Patients with Acute Myocardial Infarction and Nondiagnostic Electrocardiograms Acad Emerg Med Aug 01, 2002 9: 851-854. (In "BRIEF REPORTS") Transport Refusal by Hypoglycemic Patients after On-scene Intravenous Dextrose Acad Emerg Med Aug 01, 2002 9: 855-857. (In "BRIEF REPORTS")

Log onto www.aemj.org and start taking advantage today!

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

Some students hoped to learn more about a specific geographic region,

while others were anxious to contact an advisor whose special interest matched their own.

As the program increases in popularity, more advisors are needed. New students are applying daily, and over 100 remain unmatched! Please consider mentoring a future colleague by becoming a virtual advisor today. It is a brief time commitment – most communica-

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

Clinical Research Curriculum (K30) Award Announcement The National Institutes of Health is extending for one year the Clinical Research Curriculum (K30) Awards that were originally made in 1999. These awards, which were due to terminate in June, 2003, will be extended at the same level of funding as currently exists. As a result of this extension, the K30 awards made in 1999 will end in the summer, 2004, approximately the same

time that the K30 awards made in 2000 are scheduled to end.

Next year, NIH plans to solicit competitive applications for the K30 award, which will be scheduled to begin in the summer, 2004. All domestic, nonFederal institutions with clinical research programs will be eligible to apply. That is, those who currently have a K30 award (those institutions that

originally received an award in 1999 and those that originally received an award in 2000), and those that do not have an award may apply.

Questions concerning this announcement should be addressed to Lawrence Friedman, MD at lawrence_friedman@nih.gov.

Opportunities Through the AACEM Consult Service Glenn Hamilton, MD Wright State University Chair, AACEM Consulting Service Since the Association of Academic Chairs in Emergency Medicine (AACEM) was founded in 1989, the Consult Service of the Association has had an active role. The primary focus of this service is to assist academic medical centers in establishing academic departments of emergency medicine in the United States and Canada. The service has had a contributing role in the development of several departments and is currently at various stages of discussion with three or four sites considering this important decision. The AACEM and SAEM Consult Services have worked closely together.

The Consult Service’s activities include: 1. Overview assessment of the status of emergency medicine in an academic medical center to determine the suitability and timing for evolving to academic departmental status.

2. Assisting divisions or other institutional entities in developing a proposal for development of an academic department in the institution.

3. Site surveys to assist the division as well as the Dean’s office and hospital administration in their decision making regarding the potential and

appropriate time table for development of an academic department.

4. Discussions at any level of decision making with emergency medicine leadership about the approach, negotiations, documentation and timeframe of developing an academic department.

The actual consultation consists of two current Academic Chairs of Emergency Medicine who are selected conjointly by the consult service and the institution. These Chairs usually spend two days at the site and develop a report regarding the specific questions asked of them. Current fees for this service are $1,500 per individual per day plus overnight expenses. In addition, $500 is contributed to AACEM for administrative purposes.

One significant accomplishment of the service was to develop a monograph entitled “Establishing the Academic Department of Emergency Medicine: Commentary on Five Phases of Development”. The monograph reviews the five major phases of development beginning five years before and continuing five years after the actual establishment of an academic department. This useful monograph is avail15

able on the AACEM section of the SAEM website at www.saem.org.

Currently, the consult service is developing a listing of current sites that may have the potential for evolving from their current institutional status into a formal Academic Department of Emergency Medicine. Contacts with individuals in emergency medicine at these sites will be made over the next several years.

Emergency Medicine essentially doubled its number of academic departments in the 1980’s and doubled that number again in the 1990’s. Currently, there are 63 academic departments in the United States in 124 medical schools. This leaves the opportunity for one more doubling to ensure the complete integration of emergency medicine into academic medicine throughout the country.

Please contact me if you may have an interest in discussing the potential of an academic Department of Emergency Medicine at your institution. The full talent and capability of the AACEM is directed toward this most important goal.

President’s Message (Continued) dents contemplating careers in academics, the Board of Directors has recently initiated additional activities with the goal of more fully integrating and involving SAEM’s resident members. The Board believes that a more active and substantial investment should be made in the academic development and mentoring of our resident members. The motivation for this investment is not exclusively altruistic—the Board believes this investment will result in a greater number of young academicians being willing and able to participate effectively in SAEM’s scientific and educational activities. The Board’s efforts in this area were spearheaded by Carey Chisholm with input from, and unanimous support of, the entire Board.

Our resident-centered initiatives have four parts: 1. First, to ensure that residents who had already volunteered for leadership positions within the Society are given appropriate guidance and support, a mentoring program has been developed so that each resident member appointed to an SAEM Committee or Task Force is assigned a faculty mentor who serves on the same Committee or Task Force. The faculty mentor will help to ensure that the resident is fully integrated into the activities and work of the Committee/Task Force and, when necessary, facilitate interactions between the resident member, other Committee and Task Force members, the Chair, and the Board liaison.

2. Second, the Board wished to open up lines of communication between our resident Committee and Task Force members and the SAEM Board of Directors. To achieve this, the SAEM President, members of SAEM’s Board of Directors, and resident Committees and Task Force members have participated in two conference calls. During the conference calls, residents learned about SAEM’s structure and procedures, including the process through which goals and objectives are developed for each Committee and Task Force, the differences between Committees and Task Forces, and the role of Interest Groups. In addition, the residents were encouraged to discuss their personal experiences with their own Committee or Task Force to date. Residents were also given

some specific recommendations regarding successful participation in their Committee or Task Force.

These recommendations included seeking out a mentor on the committee (as above), understanding the objectives and the resident’s specific assignment regarding the goals and objectives of the group, focusing on the completion of specific and tangible assignments, understanding that the resident’s own performance will be graded on their accomplishments relative to the goals and objectives of the Committee or Task Force, and the importance of networking. In addition, the residents who participated made a number of insightful and useful suggestions regarding the further integration of residents into SAEM’s functions.

3. Third, with the help of current SAEM resident members, Dr. Chisholm will be developing an orientation session for resident SAEM members appointed to next year’s Committees and Task Forces, to be conducted early in the 2003 SAEM Annual Meeting. This orientation session will provide a mechanism for new resident Committee and Task Force members to hear presentations on the structure and function of SAEM, as well as to receive insights from residents who served during the prior year. Residents participating in the conference calls mentioned above also suggested that the Chairs of Committees and Task Forces be invited to attend the orientation session, so that they can meet the resident members of their Committee or Task Force prior to the first Committee/Task Force meeting.

While we are early in the process of developing this orientation program, the residents involved have already demonstrated tremendous enthusiasm about this program.

4. Lastly, the Board has agreed to eliminate the membership initiation fee for all members. While this change lowers the cost of joining SAEM for all potential members, we believe that the initiation fee was most likely to be a barrier for residents, because of the financial constraints that exist during residency. Furthermore, the Board agreed to allow resident members to join one Interest Group free of charge, to encourage residents to join an Interest Group that matches 16

their own academic interests.

SAEM’s interest groups represent an excellent opportunity for residents to develop contacts and collaborations, as a first step to becoming an active participant in the world of academic emergency medicine.

Taken as a group, these actions by SAEM represent a substantial and active investment in our resident members. We hope that these activities will encourage more resident members to actively participate in SAEM’s Interest Groups, Committees and Task Forces, and other activities and, furthermore, will encourage residents contemplating a career in academic emergency medicine to pursue that goal. While emergency medicine is still a relatively young specialty—it is not as young as it used to be! By investing in SAEM’s resident members and encouraging their involvement and growth, we hope to ensure the continuing renewal of both SAEM and academic emergency medicine through the infusion of new energy and intellectual talent.

Ethics Curriculum Available Online Catherine Marco, MD St. Vincent Mercy Medical Center Chair, Ethics Committee Now available on the SAEM website (www.saem.org) is a downloadable slide set of Ethics Cases, designed for Emergency Medicine programs to use for ethics discussions. The cases address a wide variety of professional and ethical issues, including physician impairment, autonomy, interactions with pharmaceutical companies, managed care issues, confidentiality, honesty, and many others. The cases were developed by members of the SAEM Ethics Committee, and are downloadable in Microsoft Power Point format, and are available for free use by Emergency Medicine teaching programs. Also available on the SAEM website is the Ethics Curriculum, a manual of study topics, cases, and discussion questions.

Continued additions to the online curriculum materials are being developed by the Ethics Committee, and will be available in the future. Questions or comments may be directed to: saem@saem.org or cmarco2@aol.com.

S A E M

S A E M

Call for Nominations SAEM Elected Positions

Call for Abstracts 2003 Annual Meeting

Deadline: February 5, 2003

May 29-June 1 Boston, Massachusetts

Nominations are sought for the SAEM elections which will be held in the spring of 2003. 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 must be submitted electronically to saem@saem.org. 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.

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 2003-May 2004) 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: Two members will be elected to two-year terms. 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.

Deadline: January 7, 2003 The Program Committee is accepting abstracts for review for oral and poster presentation at the 2003 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/ health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obstetrics/ gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The deadline for submission of abstracts is Tuesday, January 7, 2003 at 3:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instructions will be available on the SAEM web site at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517485-0801.

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 2003 SAEM Annual Meeting. Original abstracts presented at national meetings in April or May 2003 will be considered.

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

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FACULTY POSITIONS

The Institute for International Emergency Medicine and Health at Brigham and Women’s Hospital and the Division of Emergency Medicine at Harvard Medical School are now accepting applications for their International Medicine Fellowship.

MINNESOTA: Academic Emergency Medicine Faculty - Excellent opportunity for EM residency-trained, BC/BE Emergency Medicine faculty to join our progressive academic EM group at Regions Hospital, a Level I Trauma and Burn Center in St. Paul. Numerous opportunities in clinical research, health services research, EMS, Informatics, Toxicology, and education. Established 3-year emergency medicine residency. ED volume: 65,000. Must have or be eligible to attain Minnesota and Wisconsin medical licensure. Forward CV to: HealthPartners Medical Group, Attn: Sandy Lachman, Physician Recruitment Coordinator, Mail Code 21110Q, P.O. Box 1309, Minneapolis, MN 55440-1309. Fax 952-883-5395. For more information, email sandy.j.lachman@healthpartners.com or call 800-472-4695. EO Employer.

Fellowship involves: Two-year track combining clinical emergency medicine, international fieldwork and research project.

Academic classes lead to a Masters Degree at the Harvard School of Public Health.

Academic appointment at Harvard Medical School.

Clinical emergency medicine at affiliated teaching hospitals.

Participation in training of medical students and residents.

Competitive salary, benefits, CME, international travel funds, and training course expenses.

Opportunity to tailor experience to meet specific interest in disaster response, emergency medical systems development, health education, human rights, health emergencies, international public health, and refugee relief.

MOUNT SINAI HOSPITAL has immediate need for full and part time faculty who are EM board certified/prepared. The hospital is a 450-bed teaching hospital, major teaching affiliate of Chicago Medical School with residency programs in all major specialties and two EM residency affiliations. Part of Sinai Health System, which also includes a 275-physician multi-specialty group, community institute, urban institute and rehabilitation institute. The renovated Level I adult and pediatric trauma center has 24-beds and urgent care area treats 45,000 patients per year. Contact Leslie Zun, MD, Chairman, Emergency Medicine, at 773-257-6957, FAX 773-257-6447 or zunl@sinai.org.

THE OHIO STATE UNIVERSITY: Assistant/Associate or Full Professor.

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

Requires: Residency Training in Emergency Medicine.

Completion of application process, interview, and selection.

Inquiries should be sent to the fellowship director: Mark A. Davis, MD, Institute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women’s Hospital, PBB-Ground Pike, 75 Francis St., Boston, MA 02115, or by email to madavis@partners.org.

Phone (617)732-5813; fax (617)264-6848.

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

HEAD OF DEPARTMENT OF EMERGENCY MEDICINE THE UNIVERSITY OF IOWA

QUINCY MEDICAL CENTER seeks board certified/prepared emergency physicians with outstanding clinical skills and an interest in teaching.

Additional opportunity exists for a qualified candidate as EMS Director.

QMC (31,000 visits/year) is an affiliate of Boston Medical Center and a teaching site for the Boston University EM residency program. Faculty will have a BU academic appointment and opportunity to rotate to Boston Medical Center, the regions busiest Level I Trauma center. Please direct inquires to: William Baker, MD, Assistant Chief EM, or Octavio Diaz, MD, Chief, Quincy Medical Center, phone: (617) 376-5549; E-mail: odiaz@quincymc.org. Affirmative action/equal opportunity employer.

University of Iowa Health Care is looking for an academic and clinical leader to head a new Department of Emergency Medicine in the Carver College of Medicine and to direct the Emergency Treatment Center at University of Iowa Hospitals and Clinics. The UI Carver College of Medicine has made a commitment to develop an academic department from the existing Program in Emergency Medicine. Witt/Kieffer has been retained to assist in the recruitment of this departmental executive officer.

The Director and Department Head will be a full-time faculty member at the Associate or Full Professor rank, and will report to the Collegiate Dean. Board certification is required either in emergency medicine or in an appropriate discipline with equivalent qualifications based on experience. Previous administrative experience in an emergency medicine program or department is also required. Candidates must be eligible for an Iowa medical license.

The individual will lead the institution in establishing Iowa’s first residency in emergency medicine and the first Department of Emergency Medicine. As Department Head, the individual will be responsible for the educational and residency programs; research programs; faculty recruitment and development; and clinical programs in emergency medicine. Excellent research opportunities are present for EM faculty, including research within the clinical operation of the Emergency Treatment Center (ETC), and in collaboration with the Injury Prevention Center and other units of the College of Public Health.

As Director of the ETC, the individual will oversee the ETC (faculty, staff and budget), helicopter and ground critical care transport services, the paramedic training program, and will lead departmental participation in state and local EMS activities.

The University of Iowa Health Care comprises the University of Iowa Hospital and Clinics and the Roy J. and Lucille A. Carver College of Medicine. The hospital is an 873-bed teaching facility and is a nationally recognized teaching hospital. The Carver College of Medicine has a budget of $339 million, currently enrolls 680 medical students, and is ranked 10th in NIH research support among public medical colleges. The Emergency Treatment Center (ETC) has 29,923 visits annually and is a Level I trauma center. The hospital has approved a $17 million capital plan to renovate and expand the ETC. The successful applicant will be expected to help guide this project.

For additional information, please send a resume in confidence to:

SAINT LOUIS UNIVERSITY, a catholic, Jesuit institution dedicated to education, research and healthcare, is seeking qualified applicants for full-time faculty positions in the Division of Emergency Medicine. The Emergency Department sees approximately 30,000 patients yearly and is a Level I Trauma Center staffed by dedicated academic Emergency Medicine faculty in the School of Medicine. Applicants must be EM board certified or eligible. Applications containing a letter of interest and curriculum vitae should be sent to Chris Brooks, M.D., Director, Emergency Medicine Division, Saint Louis University, School of Medicine, Saint Louis University Hospital, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110-0250. Saint Louis University is an affirmative action, equal opportunity employer, and encourages applications from women and minorities.

UNIVERSITY OF CONNECTICUT/HARTFORD HOSPITAL: Fellowships: EMS. Administration/Research. Forensics. Beginning Summer 2003: Multi hospital program with 36 residents, 100,000+ visits. Active aeromedical, education, research programs. Includes faculty appointment, and option for Masters Degree. Contact: RD Powers MD MPH via email: Rpowers@harthosp.org

Neill Marshall Witt/Kieffer - Dallas 5420 LBJ Freeway, Suite 460 • Dallas, Texas 75240 972-490-1370 or fax resume to 972-490-3472 E-mail: neillm@wittkieffer.com

UNIVERSITY OF CONNECTICUT/HARTFORD HOSPITAL: New positions created by clinical/academic/residency expansion. Two-hospital system with 36 residents, 100,000+ patient visits. One position open now, two more in Spring 2003. Active education, aeromedical, toxicology, EMS, hyperbaric, research programs. Contact: RD Powers MD MPH, Professor & Chief. Email: Rpowers@Harthosp.org

The University of Iowa is an Affirmative Action/Equal opportunity Employer. Women and minorities are strongly encouraged to apply.

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UNIVERSITY OF KENTUCKY: The Department of Emergency Medicine at the University of Kentucky is recruiting full-time faculty members at the assistant or associate professor level. The desired individual must be BP/BC in emergency medicine. Academic tenure track and clinical non-tenure track positions available. The EM residency has full accreditation. The Emergency Department at the UK Hospital is a level I trauma center with 40,000 annual visits. The department has nine full-time faculty. Contact: J. Stephan Stapczynski, MD Department of Emergency Medicine, UKMC, 800 Rose Street, Room M-53, Lexington, KY 40536-0298, Phone: (859) 323-5908, Fax: (859) 323-8056, or E-mail: jsstap01@uky.edu. We are an EOAAE.

Emergency Medicine Rochester, Minnesota The Department of Emergency Medicine is seeking a full-time academic emergency physician.

The opportunity includes: ● practice in a 77,000 visit/year, Level 1 trauma center, with over 17, 000 pediatric visits; ● teaching in an emergency medicine residency program, as well as teaching of off-service residents and medical students; ● prehospital/aeromedical program including paramedic base station, 3 rotor and 1 fixed-wing aircraft and; ● research, with administrative support and intramural funding available; ● dynamic faculty with commitment to practice, education and research.

UNIVERSITY OF MISSOURI-KANSAS CITY SCHOOL OF MEDICINE AND TRUMAN MEDICAL CENTER: Academic physician group practice, University Physician Associates, is seeking an Emergency Medicine physician to fill a newly created full-time appointment at the Assistant or Associate Professor level for the University of Missouri-Kansas City School of Medicine and Truman Medical Center. Candidates must be residency-trained and BC/BE in EM. Clinical or academic track available, with preference given to those with an established track record in research or interest in ultrasonography, substance abuse/toxicology, or injury prevention. Contact Robert A. Schwab, M.D., Chair, Department of Emergency Medicine, 2310 Holmes Street, Kansas City, MO 64108. (816) 556-3250.

Robert.Schwab@tmcmed.org. EOE

Candidates must be: ● residency-trained emergency medicine specialists; ● ABEM board certified or eligible; ● individuals with a demonstrated interest in academic emergency medicine as proven by performance in residency or fellowship training, or faculty positions; ● Minnesota medical licensed or eligible.

UNIVERSITY STAFF PHYSICIAN FOR URGENT CARE: The staff physician provides care to students in outpatient services, where 17,000 encounters occur annually. Rotating weekday nights and weekends on-call. This is a full-time, 10-month temporary position from September 1, 2002 - June 30, 2003. M.D. degree and board certification or eligibility in a primary care specialty. Emergency Medicine experience and a strong clinical background in sports medicine are preferred. Send cover letter and CV as a Word attachment to: jobs@princeton.edu with Req. 2510 in the subject line or mail to: Princeton University, Office of Human Resources, 1 New South Req. 2510, Princeton, NJ 08544.

Competitive salary with an excellent benefit package and academic appointment through the Mayo Medical School. For further information, contact: Wyatt Decker, M.D. Chair, Department of Emergency Medicine Mayo Clinic 1216 Second Street SW Rochester, MN 55902 Phone (507) 255-6501

WASHINGTON HOSPITAL CENTER AND GEORGETOWN UNIVERSITY HOSPITAL in Washington, D.C., and Franklin Square Hospital in Baltimore, MD are seeking physicians board certified or residency trained in emergency medicine to join their faculty. Our department 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) 877-0808, 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.

Mayo Foundation is an affirmative action and equal opportunity employer and educator.

VANDERBILT UNIVERSITY: The Department of Emergency Medicine has an unexpected opening for a clinician-educator at a level commensurate with qualifications. Please consider joining our successful Department. We have 1st and 4th year medical student rotations, a Level I Trauma Center, contiguous Pediatric and Adult ED’s, a superb residency and all the other components of a well established program. We provide great benefits and Nashville is a great city. Please reply to Corey M. Slovis, M.D., Chairman, Department of Emergency Medicine, Vanderbilt University, 703 Oxford House, Nashville, TN. 37232-4700. Email: corey.slovis@mcmail. vanderbilt.edu. Vanderbilt is an equal opportunity employer.

Molecular Brain Resuscitation Fellowship The Molecular Brain Resuscitation Laboratory at the University of Pennsylvania is offering a two-year research fellowship to Emergency Medicine Residency graduates interested in studying the molecular mechanism of acute neuronal injury caused by stroke, cardiac arrest and head trauma. This training program is part of a multidisciplinary collaboration between NIH-funded laboratories in the Departments of Emergency Medicine, Neurosurgery, Neurology and Pharmacology.

The fellowship is supported by an Institutional Training Grant from the Society for Academic Emergency Medicine. Fellows will be enrolled in the Neuroscience Graduate Program enabling them to pursue a PhD in Neuroscience. Clinical duties are limited to 4 ED shifts/month. Salary ~95K. Start date July of 2003.

Send letter of interest and curriculum vitae to: Robert W. Neumar, MD, PhD Hospital of the University of Pennsylvania Department of Emergency Medicine 3400 Spruce Street Philadelphia, PA 19087 Voice: (215) 898-4960 Fax: (215) 573-5140 Email: rneumar@mail.med.upenn.edu Website: http://www.uphs.upenn.edu/em/brain/

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Boston – Harvard Affiliated Teaching Hospital The Department of Emergency Medicine of the Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center has positions available for faculty committed to academic Emergency Medicine. Board certification or preparation in Emergency Medicine with four years of training or experience are prerequisites.

The base hospital is Beth Israel Deaconess Medical Center, a Level I trauma center, with an ED that sees 50,000 patients a year. Our community practice, Deaconess Glover Hospital, sees over 10,000 patients a year. We provide needed direction for three 911 systems. Academic opportunities include access to lab space, international programs, and teaching at Harvard Medical School. Salaries are highly competitive for the community and are incentive based. We are currently seeking faculty with interests in academics, EMS, basic science, or postgraduate education.

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 Emergency Medicine residency training program in 1970. The Center for Emergency Care evaluates and treats 86,000 patients per year and has 44 residents involved in a four year curriculum. Our department has a long history of academic productivity, with outstanding institutional support.

Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers.

Women and minorities are particularly encouraged to apply. Please send a current curriculum vitae to:

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

Richard E. Wolfe, M.D. Chief of Emergency Medicine Beth Israel Deaconess Medical Center One Deaconess Road (W/CC2) Boston, MA 02215

Phone: 513/558-8086 Fax: 513/558-4599 E-mail: Diane.Shoemaker@uc.edu

ATLANTA, GA DEPARTMENT OF EMERGENCY MEDICINE Due to continued growth, we anticipate openings for full-time academic emergency physicians in both research and clinician-educator tracks. Emory offers a dynamic and professional environment with special strengths in patient care, teaching, community service, EMS, toxicology, clinical and laboratory research, and public health. Excellent salary and benefits. Applicants must be residency trained and/or board certified in EM. Emory is an equal opportunity/affirmative action employer. Women and minorities are encouraged to apply. For further information visit our web site at http://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 Emory is an equal opportunity/affirmative action employer

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EMF Grants Available The Emergency Medicine Foundation (EMF) grant applications are available on the ACEP web site at www.acep.org. From the home page, click on "About ACEP," then click on "EMF," then click on the "EMF Research Grants" link for a complete listing of the downloadable grant applications. The funding period for all grants is July 1, 2003 through June 30, 2004, except for the Congestive Heart Failure Award which will be funded for January 1, 2003 through December 31, 2003.

Directed Research Acute Congestive Health Failure Award This grant is sponsored by EMF and Scios, Inc. This request for proposals specifically targets research that is designed to improve the care for patients who present to the ED with acute congestive heart failure. Only clinical science proposals will be considered.

Proposals may focus on methods of facilitating treatment through early diagnosis, intervention and treatment of acute congestive heart failure patients. Deadline: September 20, 2002.

Notification: November 4, 2002.

Riggs Family Health Policy Research Grant Between $25,000 and $50,000 for research projects in health policy of health services research topics. Applicants may apply for up to $50,000 for a one or two year period. Grants are awarded to researchers in the health policy or health services area who have the experience to conduct research on critical health policy issues in emergency medicine. Deadline: December 20, 2002.

Notification: March 2003.

Resident Research Grant A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level. Deadline: December 20, 2002.

Notification: March 2003.

Career Development Grant A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who needs seed money or release time to begin a promising research project. Deadline: January 15, 2003. Notification: March 2003.

Research Fellowship Grant A maximum of $75,000 to emergency medicine residency graduates who will spend another year acquiring specific basic or clinical research skills and further didactic training research methodology. Deadline: January 15, 2003. Notification: March 2003.

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

The goal of this directed grant program is to fund research on towards acute disorders of the neurological system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 will be awarded annually.

Deadline: January 15, 2003. Notification: March 2003.

Medical Student Research Grant This grant is sponsored by EMF and the Society for Academic Emergency Medicine (SAEM). A maximum of $2,400 over 3 months is available for medical students to encourage research in emergency medicine. Deadline: February 3, 2003. Notification: March 2003.

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SAEM Ethics Consultation Service Emergency physicians are faced with countless ethical dilemmas. We make choices based not only on our knowledge but also on our personal beliefs and value systems. These decisions are made in typical emergency medicine style--- we think, we decide, we act, and we move on. We feel confident that we have acted appropriately, based on a reasoned assessment of the circumstances and the strengths of our convictions. We act in good faith, and hope that we have acted wisely and justly.

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

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

The advice of these groups, however, may have limited applicability to emergency medicine; they may not include emergency physicians, or have the expertise to relate to the unique aspects of the ethics of emergency medicine. In addition, these groups are charged with developing a response to a particular crisis that has arisen locally. They are goal directed and not necessarily able to provide a thoughtful method to educate beyond the concrete response to the problem at hand.

For these reasons, SAEM has developed an Ethics Consultation Service. The Ethics Consultation Service is available to assist SAEM members with questions concerning ethical issues or decisions they must make during the course of their clinical, academic or administrative responsibilities.

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

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

S A E M

SAEM 2003 Research Grants Research Training Grant This grant provides financial support of $75,000 per year for two years of formal, full-time research training for emergency medicine fellows, resident physicians, or junior faculty. The trainee must have a concentrated, mentored program in specific research methods and concepts, and complete a research project. Deadline: November 1, 2002.

Institutional Research Training Grant This grant provides financial support of $75,000 per year for two years for an academic emergency medicine program to train a research fellow. The sponsoring program must demonstrate an excellent research training environment with a qualified mentor and specific area of research emphasis.

The training for the fellow may include a formal research education program or advanced degree. It is expected that the fellow who is selected by the applying program will dedicate full time effort to research, and will complete a research project.

The goal of this grant is to help establish a departmental culture in emergency medicine programs that will continue to support advanced research training for emergency medicine residency graduates. Deadline: November 1, 2002.

Scholarly Sabbatical Grant This grant provides funding of $10,000 per month for a maximum of six months to help emergency medicine faculty at the level of assistant professor or higher obtain release time to develop skills that will advance their academic careers. The goal of the grant is to increase the number of independent career researchers who may further advance research and education in emergency medicine. The grant may be used to learn unique research or educational methods or procedures which require day-to-day, in-depth training under the direct supervision of a knowledgeable mentor, or to develop a knowledge base that can be shared with the faculty member’s department to further research and education. Deadline: November 1, 2002.

Emergency Medical Services Research Fellowship This grant is sponsored by Medtronic Physio-Control. It provides $60,000 for a one year EMS fellowship for emergency medicine residency graduates at an SAEM approved fellowship training site. The fellow must have an 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: November 1, 2002.

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: November 1, 2002.

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: February 3, 2003.

Geriatric Emergency Medicine Resident/Fellow Grant This grant is made possible by the John A. Hartford Foundation and the American Geriatric Society. It provides up to $5,000 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: March 3, 2003.

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

22

NOTE: Join SAEM in the last quarter of 2002 and receive membership benefits for the rest of 2002 and all of 2003 with payment of one year’s due payment.

SAEM Membership Application

NOTE: $25 initiation fees have been discontinued. Also, resident members may select membership in one interest group at no charge.

Please complete and send to SAEM with appropriate dues and supporting materials or join SAEM on-line at www.saem.org SAEM • 901 N. Washington Ave. • Lansing, MI 48906 • 517-485-5484 • Fax: 517-485-0801 • www.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: ____________________________________________________ Medical School or University Faculty Appointment and Institution (if applicable): _________________________________________________ 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: individuals with an advanced degree (MD, DO, PhD, PharmD, DSc or equivalent) who hold a university appointment or are actively involved in Emergency Medicine teaching or research. Annual dues are $365 payable when the application is submitted. The application must be accompanied by a CV. Active members are eligible to vote for proposed Constitution and Bylaws amendments and to fill elected positions in the Society.

I attest that I hold a university appointment or am actively involved in Emergency Medicine teaching or research: ❒ Yes ❒ No Associate: 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 $350 payable when the application is submitted. The application must be accompanied by a CV. Associate members may serve on the Board of Directors, but cannot serve as officers nor vote for Constitution and Bylaws amendments or to fill elected positions in the Society.

Resident: residents interested in Emergency Medicine. Annual dues are $90 payable when the application is submitted. My anticipated date (month and year) of residency graduation is_________. (A group discount resident member rate is available. Contact SAEM for details.)

Fellow: fellows interested in Emergency Medicine. Annual dues are $90 payable when the application is submitted. My anticipated date (month and year) to complete my fellowship is_________.

Medical Student: medical students interested in Emergency Medicine. Annual dues are $75 (includes journal subscription) or $50 (excludes journal subscription), payable when the application is submitted. My anticipated medical school graduation date (month/year) is _________.

Interest Groups: SAEM members are invited to join interest groups. Include $25 annual dues for each interest group (resident members may join one interest group at no charge): ❒ toxicology ❒ neurologic emergencies ❒ evidence-based medicine ❒ airway ❒ trauma ❒ pain management ❒ geriatrics ❒ CPR/ischemia/reperfusion ❒ pediatric emergency medicine ❒ ultrasound ❒ health services & outcomes ❒ clinical directors ❒ web-educators ❒ public health research ❒ diversity ❒ youth violence prevention ❒ research directors ❒ injury prevention ❒ domestic violence ❒ simulation ❒ international ❒ EMS ❒ substance abuse ❒ medical student educators ❒ ethics 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 ________________ 23

S A E M

NEWSLETTER

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

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

Newsletter of the Society for Academic Emergency Medicine Board of Directors Roger Lewis, MD, PhD President Donald Yealy, MD President-Elect Carey Chisholm, MD Secretary-Treasurer Marcus Martin, MD Past President James Adams, MD Glenn Hamilton, MD Katherine Heilpern, MD James Hoekstra, MD Judd Hollander, MD Donald J. Kosiak, Jr., MD

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

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

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

S A E M

Call for Papers AEM 2003 Consensus Conference: Disparities in ED Health Care Deadline: March 1, 2003

The Editors of Academic Emergency Medicine announce the 2003 AEM Consensus Conference on "Disparities in Health Care" to be held on May 28, 2003 in Boston, the day before the SAEM Annual Meeting.

Disparities in health care are likely to present both within the ED decision making process and in the larger healthcare system. The US emergency departments might be important sources of information about both facets. However, disparities need to be recognized in order to be addressed.

Do inequalities exist in our treatment of emergency patients? If so, under what circumstances, at what level and for what reason? In the larger healthcare system there is evidence that people of color and women do not always receive the same level of care. Are such disparities real? When, why, how, do disparities occur? Who is at risk of receiving less than optimal care? What is the degree of disparity? How can disparity be eliminated? In a larger sense, what are the best ways to promote a highly reliable system of low variability? Do we teach our residents to deliver disparate care? How does the greater healthcare system contribute to real or perceived disparities in ED management? Are disparities sometimes due to systems incompetence? Is there a relationship between the degrees of inequality and degrees of system incompetence? How can we study these questions? What measures can be used? Most emergency physicians assume that there should be no disparities in health care. If the general public holds this belief as well, why has our society has not insisted upon the development of an equitable system of healthcare?

The goals of the conference will be to examine the presence, causes, and outcomes related to disparities of healthcare as they occur in emergency departments, and determine the degree to which forces from outside have an impact on our patients. The conference will aim to describe means of defining, assessing, measuring, and researching disparities that may occur in emergency care. The hope is to establish a research agenda for further assessment of these, and other related questions. The conference is a logical progression in the AEM consensus series, which has included "Errors in Emergency Medicine," "The Unraveling Safety Net, " and " Assuring Quality."

We therefore issue this Call for Papers related to the topic of Disparities in ED Health Care. Submitted manuscripts must be received at the AEM editorial office by March 1, 2003. Electronic submission to aem@saem.org of the original and a blinded copy is required. Also include a cover letter indicating that the submission is in response to this Call.

Accepted papers will be published in the late fall of 2003, along with Proceedings from the Consensus Conference.

Questions can be directed to Michelle Biros (biros001@maroon.tc.umn.edu) or Jim Adams (jadams@nmh.org).