September-October 2004

S A E M

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

Newsletter of the Society for Academic Emergency Medicine September/October 2004 Volume XVI, Number 5

PRESIDENT’S MESSAGE

AEM goes to on-line submissions!

As you read this, most of you will have recently taken some time off for a summer vacation. Those with children will be gearing up for another school year. We’ve said our goodbyes to a group of graduates, and welcomed their successors. New faculty have been oriented. Overall, there seem to be fewer deadlines looming over us during the summer months. Summer marks the renewal of the acaCarey Chisholm, MD demic calendar, and a chance for reflection and future goal setting.

During my vacation I treated myself to reading the Pulitzer prize winning biography, John Adams by David McCullough. A fascinating book, if for no other reason to reinforce in this election year that politics can and have been much nastier in spirit and practice than they are now. I couldn’t help but to think about the qualities of leadership of the people involved in the establishment of our country and its system of governance. I reflected on the governance of the SAEM Board of Directors (BOD) over the time I’ve had the opportunity to serve in that capacity.

Each year the quality and style of the BOD has changed, reflective of the individuals’ expertise, experiences, and interests. I have been impressed that the BOD has always attempted to serve the mission statement of the organization as its top priority. The style is a microcosm of governance practiced on grander scales. This involves four distinct components: stewardship, leadership, the “crisis” of opportunity and the crisis of disaster management.

Most of the BOD activity appropriately is stewardship. I say “appropriately” because SAEM has become an established entity with a clear mission and purpose. In a stewardship capacity, the BOD decisions will reflect a tendency to the status quo. Although cognizant that the organization must continue to evolve in order to meet the demands of an ever-changing world, decisions tend to be conservative, debate is often brief, and a strong indication of favorable return on investment or risk-benefit ratio mandated. Consensus is easily obtained, and votes are often unanimous.

Decisions are widely accepted by the membership, with fewer than 20% thinking the course to be in error. Stability reigns. An overall sense of comfort predominates.

The danger of the stewardship role is the potential for complacency, low goal setting, underachievement, and lost opportunity.

I have also observed the BOD in the “leadership” role.

This includes visionary thinking, risk, and greater potential for failure. Debate is often lengthy, consensus may be slow in developing, and votes can be split nearly evenly for and

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

EES is a tool that enables Authors to submit articles on-line, reviewers to referee on-line and editors to manage the peerreview process via an on-line submission and editorial system.

EES is an Internet-based tool that can be accessed from anywhere in the world and works on multiple platforms. Available 24/7, the on-line submission system uploads files directly from your personal computer, and allows you to track the progress of your paper through the peer-review process. On-line submission and peer-review speeds up the whole publication process.

All authors and reviewers are now required to submit their manuscripts and reviews on-line. On-line Submission: A Guide for Authors is available at: www.elsevier.com/locate/ees authorsguide. Reviewers should go to: www.elsevier.com/locate/ eesreviewersguide to view Elsevier Editorial System: A Guide for Reviewers.

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

SAEM Research Fund Katherine Heilpern, MD Emory University SAEM Secretary/Treasurer The purpose of the SAEM Research Fund is to provide training grants and other funding opportunities for SAEM members, emergency medicine residents and medical students.

The Fund continues to perform well. The account value on June 30, 2004 was $3,155,382.00, representing a gain of 0.3% for the second quarter 2004 and a gain of 5.5% for the first six months of 2004. By comparison, the S and P 500 Index reported a gain of 3.4% for the first six months of 2004.

CPC Finals Competition The six semi-finalist presenters and discussants will compete in the CPC Finals Competition during the ACEP Scientific Assembly in San Francisco on October 18 at 1:00-5:30 pm.

Registration is not required. All are welcome. The CPC is sponsored by ACEP, CORD, EMRA and SAEM.

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

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

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

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

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

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

ABEM Call for Nominations As a sponsoring organization of the American Board of Emergency Medicine (ABEM), SAEM will develop a slate of nominees to submit to the ABEM Nominating Committee for consideration of seats that will be filled by election by the ABEM Board at its winter 2005 Board meeting. SAEM members wishing to be considered for the SAEM slate of nominees are invited to send a nomination to SAEM at saem@saem.org. Nominations should include a current copy of the nominee’s curriculum vitae, as well as a cover letter outlining the nominee’s qualifications. The deadline is October 1, 2004.

The SAEM Board of Directors will review all nominations and submit a slate of nominees to ABEM by December 1, 2004.

Successful candidates are expected to be members of SAEM with considerable experience in SAEM and academic EM, as well as experience in ABEM. The SAEM Board does not nominate current members of the SAEM Board for consideration. In addition, ABEM has established the following criteria for nominated physicians: ● ● ● ●

Be a graduate of an ACGME-accredited EM residency program.

Be an ABEM diplomate for a minimum of ten years.

Have demonstrated extensive active involvement in organized EM. Ideally, this includes long-term experience as an ABEM item writer, oral examiner, or ABEM-appointed representative.

Be actively involved in the clinical practice of EM.

Physicians selected for the SAEM slate of nominees will be notified by November and will be required to submit the official ABEM nomination form, curriculum vitae, and letter noting their willingness to serve if elected. Further information can be obtained through the ABEM web site at www.abem.org.

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Call for Abstract Reviewers Deadline: October 1, 2004 The Program Committee is currently accepting applications to serve as expert reviewers of scientific abstracts submitted for consideration of presentation at the 2005 Annual Meeting, which will be held May 22-25 in New York. The minimum requirement for new abstract reviewers is at least 2 first author peer-reviewed original research manuscripts in the topic area for which you are applying. Residents are invited to apply but must meet the same criteria. If you have been an abstract reviewer in the past 5 years, you do not need to reapply.

Individuals must submit an abbreviated CV that includes current academic position and area(s) of expertise from the abstract topics listed below. For each topic area that you would like to review abstracts, provide a list of peer-reviewed original research publications, review articles, textbook chapters, and prior scientific abstract presentations. Priority will be given to individuals with demonstrated expertise based on demonstrated research productivity. Applications must be received by October 1, 2004 and must be submitted electronically to saem@saem.org. Applications must include an abbreviated CV (full CVs will not be considered) with a detailed listing of peer-reviewed original research publications, review articles, textbook chapters, and prior scientific abstract presentations published in the specific area(s) of expertise selected from the list below: ● ● ● ● ● ● ● ●

abdominal/gastrointestinal/ genitourinary administration/health care policy airway/anesthesia/analgesia cardiopulmonary resuscitation cardiovascular (non-CPR) clinical decision guidelines computer technologies diagnostic technologies/radiology

● ● ● ● ● ● ● ● ●

disease/injury prevention education/professional development EMS/out-of-hospital ethics geriatrics infectious disease ischemia/reperfusion neurology obstetrics/gynecology

● ● ● ● ● ● ● ●

pediatrics psychiatry/social issues research design/methodology/ statistics respiratory/ENT shock/critical care toxicology/environmental injury trauma wounds/burns/orthopedics

Each year, the Program Committee will select approximately six reviewers for each of the topic areas, including expert reviewers and members of the Program Committee. Therefore, not every approved reviewer works every year. Individuals selected to review submitted abstracts will be expected to review up to 100 abstracts, must adhere to the SAEM abstract scoring system, and must submit their abstract scores by the deadline. The deadline for authors to submit abstracts is January 5, 2005. Abstracts will be sent for review by January 7 and abstract scores will be due by noon on January 19.

Call For Nominations Young Investigator Award Deadline: December 17, 2004 In May 2005, SAEM will recognize a few young investigators who have demonstrated promise and distinction in their emergency medicine research careers. The purpose of the award is to recognize and encourage emergency physicians/scientists of junior academic rank who have a demonstrated commitment to research as evidenced by academic achievement and qualifications. The criteria for the award includes: 1. Specialty training and certification in emergency medicine or pediatric emergency medicine.

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

3. Academic accomplishments which may include: a. postgraduate training/education: research fellowship, master’s program, doctoral program, etc. b. publications: abstracts, papers, review articles, chapters, case reports, etc. c. research grant awards d. presentations at national research meetings e. research awards/recognition The candidate must have training and board certification in emergency medicine or pediatric emergency medicine. Criteria taken into consideration in determining the award recipient include prior research grant awards, publications, presentation, and other awards. Research grant awards are most highly weighted, especially if from federal or major foundation sources.

Research publications will be weighted based on their quality and number. Publication in high impact or moderate impact journals will be weighted higher than publications in low impact journals. Research presentations at national meetings and nonmonetary awards will be given relatively less weight in the overall evaluation.

The deadline for the submission of nominations is December 17, 2004, and nominations should be submitted electronically to saem@saem.org. Nominations should include the candidate’s CV and a cover letter summarizing why the candidate merits consideration for this award. Candidates 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, 1998.

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

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Emergency Medicine Sessions to be Held During AAMC Annual Meeting The Association of Academic Chairs of Emergency Medicine (AACEM) and SAEM are planning a number of sessions to be held on Saturday, November 6 during the Association of American Medical Colleges (AAMC) Annual Meeting in Boston at the Marriott Copley Place.

New EMTALA Regulations and Their Effect on Medical Specialties‚ Capabilities at Community Hospitals: A Threat to Tertiary Care Centers, 8:30-10:00 am, Nantucket Room. This session will be moderated by Dave Sklar, MD, Chair, Department of Emergency Medicine, University of New Mexico. Speakers will include: Robert Bitterman, MD, JD, Director of Risk Management, Department of Emergency Medicine, Carolinas

Medical Center; Ms. Sandra Sands, Senior Counsel at the Office of the Inspector General, Office of the Counsel to the U.S. Department of Health and Human Services, Timothy C. Flynn, Department of Surgery, University of Florida, and Charlotte Yeh, MD. This session is sponsored by AACEM and SAEM. From Observation to Acute Care Medicine, 10:30-12:00 noon, Nantucket.

This session will be moderated by Gabe Kelen, MD, Chair, Department of Emergency Medicine, Johns Hopkins University. Speakers will linclude: Louis Graff, MD, Professor, Department of Emergency Medicine, University of Connecticut; James Hoekstra, Chair, Department of Emergency Medicine, Wake

Forest University; and Sandra Schneider, MD, Chair, Department of Emergency Medicine. This session is sponsored by AACEM. The above educational sessions are open to all members of AACEM and SAEM at no charge, however, pre-registration is requested. Please register by sending an e-mail to: saem@saem.org AACEM will convene a Business Meeting at 12:00-1:30 pm in the Vermont Room. All members of AACEM and their guests are welcome, however, pre-registration is required. Please register be sending an e-mail to: saem@saem.org Lastly, the AACEM Executive Committee will meet at 1:303:00 pm in the MIT Room.

Attractions for Emergency Medicine Medical Student Educators at the AAMC Group on Educational Affairs Meeting

Louis Binder, MD MetroHealth Medical Center Emily Senecal, MD Stanford University Jonathan Fisher, MD Albert Einstein Cherri Hobgood, MD University of North Carolina Chapel Hill SAEM Undergraduate Education Committee

The Association of American Medical Colleges (AAMC) serves as the umbrella organization for member medical schools, teaching hospitals, and specialty societies in medicine. Each of these three groups has a convening council within the association, tied to the leadership and governing structure of the AAMC. The association concerns itself with both the functions of its constituents, and with issues of importance to academic medicine, such as reimbursement issues, research infrastructure, faculty practice, fiscal practice and budgeting, clinical operations in academic environments, public affairs, student affairs, and most importantly, medical education. The largest section within the AAMC meeting is sponsored by the Group on Educational Affairs (GEA), which attracts deans and faculty interested in education to a variety of presentations and informative sessions. Over the four days of the GEA meeting, a variety of educational formats are employed: topical sessions on issues of interest; interest group sessions that attract faculty with common interests (see Figure); mini-workshops (small group sessions focused on an area of personal development for medical educators, such as giving feedback or writing multiple choice questions); educational research presentations and poster sessions featuring original research in medical education; and Innovation in Medical Education poster sessions (similar to what is presented at the SAEM Annual Meeting, only much larger and more diverse, touching every aspect of medical education).

Without question, the AAMC Group on Medical Education Meeting is the largest, broadest, and most diverse meeting on medical education in the world. Emergency medicine faculty

with an interest in undergraduate medical education will find a tremendous variety of topics, formats, useful information sessions, and skill development sessions that will match their interests and aid their growth in medical education. Additionally, the opportunity for meeting, networking, and collaborating with like-minded individuals across other schools, both in the U.S. and internationally, are extensive. Dr. Louis Binder has been attending the AAMC meeting regularly for the past 20 years, and views it as his best opportunity for “CME” and personal development in medical education. He always finds several sessions that are useful, and that provide information and skill development that he can subsequently use when he returns home.

The 2004 AAMC GME Meeting will be held in Boston from November 7-10, 2004. Preliminary program information can be found at the AAMC website at www.aamc.org/ meetings/annual/2004 (the AAMC meeting program) and www.aamc.org/members/gea/start.htm (the GME meeting program). Particular sessions this year that may be of interest to EM educators fall in three sections of the GME meeting: GEA Small Group Discussions, GEA/GSA mini-workshops, and Research in Medical Education (RIME) paper/poster presentations and discussion groups. Each of these sections has a link on the GEA website that allows one to find descriptions of sessions that will be held this year. The attached figure lists highlights of sessions that will be offered, providing a sense of the breadth and relevance of the sessions.

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Attractions for Emergency Medicine… (Continued) Beyond the GME meeting, the AAMC meeting itself has other sessions devoted to other aspects of academic medicine that may be of individual interest. There are also other highlighted and plenary sessions for all AAMC attendees that focus on issues of broad importance to academic medicine. This year, these include the AAMC President’s Address by Dr. Jordan Cohen; a Keynote Address by Ellen Goodman, a Pulitzer Prize winning columnist; a presentation by Julie Gerberding, Director of the CDC; a political spotlight session by Robert Reich (Secretary of Labor, Clinton Administration) and Alan Simpson (former Senator from Wyoming) which will be held one week following the November elections, dissecting the outcomes; a presentation by James Anderson, CEO of Cincinnati Children’s Hospital, on Partnerships in International Med-

ical Education; and a panel discussion on The Teaching of Clinical Skills, with an eye to the new USMLE Step 2 Clinical Skills Exam. Additionally, there is an EM presence at the AAMC meeting (see separate article in this issue of the Newsletter).

We urge you to consider attending the AAMC GME meeting. A high level of participation by EM educators raises the profile of our educational efforts nationally in medical education, and allows for greater faculty development, interdepartmental collaboration, and sophistication of our educational efforts. We would be happy to answer anyone’s questions about the meeting, or particular sessions, at our respective email addresses or telephone contacts (through the SAEM directory or through the SAEM office at saem@saem.org).

FIGURE Selected GME Small Group Discussion Sessions at the 2004 AAMC Annual Meeting Managing the Resident in Difficulty Faculty Development in International Medical Education Learning Communities in Medical Education 360 Degree Evaluation Dean’s Letters (Medical Student Performance Evaluations) Academic Faculty Competencies Developing Professionalism in Students and Residents (several sessions) Conceptual Models for Professionalism in Medical Education Educational Evaluation, Educational Research, and the IRB The Scholarship of Teaching/Education Educational Technology Assessing the Competencies – Current Best Practices Early Detection/Prevention of Student Problems Building Clinical Simulation Centers Best Practices in Student Academic Review and Promotion Components of Education Program Evaluation (two different sessions) Preparing Medical Students for USMLE Step 2 Clinical Skills Exam Remediating Student Clinical Practice Exam Performance Using Standardized Patients to Help Identify Clinical Skills Deficiencies in Students Selected GME/GEA Mini-Workshop Sessions at the 2004 AAMC Annual Meeting Video Tools to Teach Communication Skills to Students Guide for Interactions Between Residents and the Pharmaceutical Industry Team Based Learning (two different sessions) Curriculum for Students’ Transition to the Wards Personal Survival Skills for Academic Faculty Faculty Development Workshops in Systems Based Practice and Practice Based Learning and Improvement (two different sessions) Reviewing Educational Research Manuscripts Analyzing Qualitative Data Designing Mentorship Programs (two different sessions) Dealing with the Problematic Medical Teacher in your Clerkship Selected RIME Paper/Poster Sessions and Discussion Groups Professional Deficiencies as M1’s Predict Poor Clinical Performance Evaluation of Professionalism as Observable Behaviors (many others that cover professionalism) Common Peer Assessment Tools of Physicians Across Specialties Ethnicity and Clinical Skills Evaluation Developing Web Based Cases for Medical Student Teaching Integrating Basic and Clinical Sciences in the M4 Year Virtual Reality and Brain Anatomy Direct Observation in Clerkship Ratings Research in Medical Career Decision Making Resident Fatigue and Incidence of Medical Errors Errors in Surgery High Fidelity Human Patient Simulation in Junior Clerkships Human Patient Simulation to Teach Basic Sciences Eye Simulators to Measure Students’ Clinical Skills in Ophthalmology Effectiveness of M4’s and Teaching Assistants Developing Resident Autonomy Reliability/Validity in Resident Interviewing Portfolios and ACGME Competencies Teaching Practice Based Learning and Improvement

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Ilene Wilets, PhD Mount Sinai School of Medicine SAEM NIH Roadmap Task Force There is an impressive new initiative underway at the National Institutes of Health (NIH) which can potentially open doors for the emergency medicine investigator. In May 2002, Elias A. Zerhouni, MD, the Director of the NIH, convened a number of meetings to chart a “roadmap” for medical research in the 21st century. The purpose was to identify the major scientific challenges in biomedical research and to address the roadblocks to progress. It was determined that no one Institute at the NIH could accomplish this task alone, and that the agency must address this problem as a whole.

The roadmap represents the culmination of opinion from more than 300 nationally recognized leaders in academia, industry, government, and the public. It is a broad initiative whose primary goal is to accelerate the pace and efficiency of clinical research so that more and better therapies reach patients nationwide.

There are several themes comprising the roadmap, some of which will be of greater interest to the emergency medicine practitioner than others. The first theme, “New Pathways to Discovery”, focuses on molecular and cellular biology, including bioinformatics and nanomedicine. Given the relatively small percentage of EM investigators who are involved in laboratory work, this agenda will likely have limited significance for us.

However, another roadmap theme, entitled “Research Teams of the Future," should prove more important to emergency medicine. It focuses on the need for interdisciplinary research teams of physicians from a broad array of specialties, across numerous institutions. No longer will all research for a clinical trial stem from a lone principal investigator from a single academic center. The NIH is encouraging better integrated networks of academic centers to work together on clinical research. This initiative also promotes the development of new partnerships among organized patient communities, and community-based physicians who

The NIH Roadmap

care for sufficiently large groups of wellcharacterized patients. Involving community practitioners in clinical research is a smart way to access eligible patients for inclusion in clinical trials. As many investigators are well aware, several important studies are languishing due to limited subject recruitment.

The third roadmap agenda, “Reengineering the Clinical Research Enterprise," is expected to have the most profound effect on emergency medicine research. A major goal of this effort is to greatly reduce the time it takes to conduct patient-centered clinical evaluation of new and promising therapies. The NIH recognizes that the clinical research process has stalled, largely due to the increasingly complex federal regulation of drug, devices, and biologics.

In addition, the duplication of research efforts among investigators has contributed to the slowing of the clinical research process. Given the vast number of therapies, diagnostics, and treatments that must be evaluated through clinical trials, many clinical research networks operate simultaneously and independently of each other.

Consequently, researchers sometimes duplicate already existing data because they were unaware of their existence, or because they could not access these data. To counter the problem of duplication and overlap in clinical trials, the National Electronic Clinical Trials and Research Network (NECTAR) was established. NECTAR is a blueprint for a national informatics network using standardized data, software tools, and network infrastructure. This system will dovetail with current medical informatics initiatives in the Department of Health and Human Services and other existing and newly created networks. The standardization of data collection and reporting will facilitate data sharing and sample sharing among studies. This reduction in study redundancy will yield more time and funds to address additional research questions.

Another priority of the re-engineering effort is “Clinical Workforce Training."

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The scientific workforce is considered one of our nation’s greatest resources.

To pave the way for scientific progress, the NIH is committing vast resources for the training of clinical investigators across disciplines. This initiative could provide tremendous opportunity for the early or mid-career emergency physician interested in skills development and career enhancement. Through training programs and grant funding, individuals will be selected and mentored to conduct clinical studies in interdisciplinary, team-oriented environments. The emphasis will be on new strategies and curricula with training opportunities that span a wide variety of disease areas and a broad range of clinical disciplines. The Clinical Workforce Training program will complement other NIH training programs that support scholars who wish to become clinical investigators.

The roadmap presents a great opportunity for emergency medicine to be vocal in discussions about biomedical research on a federal level. The SAEM Roadmap Task Force will work to ensure that our discipline is well positioned to positively influence NIH research activities. The first item on the Task Force agenda is to connect with leading officials at each of the NIH agencies. We believe it is imperative to articulate the mission of SAEM and its membership to all influential parties at the NIH. The Task Force is comprised of emergency medicine professionals from numerous institutions across the country, including: Roger J. Lewis, MD, PhD (Harbor-UCLA Medical Center); Clifton W. Callaway, MD, PhD (University of Pittsburgh School of Medicine); Robert W. Neumar, MD, PhD (University of Pennsylvania); Craig D. Newgard, MD (Oregon Health & Sciences University); Ilene Wilets, PhD (Mount Sinai Medical Center); Robert O. Wright, MD, MPH (Children’s Hospital, Boston). For additional information on SAEM Roadmap Task Force activities, please contact Dr. Roger Lewis: roger@emedharbor.edu.

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

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

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

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

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

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

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

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

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

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

Board of Directors Update The SAEM Board of Directors meets monthly, usually by conference call.

This report includes the Board highlights from the June 8 and July 13 conference calls.

The Board nominated Robert Bitterman, MD, JD, for consideration as a member of the EMTALA Advisory Committee. The Board elected Ellen Weber, MD, to serve on the Nominating Committee, as required by SAEM Constitution and Bylaws.

The Board approved the proposal of the Undergraduate Committee to fund an emergency medicine submission to the Innovation in Medical Education Exhibit during the Annual Meeting of the Association of American Medical Colleges. The Board approved an application for a satellite conference to be held prior to the 2005 SAEM Annual Meeting.

The Board approved a request from the American College of Emergency Physicians to provide a letter of endorsement for a proposal that the Agency for Health Research and Quality (AHRQ) undertake an evidence based practice review of the literature of triage systems.

The Board approved a six months financial report that indicated $1,578,012 in revenue and $790,830 in expenses. The Board noted that nearly all revenues for the calendar year had been received, but that approximately half of the expenses for the year had not yet been received. The Board approved the recommendation that a $250,000 contribution to the SAEM Research Fund be made.

The Board agreed to undertake a review of the Society's position state7

ments and policies. Working groups of the Board will report to the entire Board at the September Board conference call.

The Board approved the document, "Standardized Reporting Guidelines for Studies Evaluating Risk Stratification of Emergency Department Patients with Potential Acute Coronary Syndromes."

The Board approved an editorial written

by Dr. Chisholm and Dr. Yealy that was submitted to the journal, CHEST, for consideration.

The Board will meet during the ACEP Scientific Assembly on Sunday, October 17, 12:00-5:00 pm in the Sierra B Room of the San Francisco Marriott Hotel. SAEM members are invited to attend.

Ethics Corner: Drugs on Line: Ethics on the ‘Net'

Jason A. Hughes, MD University of Iowa SAEM Ethics Committee

No doubt, if you have been surfing on the Internet lately, you have witnessed the mushrooming of pharmaceuticals available to the general public on-line. This incredible increase in the use of such pharmaceuticals that are being prescribed by non-customary means should be an ethical concern for numerous reasons. This article will address a few of the ethical issues that could become key points as this slightly skewed drama on the internet continues.

As if predicting the dangerous possibilities of internet pharmaceutical sells, a 1999 article in JAMA addressed the issue. At the time, three state boards had taken action against physicians prescribing over the internet without true patient-physician contact.1 In a later issue of JAMA, actual guidelines for medical and health information sites were published.2 The question remains as to whether any of this information could affect the field of emergency medicine. It certainly seems to have potential, as many patients might not regard their online prescriptions as authentic prescriptions.

As a result, patients also might not declare these medications to an emergency physician due to embarrassment or due to potential legal ramifications.

Untoward and possibly life threatening side effects could result from this vacuum of knowledge. Finally, as there are few controls on most of these pharmaceuticals, patients may even be receiving tainted or placebo medications.3 Physicians in general have licenses in the states where they practice. They pay for these licenses, and further fees are required for their continuation. Training is imperative for attaining and maintaining the licenses. Many on-line companies touting the sale of “controlled substances” through the internet are having physicians in other states or countries writing the prescriptions.3 In an on-line warning to consumers, the Food and Drug Administration suggested numerous risks involved in these online proceedings. One such risk is that medications could be tainted. Another risk includes the potential side effects of the medications and the lack of physician supervision to assist the patient with these side effects.4 Even more importantly, at times there appears to be

no physician intervention in the prescribing of medications fraught with side effects, drug interactions, and other such concerns. There is a true lack of control and the ethical issues are most numerous.

This author has performed two interesting exercises in order to find out more information concerning the prescribing of medications on line. Having been the victim of far too many “pop-up” advertisements on one particular day, this author finally took the initiative to email one of these on-line drug companies. The questions that started the dialogue included: (1) Can someone send medications on-line without knowing the nature of the patients’ medical problems and other medications that he/she is taking? (2) Who has the responsibility for any patient malfeiscence, and under what jurisdiction would a poor outcome be initiated? (3) Finally, if medications can be prescribed in this manner and without apparent physical or mental examination, why do physicians who prescribe in a more conventional manner require a DEA license, a state medical license, in some cases a state controlled substances license, and years of training and practice?

The answers to the e-mail were somewhat shocking, and our ethical concerns for our patients now require heightened “e-wareness”. The gentleman who answered the questions replied that his company does not “prescribe” medications, but the company is one of many that “direct” patients to companies that do send out such medications as Viagra, anti-hypertensives, antidepressants, and other medications that could be potentially dangerous.

Thus, it appears that there are internet tiers that direct patients to other websites and medication markets in order to cloud over the actual entity that is sending the medications out to the patients.

A second above-mentioned trial by this author was even more intriguing.

Receiving numerous “spam” e-mails about how one could buy Prozac on-line without “doctor interference”, an order was placed for this medication. An email was then shot back in a short amount of time purporting to ask medical questions in order to assist “the patient” in making sure this was the correct choice of medications. Obviously, 8

anyone could fill in the questionnaire any way he or she wanted to; this would be without the direct patient-physician contact and the nuances of non-verbal communication. In five days, 30 pills of Prozac were shipped; it would seem important to mention that these pills appeared to be Prozac, but in reality, how is someone to know that they are nothing more than placebo or tainted in some other way?

In conclusion, the internet and the anonymity afforded by it could potentially be harmful to the very patients that request prescriptions. It should be noted that there are credible pharmacies on the “web”; they are recognized on the National Association Boards of Pharmacy Website and many state boards also list them.5 In one exercise noted above, “prescribing tiers” seem to allow those involved in this type of practice a true lack of responsibility. The other exercise was merely a test to see if receiving medications on-line was as easy as mentioned in these advertisements.

As educators of medical students and residents, our obligation to the public and our ethical considerations for our patients have met even a greater challenge.

Awareness of medication “prescribing” without responsibility and without a patient-physician alliance will be important issues to address in our residency programs. Also, continued requests through the DEA and other governing institutions should be made to either stop the practice altogether, or to at a minimum to impose the same regulatory standards to internet prescribing that apply to all other forms of prescribing.

As for the Prozac received on-line?

After reviewing the fact that there was no physician listed on the label of the “prescription” nor a responsible group for the medication, the household plumbing received a large dose of purported antidepressants. The plumbing did not seem to work any better after an overdose of 30 Prozac pills.

It may be time to work on better regulation for the benefit of those who need the help of a responsible medical provider to provide the important communication, concern, and follow-up appointments that an on-line prescription cannot generate. Our duty is to first

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Ethics Corner (Continued)

American Geriatric Society Report

“to do no harm”; sometimes this requires a proactive approach to concerns such as prescribing on the internet.

References 1. Marwick, C. Several groups attempting regulation of internet rx.

JAMA. 1999; 281:975-976.

2. Winker M, Flanagin A, Chi-Lum B, et al. Guidelines, for medical and health Information sites on the internet. JAMA. 2000; 283:1600-1606 3. Federal Food and Drug Administration (FDA). Buying prescriptions online. Retrieved July 14,2004 from www.fda.gov/oc/buyonline/default. htm 4. National Association Boards of Pharmacy. VIPPS (Verified Internet Pharamcy Providers). Retrieved July 12, 2004 from http://nabp. net/vipps/consumer/listall.asp

The SAEM Ethics Committee has a consultation service (see below) for those who have had difficult issues along this line. This article is designed to generate a dialogue between our residents and resident educators. If you have any questions or concerns, please contact hughestex@sbcglobal.net and the committee as a whole will become involved in a timely manner.

Lowell W. Gerson, PhD Northeastern Ohio Universities SAEM Representative to AGS Council on Surgical and Related Medical Specialties We all appreciate the complexity of treating older patients who present to EDs. Other specialists face the same issues in treating older patients. Moreover, there are not enough geriatricians today, and the situation is likely to get worse. The John A. Hartford Foundation, recognizing the need for improving specialists’ skills in treating older patients, funds The American Geriatrics Society (AGS) Council on Surgical and Related Medical Specialties. Emergency Medicine is one of the ten specialties that participate in the project.

SAEM has a seat on the Council, which holds a business meeting and scientific program as part of the AGS Annual Scientific Meeting. This year, the scientific program had three main sessions: presentations from the Research Agenda Setting Process, a panel on preoperative management of the surgical patient, and posters presented by the Jahnigen Scholars.

The Jahnigen Scholars program offers two-year career development awards ($75,000 per year for salary and fringe benefits, plus $25,000 per year to support costs of doing research) to support junior faculty in the ten specialties of the Council. The award is intended to allow individuals to initiate and sustain a career in research and education in the geriatrics aspects of their discipline.

Five of the thirty Jahnigen awards have been SAEM members. This is an outstanding opportunity for members who have leadership potential and wish to develop careers in geriatric emergency medicine. You can find more information about this program at http://www. americangeriatrics.org/hartford/ scholars_award.shtml.

The PDA version of Geriatrics at your Fingertips was announced during one of the intermissions. It is designed to provide immediate access to specific information needed in caring for older patients and is available at http://www.americangeriatrics.org.

The scientific program had a capacity audience of well over 200 people.

Scott Wilber, MD, an SAEM member and Jahnigen Scholar, presented the emergency medicine/trauma care research agenda. The full research agenda has been posted on line at http://www.frycomm.com/ags/rasp/.

The day ended with a reception and unmoderated poster session that included work from the Jahnigen scholars.

The session provided opportunity for the future leaders from all the specialties to present their work and to form relationships that are leading to interdisciplinary research projects. Contact me at lgerson@neoucom.edu for more information.

SAEM Ethics Consultation Service Emergency physicians are faced with countless ethical dilemmas. We make choices based not only on our knowledge but also on our personal beliefs and value systems.

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

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

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

For these reasons, SAEM has developed an Ethics Consultation Service to 9

assist SAEM members with questions concerning ethical issues or decisions they must make during the course of their clinical, academic or administrative responsibilities.

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

Researcher Profile: Clifton Callaway, MD, PhD

Andrew Chang, MD Albert Einstein SAEM Research Committee

As part of the Research Committee’s continuing series of profiles of successful EM researchers, Dr. Andrew Chang interviewed Dr. Clifton Callaway, assistant professor at the University of Pittsburgh.

After obtaining his MD-PhD at the University of California, San Diego, Dr. Callaway completed the Affiliated Residency in Emergency Medicine at the University of Pittsburgh. In 1998 he received a Young Investigator Award from SAEM, and in 2001 he was named an Outstanding Reviewer for Academic Emergency Medicine. He has published over 35 original contributions, and currently has two R01 grants from the National Institute of Neurological Disorders and Stroke (NINDS).

What aspects in your career have helped you the most in your success as a researcher?

I think that my formal scientific training has helped me the most. In my case, I obtained a PhD as part of an MD-PhD program. Without that background, it would have been essential to get a PhD equivalent through a fellowship or long sabbatical. While my training was in basic science, those pursuing careers in clinical research may prefer to enroll in clinical research training programs, including clinical research fellowships, a Masters of Public Health program, or a Robert Wood Johnson fellowship. However, formal training need not be a degree program or a named fellowship.

My basic science PhD gave me very little edge into clinical research, although I had very good statistical training.

Therefore, I obtained my clinical research experience by serving on my IRB for three years. That duty allowed me to see lots of clinical research proposals and to network with clinical researchers. This gave me a much more mature perspective on human research.

In your opinion, what obstacles do young investigators face today in starting their research career? How did you overcome these obstacles yourself?

I think young investigators often lack time to obtain proper formal training. A fellowship or formally structured mentorship is essential. Peculiar to our specialty is that many departments still do

not have a research culture. Therefore, a new investigator has to negotiate for his or her needs including protected time and space.

What can a young investigator do to decrease his or her clinical time in order to have more protected time towards research (other than obviously obtaining scarce grant money)?

I would not be so pessimistic about grant money. Our specialty sometimes falls into the trap of being provincial and only looking to EMF or SAEM for funding. For research training, NIH has a variety of career development awards (K-series). These are within reach if you focus your research. Comparing the number of applications funded to the number of applications received, SAEM and EMF may actually be more competitive than the NIH! I think that the key to grant money is to keep applying.

Obtaining some release time in advance of grant funding probably requires some chairman charity and is an up-front investment in your research career. The return on the investment is both academic (you will be productive later) and fiscal (you will be more likely to bring in extramural funds).

Keep in mind that funding cycles are long. If you submit a grant now, you get a review back in 6-8 months. If it is not funded on the first try (which is most likely), you will resubmit in about 9-12 months from the original submission and perhaps have funding of the revised application in 18 months from the original submission. Therefore, reasonable expectations for a chairman would be that young faculty seeking their first grant will need support for release time for at least 18-24 months.

Regarding mentors: What is the best way to find a mentor?

Many people benefit from mentors.

However, I am not as militant an advocate for this model of career development. Instead, I propose the “Transactional Model.” In this model, you and your collaborators find each other mutually beneficial. For example, the way that I found my primary collaborators was to identify an investigator with the tools and techniques that I wanted to 10

learn. I then offered what I had in exchange. In my case, I had very little molecular biology experience six years ago, but I was pretty facile with animal models. I then collaborated with a senior professor who taught me molecular techniques in exchange for which I have extended his work from cell culture into animals. It really is more of a collegial process than mentorship.

How important is it to have a mentor that is NIH-funded?

In biomedical science, the NIH has the deepest pockets for research. NIH funding is also a form of peer-review and its absence in a senior investigator is similar to a short publication record.

Therefore, serious investigators will ultimately need NIH funding to sustain their work. Although there are some exceptions, lack of NIH-funding in a long time investigator should raise a red flag about his or her focus, quality of investigation, or persistence.

How important is it for a mentor to be in the same hospital?

Contact with your mentor is critical.

Most of my collaborators to date have been faculty in the Arts and Science campus. They are located on the same campus, but at a different institution.

Effective collaboration between cities is more difficult and really means that you are independent and want to have a professional friend with whom to bounce around ideas.

For a young investigator, what is the value of conducting individual projects as opposed to joining larger networks (such as MARC or NEAR) or drug-company sponsored trials?

Large networks and industry-sponsored trials may let you see day-to-day operations, but they are unlikely to involve you in planning and design. Therefore, providing service for these trials may not move you forward to becoming an independent investigator. One advantage, however, is that these large-scale studies do offer funding that can be leveraged into time (or even resources) for doing your own study. Although I think it is critical to develop your own ideas and projects (small at first, then bigger), these studies can go on concurrently while participating in a big trial (espe-

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Clifton Callaway (Continued) cially if that helps pay the bills).

In your opinion, what are the most important elements in a grant application?

A grant application proposes that someone spend money to answer a scientific question. You must convince the reviewer (1) the question is worth answering and (2) you are the best person to answer the question. In order to sell point #1, you need to really focus your question into specific hypotheses. In order to sell point #2, a track record helps immensely as would unique resources that you can access (for example, specific patient populations or unusual clinical material).

In the absence of your own record, enlisting the help of other people who are well qualified is essential.

My best experience about grant writing

came from submitting grants and getting rejected. In my first two years as faculty, I wrote about 10 applications before one was funded. Each time, I learned which things were well received and which things were not. I also had some friends who shared their copies of successful applications (an invaluable example).

Preparing a grant de novo is a process that deserves your full-time attention. I budget about 150 hours of preparation time (actually at the keyboard) for a new grant. It may be as little as 80 hours for a grant revision.

How would you advise a young investigator in balancing his/her career goals with familial and social commitments?

Your family will outlast your academic position and must come first. The con-

verse of that fact is that your research is part of your professional identity. Therefore, your family and social contacts need to understand that research is just as serious and demanding as providing patient care. Needless misunderstandings and hard feelings may occur if your significant other doesn’t appreciate this fact.

What are your plans/goals for the near future? What obstacles do you foresee as an established investigator?

The fact that you are asking me that is funny, because I do not perceive myself as established! Our work is funded for right now, but I am currently looking at how to keep things running smoothly in the 2006 fiscal year. I don’t know if that process ever changes.

The Aftermath of My SAEM Scholarly Sabbatical Grant Daniel Davis, MD University of California, San Diego The SAEM Scholarly Sabbatical Grant is intended to provide clinical release time for a young investigator to explore research career opportunities and establish some momentum with the ultimate goal of sustainable grant support and a successful research career.

As the 2001-2002 recipient, I have been asked to provide an update on my activities to demonstrate the potential for such a period of mentored research experience, whether funded by a grant like the SAEM Scholarly Sabbatical Grant, or by a department as part of the developmental plan for young faculty members.

My grant application was based upon an ongoing project in the University of California, San Diego (UCSD) Neuroanesthesia Laboratory exploring the relative neuroprotective efficacy of an anti-excitotoxic agent and an anti-apoptotic agent in a rodent model of ischemia. My basic science research mentor, Dr. Piyush Patel from the UCSD Department of Anesthesiology, was performing this work under NIH grant support and was in his first renewal period.

While I was involved in the data collection and analysis for this project, Dr. Patel quickly placed me in charge of another project using a cDNA microar-

ray to identify potential neuroprotective genes involved in ischemic preconditioning. There was no extramural funding designated for this work. However, we were recently informed that our preliminary results were intriguing enough to win us an R01 to continue this project for a minimum of 4-5 additional years.

The other avenue I chose to explore as part of my scholarly sabbatical was in the area of clinical research. Dr. David Hoyt from the UCSD Division of Trauma was willing to serve as my mentor on the San Diego Paramedic RSI Trial, which was a prospective study to explore the efficacy of paramedic-performed rapid sequence intubation in patients with severe traumatic brain injury. While my involvement in the initial phases of this trial was mainly as a paramedic educator, Dr. Hoyt was willing to give me responsibility for most of the analyses related to the project. To date, almost a dozen different publications have resulted from this work.

More importantly, the working relationship we established made it possible for us to produce a competitive application for the Resuscitation Consortium formed through support generated from multiple institutes with the NIH as well as the Department of Defense and 11

American Heart Association. With Dr. Hoyt as Principal Investigator and myself as co-Principal Investigator, we were recently notified that our application was successful and that we would be participating in this first-ever clinical trials network to study resuscitation from trauma and cardiac arrest.

While I would like to take most of the credit, I recognize that it is the quality of mentorship I received from both Dr. Patel and Dr. Hoyt that were directly responsible for this early success. I firmly believe that the success of a sabbatical period is as dependent on the mentors and the path that they lay out for the young investigator as on the grant recipients themselves. In this era of scarce resources available for research endeavors, it is certainly important to select an individual with both enthusiasm and aptitude for a successful research career; however, it is an even greater tragedy to squander this talent through uninvolved, disinterested mentorship.

I would like to humbly thank SAEM for the opportunity of a lifetime, and my mentors for igniting my passion and guiding me in the right direction.

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

Edited by the SAEM GME Committee

A Medical Liability Primer for Residents Sharhabeel Jwayyed, MD John Robinson, MD Summa Health System Akron, Ohio For the GME Committee

burden of proof must show guilt beyond any reasonable doubt. In malpractice trials, the plaintiff only has to show that a preponderance of the evidence proves their claim of medical liability.

Plaintiffs attempt to recover economic damages and noneconomic damages. Actuarial experts are retained to calculate to economic damages that may result from lost wages, lost benefits, and medical expenses. Non-economic damages are sought for “pain and suffering”. Many claims of medical liability are never taken to trial but are settled by both parties. Both parties agree to a resolution of the case that usually involves a payment to the suing plaintiff. The decision to settle a case is complex but involves all parties weighing the risk of winning or losing a jury trial. The local liability climate, the nature of the allegation, and the type of patient all may influence a defendant’s decision to offer a settlement or a plaintiff’s decision to accept a settlement. If a physician loses a medical liability lawsuit, his or her name is often entered into the National Practitioner Databank.

Settlements, even when no determination of liability is made, may also be entered into the National Practitioner Databank.

Medical malpractice lawsuits are a fact of life for medical providers. Hospitals, physicians, nurses, emergency medical technicians, and others who provide patient care can be named as defendants in medical liability lawsuits. The risk of residents being sued is unknown but because residents may become targets of a lawsuit, they must have a basic understanding of medical liability and learn strategies to mitigate the risk. This article describes the elements of a medical liability claim and describes some basic strategies to employ in the emergency department to avoid lawsuits. There are four components that must be present to prove a claim of malpractice: duty to provide care, breach of the standard of care, proximate cause, and injury/damage.

Emergency physicians assume a duty to care for every patient presenting to the emergency department because of the medical screening exam mandated by EMTALA. The first component is thus always present in emergency department malpractice claims. The second component mandates that the care provided to the patient meets the “standard of care”. When a provider with similar training and expertise would provide like or similar care in like or similar circumstances, the “standard of care” has been met. Medical “experts” from both sides often testify as to what constitutes “standard of care” and whether it was met. While some circumstances may appear to be very straightforward, defining the standard of care is often the most debated element of a medical liability claim. After arguing to establish the “standard of care”, the plaintiff’s attorney must argue that the standard of care was not met. The third component requires that “proximate cause” be established. The breach of the standard of care must be the “proximate cause” for the injury suffered. In other words, the plaintiff’s attorney must argue that the patient’s injury would not have occurred but for the action (or inaction) of the physician being sued. Finally, the patient must have suffered some sort of injury. Injury can take many forms including death, dismemberment, pain, suffering, mental anguish, loss of consortium, and loss of income.

Many consider emergency medicine a specialty at high risk for medical liability. According to data from Pro Assurance Group, a multi-state malpractice insurance company, risky areas within emergency medicine include acute myocardial infarction, meningitis, undefined chest pain, fractures of the vertebral column, and appendicitis.

Most suits against emergency physicians base their liability claim on an error in diagnosis, improper performance (of history, physical exam, or a procedure), or failure/delay in consultation or admission.

Of the three, error in diagnosis is the most common alleged mistake cited in malpractice suits against emergency physicians. Factors that contribute to diagnostic error are found in Table 1. Avoiding common pitfalls can also reduce diagnostic error and improve patient care (Table 2). Documentation of the ED encounter is the most important element relied on to defend a malpractice claim. Unfortunately, sufficient documentation is lacking in many malpractice cases. Important aspects that should be documented for each patient encounter are found in Table 3. The last paragraph of the patient’s ED record is often the most important. The differential diagnoses considered and the diagnostic, therapeutic, or disposition strategies employed are outlined in a statement of the “medical decision making”. The patient’s instructions and understanding of the disposition plan are described here.

To prove or win a malpractice suit, the plaintiff must prove that all four elements are present. A medical error by itself does not constitute malpractice. If a duty to care, and breach of the standard of care are present, but not an injury, a claim of malpractice cannot be supported. If proximate cause is lacking, malpractice is similarly not supported. The burden of proof rests with the plaintiff. Many physicians are unaware that the burden of proof (weight of the evidence) is different in malpractice trials than criminal trials. In criminal trials, the

Residents in training can learn to manage the risk inherent in the practice of emergency medicine and learn to accurately document the ED encounter to adequately convey the care provided. It is important for EM residents to understand the basic elements of a malpractice lawsuit and the high-risk 12

areas encountered daily. Residents must enhance diagnostic accuracy, avoid diagnostic and therapeutic pitfalls, and improve documentation. Doing so will improve patient care and assist in the navigating of a perilous aspect of our profession.

Table 1- Factors That Contribute to Diagnostic Error Incomplete patient history recorded Failure or delay in ordering appropriate studies, timely consultation, or admission Condition not considered (can’t possibly be MI, meningitis, etc) Misinterpretation of studies, particularly equivocal results Physician not aware of results Failure to communicate results to the patient Table 2- Strategies to Avoid Pitfalls Consider conditions with high mortality and morbidity The atypical presentation of common illness is more likely than a “zebra” Patients at extremes of age may present atypically Alcoholics or drug abusers may be at high risk If a disease is considered likely and initial studies are equivocal, consider more tests or admission Repeat visits mandate an expanded differential diagnosis Consider consultation, admission, or ED observation if the patient is symptomatic and diagnosis not established, particularly when serious illness or injury is contemplated Table 3- Documentation Document the chief complaint Document personal/family history Document risk factors for disease Document the differential diagnoses considered Document why the diagnostic approach was selected Document the patient response to treatment Document consultations with other physicians Document why admission/discharge is appropriate Document the times of sentinel events during the encounter Document patient understanding/acceptance of treatment/disposition plan

Spadafora Scholarship Winners Announced Leslie R. Dye, MD Wright State University Michael P. Spadafora, MD, was an academic emergency physician and medical toxicologist. A member of SAEM and the American College of Medical Toxicology (ACMT), for many years he was committed to teaching and the development of medical students emergency medicine residents, and medical toxicology fellows. After his sudden death in October 1999, a scholarship was established in his name through the SAEM Research Fund to encourage emergency medicine residents to pursue fellowship training in medical toxicology. The ACMT graciously matched the award and two recipients are chosen each year to receive $1,250 each to attend the annual North American Association of Clinical Toxicology (NAACT) meeting.

This year there were nine outstanding candidates for the scholarships. The applications were scored based on interest in medical toxicology, letters of recommendation, curriculum vitae, and essays written by each applicant. All applications were reviewed and scored by a group of reviewers representing SAEM and ACMT. The winners are: Shaun Carstairs, MD, Naval Medical Center, San Diego Brad Weir, MD, Indiana University Dr. Carstairs and Dr. Weir will attend the NAACT meeting, which will be held in Seattle in September, and as a condition of their award, will submit a summary of the ACMT scientific symposium and the ACMT practice symposium.

These summaries will be published in a future issue of the SAEM Newsletter and IJMT.

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

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

an advisor whose special interest matched their own.

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

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– most communication takes place via e-mail at your convenience.

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

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

Northwestern University’s Feinberg School of Medicine has announced that the Division of Emergency Medicine was granted full departmental status effective July 1. James G. Adams, MD, has been named the Chair of the Department of Emergency Medicine, having served as Chief of the Division since 2000. The ED at Northwestern Memorial Hospital cares for 72,000 patients annually with 24 full-time emergency physicians and is a level 1 trauma center. The residency program trains 10 emergency physicians in each of the four years of the program, and the 170 senior medical students at the Feinberg School of Medicine have a mandatory fourth year clerkship that is led by the EM faculty.

Timothy E. Albertson, MD, PhD, MPH, has been named interim chair and chair of the sear committee that is seeking a permanent chair of the newly established Department of Emergency Medicine at the University of California, Davis.

Steven L. Bernstein, MD, Assistant Professor of Emergency Medicine at Albert Einstein College of Medicine, has been awarded a five-year $1.5 million dollar grant by the New York State Department of Health to develop a comprehensive training program in the Bronx. The project is called the Bronx Einstein Alliance for Tobacco-Free Health (Bronx BREATHES) and Dr. Bernstein will be the principal investigator.

Judith C. Brillman, MD, has been promoted to Professor of Emergency Medicine at University of New Mexico.

Daniel Davis, MD, University of California, San Diego, has received an RO1 grant entitled “Microarray Analysis of Neuronal Ischemic Preconditioning.”

William D. Fales, MD, has been named Associate Professor of Emergency Medicine at Michigan State University.

Dr. Fales is the Director of Pre-hospital Care at Michigan State University’s Kalamazoo campus.

Marianne Gausche-Hill, MD, has been appointed to the Institute of Medicine’s Committee on the Future of Emergency Care in the U.S. System, as well as to the Subcommittee on Pediatric Emergency Care. Dr. Gausche-Hill is the Director of Pediatric Emergency Medicine Fellowships at Harbor-UCLA and Professor of Clinical Medicine at UCLA. On September 1, Jeffrey Hackman, MD, will assume the role of Associate Program Director of the Emergency Medicine Residency Program at the University of Missouri-Kansas City/Truman Medical Center. Dr. Hackman is an Assistant Professor in the Department of Emergency Medicine at the University of Missouri, Kansas City.

Jon Mark Hirshon, MD, MPH, Associate Professor at the University of Maryland, has been named as one of the vice-chairmen of the Institutional Review Board and the Associate Director of the Charles McC. Mathias, Jr National Study Center for Trauma and Emergency Medical Systems (NSC).

The NSC, established by Congressional resolution in 1986, is an academic research organization dedicated to studying the causes, dynamics, treatment, and outcomes of traumatic injury and sudden illness.

Joseph LaChica, MD, has joined the faculty at the University of Illinois where his area of concentration will be the application of technological advancements in Emergency Medicine education.

Richard L. Lammers, MD, has been promoted to Professor of Emergency Medicine at Michigan State University.

Dr. Lammers serves as Director of Emergency Medicine Research at Michigan State University’s Kalamazoo campus.

Janet Lin, MD, MPH, has joined the faculty at the University of Illinois as the Director of the International Medicine Fellowship.

O. John Ma, MD, Vice Chair of Emergency Medicine at Truman Medical Center, has been promoted to Professor Emergency Medicine at the University of Missouri-Kansas City School of Medicine.

James J. Menegazzi, PhD, is the principal investigator of a $310,000 grant funded by the National Heart, Lung, and Blood Institute. The grant is entitled, “Derivation of Innovative Treatments for Cardiac Death.” The project will combine cardiac arrest databases at the University of Pittsburgh, Harbor-UCLA, and William Beaumont Hospital and then use advanced statistical modeling to derive and internally validate clinical decision rules for determining which patients should receive immediate defibrillation, and which should be first treated with CPR and/or other therapies.

Roland C. Merchant, MD, MPH, Assistant Professor at Brown Medical School, has received a five-year K23 Career Development Award of $681,480 from the National Institute of Allergy and Infectious Diseases to support my research on rapid HIV testing in the emergency department.

Carl H. Schultz, MD, has received this year's Emergency Medical Services Achievement Award from the California Chapter of the American College of Emergency Physicians, in recognition of his contributions to the field of disaster medicine, especially in the areas of earthquake and terrorism preparedness and response.

Edward Sloan, MD, has been promoted to Professor of Emergency Medicine at the University of Illinois.

Susan Stone, MD, MPH, has received a joint faculty appointment in the Department of Anesthesiology and Pain Medicine at the University of Southern California Keck School of Medicine.

She is developing projects to improve the management of pain and palliative care.

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Academic Announcements (Continued) Christine Sullivan, MD, has been named the director of the Emergency Medicine Residency Program at the University of Missouri-Kansas City/Truman Medical Center. Dr. Sullivan is an Assistant Professor in the Department of Emergency Medicine at the University of Missouri, Kansas City.

Newsletter Submissions Welcomed SAEM invites submissions to the Newsletter pertaining to academic emergency medicine in the following areas: 1) clinical practice; 2) education of EM residents, off-service residents, medical students, and fellows; 3) faculty development; 4) politics and economics as they pertain to the academic environment; 5) general announcements and notices; and 6) other pertinent topics. Materials should be submitted by e-mail to saem@saem.org. Be sure to include the names and affiliations of authors and a means of contact. All submissions are subject to review and editing. Queries can be sent to the SAEM office or directly to the Editor at david.cone@yale.edu.

John Younger, MD, Assistant Professor at the University of Michigan, has been awarded a five-year RO1 grant from the National Institute of General Medical Sciences for the project, “C5a in Defense Against Murine Gramnegative Pneumonia,” which will examine the role of the complement protein C5a in directing early inflammatory and immune events during pneumonia and explore whether C5a or C5a-like designer peptides might be used as an adjunct to antibiotics early in the course of lung infection. Dr. Younger also recently receive a three-year Career Investigator Award from the American Lung Association of Michigan to study strategies by which Gramnegative bacteria interfere with complement activation on their surfaces.

President’s Message (Continued) against an idea (we have 11 members for a reason!). Profound changes such as combining our precursor organizations, UAEM and STEM, the decision to establish our own journal, include a resident as a full voting member of our BOD, and the development of the Research fund are now a thing of our past, whose history is unknown to many of our current membership. These examples of leadership activities were associated with initial controversy. By definition, one steps beyond the status quo in the “leadership” capacity. The risk of losing something is present, which runs counter to our human nature to gravitate towards comfort zones. The potential of a bad outcome is very real, and as physicians, adds additional anxiety due to our predisposition to firstly do no harm. In times of “leadership”, one-third to one-half (or more) of one’s constituency will resist or actively oppose the decisions.

The “crisis” of opportunity arises when unexpected events present a narrow window of time for decision-making. These opportunities appear to fall within the mission of the organization, and are largely external in nature. Decision-making is proactive in nature. Discussion is curtailed by an imposed deadline, and not all stakeholders can be full participants. Voting is at times a 2/3 – 1/3 split for or against, but usually tends towards unanimity. I have been pleased that many BOD activities fall in this area.

The final component is crisis disaster management. These result from completely unforeseen or improbable events and are reactive in nature. Decisions must be made rapidly, without as much data as one would like, and without time to ponder long-term consequences. They are usually unanimous, and often have little debate. An undercurrent theme of “if you’re not with us, you must be against us” may stifle dissension. Once the decision is reached, a united front is displayed, and action follows. Over 90% of the constituency will support the governing body, since all have been torn from the status quo, which no longer exists. They will seek their comfort through the stability afforded in the governing body. Think back to the days immediately following the 9-11 attacks, JFK’s assassination or how America reacted after Pearl Harbor.

Astute governing organizations will attempt to salvage a component of “win-win” through the loss associated with the crisis of disaster. Through the “leadership” role, novel ideas can be brought forward with fewer barriers. Decisions made in the time of crisis (opportunity or disaster) invariably have unintended and unforeseen ramifications.

It is rare to find an individual who functions well in all 4 of these governance domains. One can look across their departments, medical schools or elected politicians for testimony.

Some excel as stewards yet perform poorly when presented with a crisis of disaster. Others shine in disaster, yet may squander resources in their stewardship role. Using a BOD as the vehicle of governance increases the likelihood that the 4 domain strengths are collectively represented across the breadth of the BOD. This year’s BOD has many challenges ahead. Most of our activity will be in a stewardship mode. There are also many leadership issues that will create more controversy…information technology platforms, SAEM’s interaction with the AAMC, and the Development Committee’s debate about an expanded interaction with industry to name a few. In October the BOD will have a full day meeting to develop our 5 year strategic planning in five areas: advocacy, education, research, operations and membership services. Each BOD member will work on two areas. SAEM’s past presidents have been invited to participate in this process, and we are pleased to note that their expertise will be represented in every area. The BOD is also currently reviewing all of our policy and position statements for potential revisions or areas requiring future development. Finally, in an effort to better serve the membership in meeting our mission, we will conduct SAEM’s first membership survey later in the academic year.

In parting, we all are “leaders” in some fashion within our work settings, with or without title, whether we wish to consciously acknowledge that role or not. Do not underestimate your impact on those with whom you work and interact. Learn your domain strengths and share those within your department and organizations.

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FACULTY POSITIONS John H. Stroger, Jr. Hospital of Cook County

NEBRASKA: The University of Nebraska Medical Center, Section of Emergency Medicine is recruiting 1-2 additional faculty members committed to developing an academic career. Adequate protected time is provided and start-up funding is available. Preference is given to individuals with fellowship training or research experience. With an accredited residency which began in July 2004, this is a great opportunity to help shape the future of emergency medicine in this region. Candidates who have toxicology training will also have the opportunity to work with the Nebraska Regional Poison Center. Respond in confidence to: Robert Muelleman, M.D., Professor, Chief of Emergency Medicine, University of Nebraska Medical Center, 981150 Nebraska Medical Center, Omaha, NE 68198-1150. (402-559-6705) The University of Nebraska is an affirmative action/equal opportunity employer. Minorities and women are encouraged to apply.

Chairman - Department of Emergency Medicine Cook County Hospital, now know as the John H. Stroger, Jr. Hospital of Cook County, is currently seeking a qualified candidate for the position of Chairman of the Department of Emergency Medicine.

In December 2002, the new John H. Stroger, Jr. Hospital of Cook County opened to continue the legacy of service, superior clinical teaching, and innovative research established by the original County Hospital. This new state-of-the-art facility is a Level-1 Trauma center and has over 130,000 annual adult visits making it one of the busiest Emergency Department’s in the country.

It serves as the centerpiece of emergency medical healthcare in Cook County Bureau of Health system. An additional 80,000 (total) emergency patients are treated annually at Provident and Oak Forest Hospitals, two Bureau affiliates.

During the past 15 years, the Department of Emergency Medicine has become a center of emergency medicine excellence. There is a well-established, nationally recognized residency program with 54 EM residents and 26 full-time faculty who hold appointments at Rush University. There are numerous opportunities for clinical research. The Research Division is supported by PhD and Master’s level scientists and is actively engaged in several NIH and other nationally funded investigations.

The successful candidate will have proven leadership ability, administrative experience in the delivery of emergency healthcare in large systems, demonstrated academic accomplishment, and a commitment to the department’s mission and provide the highest quality emergency care regardless of the ability to pay.

Please send letter of application and CV to: Deepak Kapoor, MD, Chair, Search Committee, Department of Psychiatry, 1900 W. Polk St., Rm. 843, Chicago, IL, 60612; phone 312-864-8005; email kapoor11@comcast.net

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

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

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

OREGON: The Oregon Health & Science University, Department of Emergency Medicine is conducting an ongoing recruitment campaign for talented faculty members. Entry-level clinical faculty members at the instructor and assistant professor level. Preference given to those with fellowship training (especially in pediatric emergency medicine) or equivalent experience. Knowledge of emergency medicine as a faculty discipline is expected. 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, CDW -EM, Portland, OR 972393098.

John H. Stroger, Jr. Hospital of Cook County is an EOE.

Medical College of Georgia

PENNSYLVANIA: University of Pittsburgh: Full-time emergency medicine faculty positions are available at the Instructor through Associate Professor levels.

Candidates must be residency trained and board certified/prepared in emergency medicine. We offer career opportunities as a clinician-investigator or clinician-teacher. Our faculty have local, national and international recognition in research, teaching and clinical care. The ED serves a primarily adult population with a volume of approximately 50,000 per year, and is a Level I trauma center with both toxicology and hyperbaric medicine treatment programs housed within our Department. Salary is commensurate with experience. For further information write to: Donald M. Yealy, MD, Vice Chair, Department of Emergency Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 500, Pittsburgh, PA 15213. The University of Pittsburgh is an Affirmative Action, Equal Opportunity Employer.

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

Experience in emergency ultrasound is highly desirable.

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

PENNSYLVANIA: SUMMER OF 2005 – SEEKING TWO additional EM Residency-trained physicians to join 36 BC physicians and 10 PAs evaluating 100,000 patients at the three sites of 750-bed Lehigh Valley Hospital. Ultrasound certification a plus. Collegial group salaried by hospital, with good mix of experience and great opportunity for advancement. Electronic medical records and documentation and PACs system. Academic, tertiary hospital with Level I trauma, 9-bed Burn Center, 11 freestanding, fully-accredited residency programs, including one in Emergency Medicine. Eligibility for faculty appointment at Penn State/Hershey. LVH located in the beautiful Lehigh Valley, with 700,000 people, excellent suburban public schools, safe neighborhoods, moderate cost of living, 60 miles north of Philadelphia and 80 miles west of NYC. Email CV to carol.voorhees@lvh.com. Phone (610) 402-7008.

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

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

Department of Emergency Medicine

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

82,000 patients per year, one-third children. We are dedicated to teaching, research, and clinical excellence and seek to deliver the highest quality emergency medical care in an way that patients leave with an experienece of being cared for and valued as human beings. Very competitive salary and benefits. Please submit resume and letter of interest via mail, fax, or e-mail: Marc Borenstein, MD, FACEP Chair and Residency Program DIrector Department of Emergency Medicine Newark Beth Israel Medical Center 201 Lyons Avenue Newark, New Jersey 07112 973-926-7562 office 973-282-0562 fax mborenstein@sbhcs.com Take Pride. Take Ownership. Deliver Excellence. Patients 1st.

Academic Emergency Physician Exciting position for an experienced, residency trained, board certified/ prepared emergency physician to join the faculty of the Department of Emergency Medicine, a full academic department of the Mount Sinai School of Medicine in New York City.

The Mount Sinai School of Medicine is a leader in medical education and research. The hospital is a 900 bed tertiary center with an annual ED census of over 70,000. The EM residency is fully accredited.

Academic rank commensurate with qualifications.

Please submit confidential letter and C.V. to: Carol Barsky MD, Director and Vice Chair, Department of Emergency Medicine, Mount Sinai School of Medicine, Box 1149, One Gustave L. Levy Place, New York, NY, 10029. Fax (212) 427-2180.

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The Mount Sinai Hospital Department of Emergency Medicine Associate Director

We are seeking an experienced emergency physician to assume the role of Associate ED Director in our high-volume (~75,000), medical school based practice. The Mount Sinai Hospital is one of two main sites for our fully accredited, 36-resident, training program. Our mission embodies a firm commitment to excellence in patient care, education and research.

The clinical leadership team is physician-led and includes Nursing, Administrative Support, IT and Finance. The Emergency Department leadership is highly regarded in both the hospital and medical school and is represented on all major committees.

The position includes a competitive salary, an academic MSSM appointment, administrative space, and support.

If interested in becoming part of a dynamic team and prepared to bring innovative management to a progressive department, please send your letter of interest and curriculum vitae to: Carol Leah Barsky, MD, Director and Vice Chair, Department of Emergency Medicine, 1 Gustave Levy Place, Box 1149, NY, NY 10029, Tel: (212) 241-7403, Fax: (212) 427-2180, Email: carol.barsky@mssm.edu We are an equal opportunity employer.

EMERGENCY MEDICINE Academic Positions Available in the

Department of Emergency Medicine of

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

Emergency Medicine Residency Training Program Level I Trauma Center Level I HAZMAT Receiving Facility 20% Pediatrics Medical Toxicology Treatment Center Fellowships - EMS, Sports Medicine, Administration, Research, Toxicology, Patient Safety ✩ Salary Commensurate with Experience Contact: Fred Harchelroad, M.D. via Michelle Malsch, Executive Asst.

(412) 359-3961 mmalsch@wpahs.org ✩✩ West Penn Allegheny Health System, an Equal Opportunity Employer ✩✩

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Yale University School of Medicine Section of Emergency Medicine Associate Section Chief Associate Professor Level Section of Emergency Medicine Yale University School of Medicine

The Department of Emergency Medicine of the Christiana Care Health System has a full-time clinical teaching position available at the assistant or associate professor level. Candidate must be residency trained and certified in Emergency Medicine and have a strong in bedside teaching and working a busySystem Levelhas Onea fullThe Department of interest Emergency Medicine of the Christiana CareatHealth time clinical teaching position at the assistant or associate Trauma Center that also has aavailable high medical acuity. There is alsoprofessor potentiallevel. for proCandidate must beasresidency trained and certified tected academic well as research time.

LevelinofEmergency protectedMedicine time willand be have baseda on strong interest in bedside teaching and working at a busy Level One Trauma Center that qualifications and prior experience. also has a high medical acuity. There is also potential for protected academic as well as

The Section of Emergency Medicine at Yale University School of Medicine is seeking an experienced clinician with academic interests and administrative skills for the position of Associate Section Chief in the Section of Emergency Medicine.

Duties will include oversight and further development of clinical operations in conjunction with the Medical Director of the Emergency Department, as well as development of a quality improvement program and participation in faculty development activities.

Candidates must be board certified in Emergency Medicine, obtain licensure in Connecticut, have a minimum of 7 years of experience with significant administrative responsibility within a Section or Department of Emergency Medicine in an academic setting. The successful candidate will also have significant teaching experience, as well as demonstrated leadership skills and a strong commitment to medical education and clinical excellence. Rank and salary will be commensurate with education, training and experience.

Yale New Haven Hospital which is the primary practice site is a level I trauma center with over 90,000 ED visits per year and an accredited Emergency Medicine residency program with 40 residents (PGY 1-4). Ultrasound and EMS fellowships are also offered. In addition, faculty will be staffing a new satellite facility expected to open in the summer of 2004.

For more information, contact Dr. Gail D’Onofrio at (203) 785-4363 or gail.donofrio@yale.edu. To apply, please forward your CV and cover letter via fax at (203) 785-4580, email jamie.petrone@yale.edu, or mail at Yale University School of Medicine, Department of Surgery, Section of Emergency Medicine, 464 Congress Ave, P.O. Box 208062, New Haven, CT 06519-1315.

research time. Level of protected time will be based on qualifications and prior

The Department of Emergency Medicine sees over 130,000 patients annually at a experience. level one suburban regional trauma center serving Delaware, and parts of New The Department of Emergency Medicine over 130,000 patientshospital annuallyinat a level Jersey, Pennsylvania, and Maryland andsees at an urban inner-city one suburban regional center serving and parts of New Jersey, Wilmington.

Private trauma fee-for-service groupDelaware, offers a highly competitive compensation Pennsylvania, and Maryland and at an urban inner-city hospital in Wilmington.

Private package.

New members of the group participate in all benefit programs within the fee-for-service group offers a highly competitive compensation package. New members first year of employment and become voting stockholders of the group after of the group participate in all benefit programs within the first year of employmentonly and one yearvoting with no buy-in required. become stockholders of the group after only one year with no buy-in required.

There are51 51emergency emergencymedicine medicineresidents residents in categorical EM/IM programs.

There are in categorical and and EM/IM programs.

Fellowships are EDED administration, and and EMS. The emergency Fellowships areoffered offeredininultrasound, ultrasound, administration, EMS. The emermedicine researchresearch section employs three full-time gency medicine section employs three research full-timenurses. research nurses.

If you ourour opportunity to become a co-owner of a medical If you desire desiretotolearn learnmore moreabout about opportunity to become a co-owner of a medgroup in a dynamic and stimulating practice environment, please send your Curriculum ical group in a dynamic and stimulating practice environment, please send your Vitae to: Curriculum Vitae to: Charles L. Reese, MD

Charles L.Department Reese, MDof Emergency Medicine Chairman, Christiana Care Health System Chairman, Department of Emergency Medicine 4755 Ogletown-Stanton Christiana Care Health Road System P. O. Box 6001 4755 Ogletown-Stanton Road Newark, DE. 19718 P. O. Box 6001 Newark, DE. 19718

Yale University is an affirmative action, equal opportunity employer and women and members of minority groups are encouraged to apply.

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

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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.

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.

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, Neville House, 75 Francis St., Boston, Massachusetts 02115, or by email to madavis@partners.org. Telephone (617) 732-5813; Fax (617) 713-3060.

University of Pittsburgh

The University of Chicago Department of Medicine Section of Emergency Medicine

The Department of Emergency Medicine offers fellowships in the following areas: • Toxicology • Emergency Medical Services • Research • Education

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

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

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14th Annual Midwest Regional SAEM Meeting

7th Annual Mid-Atlantic Regional SAEM Meeting

September 9-10, 2004 The Wyndham Milwaukee Center Hotel Milwaukee, Wisconsin

October 1, 2004 Washington Hospital Center Georgetown University Medical Center/ Marriot Conference Center Washington, DC

The meeting will take place Thursday, September 9, 6:308:30 pm, and Friday, September 10, 8:00 am-4:00 pm at the Wyndham Milwaukee Center Hotel, 139 East Kilbourn Avenue, Milwaukee, WI. Registration forms are available from Dawn Kawa, dkawa@mcw.edu Registration Fees: Faculty--$75; Other health care professionals--$40; Fellows/residents/students--No Charge. Late fee after Wednesday, September 1: add $10. For information, call 414-805-6452.

The meeting will take place Friday October 1; 8 am to 4 pm. Registration and hotel information is available on-line at www.saem.org. There will be teaching, research and a large medical student residency application session. All medical students from the Mid-Atlantic Region are enouraged to attend.

Call for Abstracts 9th Annual SAEM New England Regional Meeting

The SAEM Newsletter is mailed every other month to approximately 6000 SAEM members.

Advertising is limited to fellowship and academic faculty positions. The deadline for the November/December issue is October 5, 2004. All ads are posted on the SAEM website at no additional charge.

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

The deadline for abstract submission is Wednesday, January 5, 2005 at 3:00 pm Eastern Standard Time.

Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted.

Acceptance notification will be sent mid-March 2005.

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

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

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

$100 $125 $300

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

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

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

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SAEM 2005 Research Grants Emergency Medicine Medical Student Interest Group Grants These grants provide funding of $500 each to help support the educational or research activities of emergency medicine medical student organizations at U.S. medical schools. Established or developing interest groups, clubs, or other medical student organizations are eligible to apply. It is not necessary for the medical school to have an emergency medicine training program for the student group to apply. Deadline: September 9, 2004.

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

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

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

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

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

Erratum In the July/August issue of the SAEM Newsletter two of the 2004 Annual Meeting Presentation awards were inadvertently transposed. The correct awards are: Basic Science Fellow Presentation Jing Chen, MD, Thomas Jefferson University Luna Benvenisti-Zarom, Raymond F. Regan: Increasing Expression of Endogenous Heme Oxygenase-1 Protects Astrocytes from Heme-mediated Oxidative Injury Clinical Science Resident Presentation Basmah Safdar, MD, Yale New Haven Hospital Linda C. Degutis, Keala Yamamoto, Harry C. Moscovitz, Swarupa R. Vedere, Gail D’Onofrio: Comparison of Efficacy and Adverse Events of Intravenous Ketorolac and Parenteral Morphine Alone and in Combination in the Treatment of Acute Renal Colic

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S A E M

Newsletter of the Society for Academic Emergency Medicine

Board of Directors Carey Chisholm, MD President

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

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

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

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

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

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

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

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

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

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