SAEM and theCorporate World

SAEM is an academic, profes-sional organization that has a myr-iad of interactions and relationshipswith individuals at all levels of train-ing, and with other national emer-gency medicine and non-emergencymedicine organizations. For SAEM,the activities, communications, andboundaries that develop in theseindividual and inter-organizationalrelationships are usually fairly clear,

and center around whether the interaction is in keeping withour mission — to improve patient care by advancing re-search and education in emergency medicine. Most individ-uals and organizations with whom we partner have objec-tives that are similar to our own, and it is relatively easy tocollaborate on activities or projects. When SAEM interactionsextend to the corporate world, the picture is less clear. Atleast part of the mission of businesses and corporations is toto make a profit. A profit motive does not necessarily set themissions of the corporate world and SAEM at odds. As afiscally responsible organization, we also seek to generaterevenue to help fund grants, awards, and the Annual Meetingand other Society activities. However, if a corporate profitmotive leads SAEM to compromise academic freedom,injects bias, or promotes an unacceptable conflict of interest,our members and our emergency patients are not wellserved. Over the past few years, the SAEM Board of Direc-tors has attempted to create a consistent position on our in-teractions with industry. This has resulted in a Policy onCommercial Support, and related policies on co-sponsorshipof meetings and satellite meetings. (See the SAEM websitefor these policies.) Some members have regarded the SAEMposition to be prudish and too restrictive, others have decriedthe fact that any association with commercial entities ispermitted. Somewhere in the middle of these viewpointsrests our rationale, and in the following paragraphs I willattempt to explain why I think we are where we should be.

In a 1999 article in JAMA, Pellegrino and Relman de-livered a fairly scathing assessment of professional medicalassociations, stating: “Too many have already become cor-poratized entities in pursuit of profit to finance bulky adminis-trative staffs or to lobby for the protection of privileges andbenefit of their members.”(1) Not many people would accuseSAEM, with its 5 person administrative staff for a member-ship of 5,000, and it’s strong research, education, and publichealth focus, of being too corporatized. As part of our non-profit status, we are not permitted to lobby. We do take

NEWSLETTERNEWSLETTER901 North

Washington Ave.

Lansing, MI

48906-5137

(517) 485-5484

saem@saem.org

www.saem.org

November-December 2000 Volume XII, Number 6Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE

Brian Zink, MD

(continued on page 13)

Neuroscience Research FellowshipSAEM is pleased to announce the availability of the

FAEM Neuroscience Research Fellowship, made possibleby an unrestricted educational grant from AstraZeneca LP.The Grant provides for one year of funding at $50,000 for amentored research training experience in cerebrovascularemergencies. The research training may be in basic scienceresearch, clinical research, or a combination of both. Com-pletion of a research project is required, but the emphasis ofthe fellowship is on the acquisition of research skills.

The Grant application and criteria will be posted on theSAEM web site at www.saem.org by December 10 . Thedeadline for the submission of completed applications will beFebruary 15, 2001 , with announcement of the recipient byMarch 15. The funding will be for the period from July 1,2001 to June 30, 2002. Contact SAEM at saem@saem.orgfor questions or further information.

The Unraveling Safety Net: CurrentCrises of U.S. Emergency Departments

Call for PapersAcademic Emergency Medicine is sponsoring a Consen-

sus Conference to discuss this topic on May 9, 2001 at theSAEM Annual Meeting in Atlanta. Topics to be discussed in-clude the importance of emergency departments as a medi-cal and social safety net, challenges currently faced by U.S.emergency departments, and trends that threaten emer-gency care delivery. Manuscripts relevant to this theme arebeing solicited. The deadline is March 1, 2001, and authorsshould use the AEM Instructions for Authors posted on theAEM and SAEM web sites.

Please send manuscripts electronically to aem@saem.orgor by mail to: Academic Emergency Medicine, Special Issue,901 North Washington Ave., Lansing, MI 48906.

Password Required to ReceiveAEM Online

Academic Emergency Medicine (AEM) has been availableonline since mid-May. Beginning November 15, SAEMmembers must use a password to access their online sub-scription. All SAEM members are entitled to a receive a freesubscription of both the print copy and online version of AEM.

To activate your subscription go to the website: <www.aemj.org>. Click on the subscriptions button. Click on the link“activate your member subscription.” Enter your membershipnumber (which is printed above your name on the mailing labelof this Newsletter) and click the submit button. You will then beasked to select a user name and password. If you needassistance or do not have a member number, send an e-mailto saem@saem.org or call 517-485-5484.

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SAEM Representatives Visit ACEP Washington OfficeBrian Zink, MDSAEM PresidentUniversity of MichiganJames Hoekstra, MDChair, SAEM National Affairs Task ForceOhio State University

On September 15 we traveled toWashington, DC to visit the WashingtonOffice of the American College of Emer-gency Physicians (ACEP). The purposeof the trip was to improve SAEM’s un-derstanding of the Washington ACEPOffice’s involvement in national affairsas they relate to academic emergencymedicine, and to explore how SAEMand ACEP can collaborate on issues ofcommon interest in national andgovernmental affairs.

During the two-day visit we met withthe ACEP President, Michael Rapp,MD, and ACEP President-elect, RobertSchafermeyer, MD, to discuss issues ofconcern for academic emergency medi-cine. Mr. Gordon Wheeler, the Wash-ington ACEP Office Director, reviewedthe organizational structure and meth-ods that are used to advance ACEP’spositions in the regulatory and legisla-tive branches of the federal government.

We met with Ann LaBelle, Director,Congressional Affairs, Michelle Fried,Director, Federal Affairs, Debbie Camp-bell, Political Action Manager, and LauraGore, Public Relations Manager. Thesemeetings provided information and in-sights as to how the Health Care Fi-nance Administration (HCFA) and Con-gress function, and the strategies usedto promote improved care foremergency patients, and a healthyworkplace and secure career foremergency physicians. Major issues inacademic emergency medicine thatrelate to HCFA and current legislation,such as the Balanced Budget ActRefinement proposals, GraduateMedical Education Provisions, the prac-tice expense component of the Phy-sician Payment System, the proposedPatient Protection Act of 2000, theHCFA medical history caveat for emer-gency care, and payment codes for ob-servation units were reviewed. SAEMpriorities were outlined in relation tonational affairs, including the plight ofthe medically uninsured, patient safety,federal funding for emergency medicineresearch, ED overcrowding, thefinancial stresses facing academic

Nominations Sought for SAEM Elected PositionsDeadline: January 1, 2001

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

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

The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more thanone nominee for each position. Nominations may be submitted by the candidate or any SAEM member. Nominations should in-clude a copy of the candidate’s curriculum vita and a cover letter describing the candidate’s qualifications and previous SAEM ac-tivities. Nominations may also be made from the floor in San Francisco. Nominations are sought for the following positions:President-elect — The President-elect serves one year as President-elect followed by one year as President and one yearas Past President. Candidates are usually current members of the Board of Directors. Board of Directors — Two members will be elected to three year terms on the Board of Directors. Candidates should havea track record of excellent service and leadership on SAEM committees and task forces and are often currently serving ascommittee or task force chairs.Resident Board Member — The resident member is elected to a one year term and is a full voting member of the Board of Dir-ectors. Candidates must be a resident during the entire term on the Board (May 2001-May 2002). Candidates should demon-strate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of sup-port from the candidate’s residency director.Nominating Committee — Two members will be elected to two year terms on the Nominating Committee. The NominatingCommittee is charged with selecting the recipients of the Young Investigator Award, the Academic Excellence Award, and theLeadership Award, as well as developing the slate of nominees for the elected positions within the Society. Candidatesshould have considerable experience and leadership on SAEM committees and task forces.Constitution and Bylaws Committee — One member will be elected to a three year position on the Constitution and BylawsCommittee. The final year will be served as the chair of the Committee. The Committee is charged with reviewing the Con-stitution and Bylaws and making recommendations to the Board for any proposed amendments to be considered by themembership. Candidates should have considerable experience and leadership on SAEM committees and task forces.

medical centers and GME funding.The visit to the Washington ACEP

Office was enlightening, and we wereimpressed by the broad-basedexperience, knowledge, and activities ofMr. Wheeler and the Directors andManagers in the office. The next step isto define how SAEM and ACEP canwork together to influence governmen-tal policy and legislation when we seekto advance common issues in aca-demic emergency medicine. Dr. Hoek-stra is representing SAEM on the ACEPGovernmental Affairs Committee.

2000-2001Committee/Task ForceInterest Forms are dueJanuary 15, 2001. Theform is on the web site

at www.saem.org.

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Call for NominationsDeadline: January 1, 2001

Nominations are sought for the HalJayne Academic Excellence Awardand the Leadership Award. Theseawards will be presented during theSAEM Annual Business Meeting onMay 8 in Atlanta. Nominations forhonorary membership for those whohave made exceptional contributionsto emergency medicine are alsosought.

The Nominating Committee wishes toconsider as many exceptional candi-dates as possible. Nominations maybe submitted by the candidate or anySAEM member. Nominations shouldinclude a copy of the candidate’s CVand a cover letter describing his/herqualifications. The awards and criteriaare described below:

Leadership AwardThe Leadership Award is presentedto a member of SAEM who has dem-onstrated exceptional leadership inacademic emergency medicine.Candidates will be evaluated on theirleadership contributions including:1. Emergency medicine organiza-

tions and publications.2. Emergency medicine academic

productivity.3. Growth of academic emergency

medicine.

Academic Excellence AwardThe Hal Jayne Academic ExcellenceAward is presented to a member ofSAEM who has made outstandingcontributions to emergency medi-cine through research, education,and scholarly accomplishments.Candidates will be evaluated on theiraccomplishments in emergencymedicine, including:1. Teaching

A. Didactic/BedsideB. Development of new tech-

niques of instruction or instruc-tional materials

C. Scholarly worksD. PresentationsE. Recognition or awards by stu-

dents, residents, or peers2. Research and Scholarly Accom-

plishmentsA. Original research in peer-re-

viewed journalsB. Other research publications

(e.g., review articles, bookchapters, editorials)

C. Research support generatedthrough grants and contracts

D. Peer-reviewed research pre-sentations

E. Honors and awards

Medical Student Interest Group GrantRecipients Selected

SAEM is pleased to announce the recipients of the Medical StudentInterest Group Grants. Fifteen proposals were received and reviewed by acommittee of peers involved in medical student education. The criteria usedincluded: the merit of the proposal, the qualifications of the perceptor andthe instituional support including the budget justification. The Board of Dir-ectors approved the selections and the funding of $500 each for thefollowing six recipients:

Case Western Reserve UniversityChristian Chisholm Halloran, class of 2003, and the faculty advisor, MaryStewart, MD, project proposes a major lecture primarily for medicalstudents reviewing lessons from on a local disaster where one person waskilled and 75 persons injured. They also propose a medical student leadcommunity education project on seat belts, child safety seats, bike helmetsand smoke detectors.

Moorehouse School of MedicineSaira Najma Rahman, class of 2001, and Sudha Reddy, MPH, class of2001, and the faculty advisor Douglas Ander, MD, proposal was a requestfor funding for a newly formed interest group to start a mentorship programand a series of invited lectures and interactive seminars involvingMoorehouse, Emory and CDC and the Carter Center. The topics will includepublic health interventions in emergency medicine, the role of theemergency medicine in primary care, international emergency medicine,diversity with emergency medicine and potential careers within the specialty.

Louisiana State UniversityAshley E Booth, class of 2001, and the faculty advisor, Peter DeBlieux, MD,proposed to involve medical students to train 1200 ninth-grade students in29 high schools in BLS-skills at the heartsaver level. The medical studentsalso hope to have an influence with teens by stressing healthy living,smoking cesssation and accident and violence prevention.

Georgetown UniversityDave A Callaway, class of 2001, and the faculty advisors, David Milzman,MD, Eric Glasser, MD, and Emergency Medicine Resident E. Reed Smith,MD, propose to implement a core curriculum of important first aid topics,the BSL/FA course to 160 first year students. Students will receivecomprehensive syllabus with lecture notes, diagrams and proceduraltechniques taught by Emergency Medicine Interest Group students andEmergency Medcine Residents. The Dean has promised matching funds tosupport the effort.

University of ArkansasMichael Wagner, and Jim Coghill, class of 2002, and the faculty advisor,Martin Carey, MD, propose a hands-on skills workshop, lectures and EDobservations. A website dedicated to Emergency Medicine Interest Groupswill be designed as a networking communication tool to keep studentsappraised of latest events and information.

University of New England College of Osteopathic MedicineJason Cohen, and the faculty advisor, Neal Cross, PhD, proposal is veryunique in that they will use “fresh” cadavers for the introduction andpractice of emergency medicine skills. The skills to be taught includeintubation, chest tubes, central lines, needle thoractomies, wound closureand surgical airway approaches.

The Medical Student Interest Group grants were developed to recognizeand assist the development of medical student interest groups for medicalstudents interested in a career in emergency medicine. Applications mustfocus on educational activities or projects related to undergraduateeducation in emergency medicine and funds may be used for supplies,consultation and seed money to support activities such as skill laboratories,lectures, or workshops. The deadline for submission of applications for thenext grant cycle will be August 15, 2001.

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Future SAEM Annual MeetingsMay 6-9, 2001 • Atlanta Hilton and Towers Atlanta, GA

May 19-22, 2002 • Adam’s Mark Hotel — St. Louis, MO

May 29-June 1, 2003 • Marriott Copley Place — Boston, MA

Protection of Human Subjects — New DevelopmentsJohn A. Marx, MDSAEM National Affairs Task ForceCarolinas Medical Center

In May, Department of Health andHuman Services (HHS) SecretaryDonna Shalala announced several newinitiatives to strengthen protection ofhuman research subjects in clinicaltrials. The announcement was incitedby the tragic death of a student at theUniversity of Pennsylvania in a gene-transfer trial funded by the National In-stitutes of Health (NIH) and the result-ing loss of the public’s confidence in theprotection of human research subjects.

The most widely published andfeverishly implemented initiative wasannounced on June 5, 2000. This re-quires that all research institutions de-velop and implement a formal programof education on the protection of humansubjects. The education has to be com-pleted by all investigators and otherpersonnel involved in human subject re-search who receive funding from theNIH or the Federal Drug Agency (FDA)and becomes effective October 1,2000. This is a condition of the NIHgrant award process and of the Officefor Human Research Protections(OHRP) assurance process. Althoughno specific guidelines were issued,each institution must document thattraining in the ethical conduct of clinicalresearch has been completed prior toissuance of an award. The documenta-tion has to be in the form of a letter list-ing key personnel and the title of theeducation program as well as a one-sentence description of the program,signed by the principal investigator andan institutional official. Many institutionsin response have developed web-basedtutorials and have voluntarily appliedthis policy to all personnel involved inhuman subject research regardless offunding source.

HHS is also developing legislation toenable the FDA to levy civil monetarypenalties of up to $250,000 per investi-gator and up to $1 million per researchinstitution for violations of informed con-sent and other research practices. Thecurrent tools available to the FDA in-clude issuing warning letters or imposingregulatory sanctions that require a halt inresearch until problems are corrected.This practice has received much mediaattention and has resulted to date in thetemporary suspension of seven institu-tions from federally funded research. Ad-ditional measures include strengtheningthe informed consent process, improvingmonitoring and oversight, and ensuringthat researchers understand and complywith federal conflict of interest regula-tions. Further, the OHRP issued gui-dance allowing grant applicants to

postpone IRB review until after comple-tion of the initial phase of NIH peer re-view but before final funding approval.This had been an enormous drain onIRB resources and considering fewerthan half of all applications submitted tothe NIH are actually funded, comes aswelcome relief.

On June 8, 2000, the Human Re-search Subject Protections Act of 2000bill was introduced. The key provisionof this bill is the proposal that the Com-mon Rule (45 CFR 46), which protectshuman subject research conducted byHHS and 16 other federal agencies, beapplied to all human subjects researchindependent of setting and fundingsource. In addition, the bill requires thatall IRBs must be accredited by a non-profit, private entity, effective two yearsafter enactment. This new legislationwas endorsed by over 300 academic,scientific, and patient groups includingthe AAMC and the Coalition for Ameri-can Trauma Care.

On the heels of the release of theseinitiatives came the announcement thatin order to “elevate its stature and effec-tiveness”, the Office for Protection fromResearch Risks (OPRR) of the NIHwould be replaced by the Office forHuman Research Protections (OHRP)and be located at the Department ofHealth and Human Services. As part ofNIH, the OPRR was required to over-see the research of the same organiza-tion from which it derived its authority,which made for an awkward situationand the perception of conflict of inter-est. OHRP is headed up by EdwardKoski, PhD, MD, former director of hu-man research affairs at PartnersHealthCare System, Inc. in Boston.After taking over as director in Septem-ber, one of his first acts was to supportthe establishment of uniform standardsfor the accreditation of institutionalreview boards.

In addition, the NIH has requiredrecipients of National Research ServiceAward research training grants to com-plete a program of instruction in the re-sponsible conduct of research. The Of-fice of Research Integrity and the PublicHealth Service (PHS) research agen-cies are proposing to expand this re-quirement from trainees to all personsconducting research with PHS support.

This decision was based on the Depart-ment’s commitment to ensure that allPHS-supported researchers receivebasic instruction in the key elements ofresponsible research and are familiarwith basic regulatory requirements, Al-though only applicable to PHS-sup-ported research, it is recommended thatthis proposed program be implementedfor all personnel involved in research atthe institution and eventually replacethe NIH policy. The program covers tencore instructional areas from dataacquisition to human subjects andconflict of interest. It was proposed thateach institution receiving PHS fundingstarting October 1, 2000 must certifythat they will establish such a programby June 1, 2001 and that it will beimplemented by October 1, 2002. Thefinal implementation policy is expectedto be issued in November 2000.

In September, the AAMC released a“Proclamation and Pledge of Academic,Scientific, and Patient Health Organiza-tions” to “reaffirm their commitment tothe safe and ethical pursuit of the newknowledge necessary for the develop-ment of treatment and cures” and acommitment “to the protection andpreservation of the rights and welfare ofall the individuals who volunteer to par-ticipate in human subjects research.”As of the end of September, over 400organizations and institutions haveendorsed this proclamation.

As we reflect on the last few years,IRBs continue to face the challenge ofkeeping up with these regulatory bur-dens but with limited resources. IRBsare inundated with paperwork andspend an enormous amount of time onreview responsibilities that can beargued to be of little protective value.Although the Office of Inspector Gen-eral conducted an evaluation of Institu-tional Review Boards and made severalrecommendations to reduce some ofthe regulatory burden, few have beenimplemented to date and in fact the bur-den has continued to grow. The newinitiatives are laudable. But, so long asthe underlying workload pressures con-tinue without a concomitant increase inflexibility and resources, IRBs will behard-pressed to enact these new re-sponsibilities in the manner proposedand intended.

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Call For NominationsYoung Investigator

AwardDeadline: December 15, 2000

Again this May, SAEM will recog-nize a few young investigators whohave demonstrated promise and dis-tinction in their emergency medicineresearch careers. The purpose ofthe award is to recognize and en-courage emergency physicians/sci-entists of junior academic rank whohave a demonstrated commitment toresearch as evidenced by academicachievement and qualifications. Thecriteria for the award includes:

1. Specialty training and certificationin emergency medicine or pedi-atric emergency medicine.

2. Evidence of significant researchcollaboration with a senior clinicalinvestigator/scientist. This may bein the setting of a collaborative re-search effort or a formal mentor-trainee relationship.

3. Academic accomplishmentswhich may include:a. postgraduate training/educa-

tion: research fellowship, mas-ter’s program, doctoral pro-gram, etc.

b. publications: abstracts, papers,review articles, chapters, casereports, etc.

c. research grant awardsd. presentations at national re-

search meetingse. research awards/recognition

The deadline for the submission ofnominations is December 15, 2000 .Nominations should include the can-didate’s CV and a cover letter sum-marizing why the candidate meritsconsideration for this award. Candi-dates can nominate themselves orany SAEM member can nominate adeserving young investigator. Candi-dates may not be senior faculty (as-sociate or full professor) nor be morethan seven years beyond residencytraining at the time of application.

The core mission of SAEM is toadvance teaching and research inour specialty. This recognition mayassist the career advancement of thesuccessful nominees. We also hopethe successful candidates will serveas role models and inspirations to usall. Your efforts to identify and nom-inate deserving candidates will helpadvance the mission of our Society.

2000-2001 Interest Group ReportsThe September/October Newsletter included many interest group reports and three

additional reports are included below. Interest groups were developed to allowmembers to participate with other SAEM members in areas of mutual interest.Currently there are approximately 25 interest groups. All interest groups are asked tomeet at the SAEM Annual Meeting and the chairs were asked to develop objectives forthe 2000-2001 academic years, as well as provide a narrative report on their meetingsin San Francisco. The full text of the reports can be found on the SAEM web site at:www. saem.org/inform/intgrps.htm

All SAEM members are invited to participate in the interest groups. Contact theSAEM office at saem@saem.org or call 517-485-5484 to become a member of an in-terest group. Dues are $25 per year per interest group. For information on specific in-terest groups, please feel free to contact the interest group chairs listed below. Forgeneral information on interest groups or how to develop an interest group, please re-view the Interest Group Orientation Guidelines on the SAEM web site at: www.saem.org/inform/igorient.htm. The SAEM Board recently approved the development oflist-servs for interest groups that request a list-serv and have at least 20 members.

Neurologic EmergenciesDexter Morris, MD, Chair: dmorris@med.unc.eduObjectives1. Complete development and dissemination of a model Neurologic Emergencies

Curriculum2. Provide a “Teach the Teachers” symposium at the 2001 SAEM Annual Meeting3. Pursue the development of a Neurologic Emergencies Research Fellowship or

Grant4. Continue discussions about joint research projects and data base.

PediatricJill Baren, MD, Chair: jbaren@mail.med.upenn.eduObjectives1. Define the scope of pediatric emergency medicine education within emergency

medicine residencies. This objective began with a survey to EM programdirectors several years ago and culminated with the publication of results thispast summer in Academic Emergency Medicine.

2. Provide awareness of the activities of other organizations focused on theemergency care of children such as the federal emergency medical services forchildren program, American Academy of Pediatrics section on emergency medi-cine, and Ambulatory Pediatric Association. This is accomplished throughout theyear on an ongoing basis through a group email list as well as hearing summaryreports at the annual meeting by members who also belong to other organizations.

3. Provide information about research funding opportunities in pediatric emergencymembers. This objective is ongoing but has been partially completed by the in-clusion of interested members on the EMSC research listserv maintained by theEMSC National Resource Center.

4. Provide a forum for networking during the annual meeting especially for PEMfellows and for residents considering a PEM fellowship. This objective will be metat the 2001 annual meeting by planning a luncheon session and discussion andwe will work in conjunction with EMRA to encourage interested residents to attend.

5. Educate the general membership of SAEM on important issues in pediatricemergency medicine or in new developments in EMSC research. This objectiveincludes developing and submitting at least 2 didactic proposal submissions tothe Program Committee each year, as well as serving as a resource to theProgram Committee for abstract review.

TraumaMichael Gibbs, MD, Chair: mgibbs@carolinas.orgObjectives1. Develop a Trauma Interest Group e-mail list-server to improve communication

between members.2. Establish a Trauma Interest Group Website to update SAEM members about

Trauma Interest Group activities and to share research ideas, interesting cases,important articles, digital images, and a listing of trauma-related meetings. Thewebsite will be developed, organized and administered by the Group Chair, withguidance from SAEM.

3. Establish an Emergency Medicine Trauma Research Network to develop newresearch ideas, and facilitate collaboration and multicenter trials. Informationregarding this Network would be shared on the Trauma Interest Group Website.

4. Facilitate future submissions of SAEM State-Of-The-Art proposals.

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Error in the Emergency Department: A Different PerspectiveMarc J. Shapiro, MDSAEM Patient Safety Task ForceBrown University

“Just another drunk” A 45- year- old male was brought intothe ED from the police station becausehe became less responsive while incustody. Earlier in the evening he hadbeen involved in a single car crash andwas arrested for driving while intoxi-cated. No additional history was avail-able. His initial vital signs were HR-110,RR-12, T-97ºF, BP 130/70. The initialtriage evaluation concluded that his al-tered mental status was a result ofalcohol intoxication, and he was dir-ected to the detoxification area of theemergency department. Further nurs-ing evaluation revealed a GCS of 11and raised the concern for a head in-jury. The resident physician quickly re-triaged the patient to the trauma roomand performed endotracheal intubationusing Rapid Sequence Induction (RSI).A subsequent head CT was unre-markable, and the patient was returnedto the trauma room. Shortly after hisreturn to the trauma room, the labora-tory notified the ED that the patient hada critical glucose of 24 mg/dl. Thepatient then received D50 and returnedto a normal mental status.

Is this an error? The traditional ap-proach to this incident would have beento discuss it at Morbidity and Mortalitywhere the focus would be on the indi-vidual physician’s error(s) and review ofexisting protocols. In this case, no seri-ous morbidity occurred, and many mayhave been tempted to gloss over it onthe grounds of “no harm, no foul.” How-ever, this patient was certainly at in-creased risk for serious harm, so exam-ination of this “near miss” provides afree lesson on problems in the caresystem to those willing to invest thetime in studying it.

On the surface, this case does rep-resent a simple violation of the standard“unconscious patient protocol”. How-ever, it also represents an example of acognitive bias (anchoring bias), a prob-able teamwork failure, and most nota-bly, a system breakdown. Medical pro-fessionals need to move away fromplacing blame on individuals to thinkingfrom a systems perspective. Systemschanges aimed at preventing future er-ror patterns, making visible those errorsthat cannot be prevented, and ‘buffer-ing’ or protecting patients from the con-sequences of errors that slip throughare at the heart of patient safety efforts.

Bias. Emergency physician traininghas devoted minimal attention to cog-nitive behaviors despite an establishedliterature on medical decision-making.1,2

Most of us do not desire to be cognitivepsychologists, but understanding thebasics of reasoning strategies, cogni-tive biases, and forcing strategies mayhelp prevent many medical errors. Thecognitive bias most notable in this caseis “anchoring bias”, the tendency to beunduly persuaded by features encoun-tered early in the presentation of illness,thereby committing to a prematurediagnosis. Once the mental “anchor”has been placed, new information thatwould tend to refute the current assess-ment is ignored or explained away, andinformation tending to reinforce the ini-tial assessment is accepted at facevalue. This process is not a consciousone – subjects are not willfully ignoringconflicting information, but simply failingto perceive it.

Teamwork. Good teamwork is a power-ful general tool for preventing errors andreducing their impact. The Med Teamsproject has developed a standard cur-riculum for error manangement and pre-vention, which leverages rudimentaryteamwork skills that many emergencyphysicians possess (http://teams.drc.com). Three specific teamwork be-haviors may have prevented the error inthis case. If caregivers were accustomedto maintaining a shared “mental model”,that required that a specific plan bearticulated, it would have prevented anassumption that the blood glucose hadbeen previously been evaluated. Asecond behavior shown by highly trainedteams is cross-monitoring of eachother’s actions. This can occur explicitly(asking for and receiving confirmation ofcritical information) or implicitly (observ-ing co-workers and questioning apparent

deviations). Cross-monitoring is notnaturally part of physicians’ culture, butcould have caught the mental lapse thatled to this error. The third team behaviorinvolves advocacy and situationalleadership, such as speaking out whenmental models diverge, questioning acourse of action, or suggesting a courseof action different than that beingplanned. Had any team member as-serted themselves and suggested the“unconscious protocol” be followed priorto Rapid Sequence Induction and headCT the course would have been differ-ent. Social pressures make it difficult forlower ranking members of teams toengage in this behavior, even whenmembers are on the best of terms, soexplicit efforts are needed to elicitadvocacy and assertion.

Systems Change. Since this event,ED nurses now routinely follow a stand-ing protocol to obtain a fingerstick bloodsugar on all patients triaged to the de-toxification area with an altered mentalstatus. In addition, RSI procedures forunconsciousness or altered mentalstatus have been modified from thosefor respiratory distress by including theunconscious protocol as a component.

References1. Kassirer, JP. And Kopelman, RI.

Learning Clinical Reasoning. 1991:Baltimore: Williams and Wilkins.

2. Tversky,A. and Kahneman, D. Be-lief in the law of small numbers. InJudgment under Uncertainty: Heu-ristics and Biases. Kahneman, D.Slovic, P. and Tversky, A. (Eds.).1982; New York: Cambridge Univer-sity Press.

CORD/AACEM Faculty DevelopmentConference: Navigating the Academic Waters

March 3-5, 2001 — Washington, DCFaculty development continues to be one of the most carefully scrutinizedareas by the RRC-EM. Due to the relative growth of our specialty, coupledwith rapid growth of residency programs over the past 10 years, manyyounger faculty struggle to develop needed personal, management, teaching,and research skills required for successful career advancement. CORD andAACEM have conjointly developed a seminar entitled: “Navigating the Aca-demic Waters: Tools for Emergency Medicine.” This conference was first heldin November 1996 and received high praise from attendees. The conferenceis designed specifically for the unique needs of junior Emergency Medicinefaculty and will address essential elements necessary for success in an aca-demic environment including research development, grants, presentationskills, resident evaluation, mentoring, and clinical teaching, as well as time andpersonal management. This course nicely augments the ongoing efforts madeby SAEM in the area of faculty development. Young faculty or senior residentsinterested in an academic career should contact the CORD/AACEM office at517-485-5484 or the CORD web site at www.cordem.org. Registration islimited to 125 people, so call today!

7

Errors in Medicine: The Emergency Medicine ResponseJames Hoekstra, MD Chair, National Affairs Task ForceOhio State University

On October, 28, 2000, at the Associa-tion of American Medical Colleges(AAMC) Meeting in Chicago, SAEMsponsored an educational program en-titled “Errors in Medicine: The Emer-gency Medicine Response.” Jim Adamsand Bob Wears presented some of theirwork and ideas resulting from the Aca-demic Emergency Medicine (AEM) spon-sored consensus conference on errors inemergency medicine. The results of thatconference were published in the No-vember issue of AEM. Paul Griner, MD,from the AAMC, was kind enough toattend the program, and provided somevaluable input regarding the process oferror identification and mounting anappropriate response. The program waswell received, both by the audience, aswell as Dr. Griner and the AAMC. It wasclear from our discussions with Dr. Grinerthat emergency medicine is well aheadof other medical specialties in dealingwith this issue. The question is, will we asa specialty take advantage of it?

When the Institute of Medicine (IOM)report on medical errors was publishedearlier this year, it was followed by apublic outcry for action to reduce med-ical errors. The high prevalence of med-ical errors sited in the report is not, how-ever, a new issue. There have been anumber of reports in the literature in thepast decade citing high error rates inmedications prescribed and the routeand frequency by which medicines aregiven. These medical errors were foundto be mostly preventable and often initi-ated by physicians. The IOM report sim-ply brought the problem into the public

ED. If a potential error can be identified,a system can be modified or put inplace to avoid that error. By systems,they were not talking about simply de-signing forms or more paperwork todeal with the issue, but actually rede-signing processes to maximize effi-ciencies and eliminate inefficiencies,coordinate activities as a team, and fa-cilitate the adoption of specific be-haviors to optimize outcomes. The EDmust be systematically reengineeredalong lines that stress simplicity, con-sistency, ease and automaticity in orderto decrease errors.

There was a lot of lively discussionat the conference, mostly centering onthe appropriate “next steps” that areneeded to take advantage of our mo-mentum in dealing with medical errors.The audience had a number of sugges-tions regarding future steps in the erroridentification and systems-building ap-proach. There was consensus that strictdefinitions are needed for medical er-rors. In order to fix a problem, we needto correctly identify the problem in sucha way that there is uniformity in ourdefinitions. Once we have uniform def-initions, we can begin to work on sys-tems approaches to attack the prob-lems. The audience stressed that this isa fertile area for new investigators whoare interested in outcomes research. Itshould be easy for each of us in ourown EDs to identify a potential error,define it, and design an approach tosolve it. If we can do so in a way thatbenefits all of emergency medicine, theresults of our efforts should be fundableand publishable. Academic emergencymedicine should be leading the way onthis effort, and striking while the iron ishot.

light. We can argue about the meth-odology used in the IOM report, or wecan point to the fact that they analyzeddata from 1985, but the fact remainsthat organized medicine has a problemwith high medical error rates, and nowthe public is demanding solutions.

In emergency medicine, the problemof medical errors is even more acute.We work in a high volume, high stress,high variety setting, where the potentialfor errors is enormous. Emergency phy-sicians tend to “shoot from the hip” andmake snap decisions based on minimalinformation. We work in a relativevacuum, where follow-up information issketchy, and feedback on our errorsmay not be available to change ourpractices. It’s no surprise that the IOMreport found that the highest prevalenceof medical errors was present in theED. The survey used for the IOM re-port was “old data” from an era whenEDs were not staffed by board certified,residency trained EM physicians, and24 hour coverage was lacking. As such,we can say that the times havechanged, and we’ve improved. Unfor-tunately, if we take that stance, we areessentially denying a problem that weall know exists. We may miss the op-portunity and momentum to change theway we are thinking about medicalerrors, and to act proactively to identifypotential errors and correct them beforethey occur. Worse yet, we may bemissing a golden opportunity for re-search funding in an area that the pub-lic wants to see funded.

Jim Adams and Bob Wears reportedon the results of the AEM ConsensusConference on Errors in EmergencyMedicine. They recommended a sys-tems approach to medical errors in the

Academic Announcementsvidual National Research Service Award(NRSA) from the Agency for HealthcareResearch and Quality (AHRQ). Thisfellowship-training grant will support Dr.Newgard during his pursuit of a Mastersof Public Health Degree at the UCLASchool of Public Health, and for theduration of his research training.

Janet M. Williams, MD, will serve asthe co-investigator of a 1.4 million dollargrant from the Agency for Health CareResearch and Quality entitled, “TheRural ED as Access Point for TeenSmoking Interventions.” This 4-year col-laborative effort includes the Depart-ment of Emergency Medicine, the Cen-ter for Rural Emergency Medicine, andthe Prevention Research Center atWest Virginia University. Dr. Kim Horn,EdD is the principal investigator.

Jerris R. Hedges, MD, MS, Professorand Chairman of Emergency Medicine,Oregon Health Sciences University, hasbeen elected to membership to theInstitute of Medicine (IOM). Membersof the Institute of Medicine are electedby the incumbent membership on thebasis of professional achievement, anddemonstrated interest, concern and in-volvement with problems and criticalissues that affect the health of thepublic. The Institute conducts studies ofspecific problems, such as the recentreport on medical errors in hospitalsettings. The Institute is a division ofthe National Academy of Sciences.

Craig D. Newgard, MD, a research fel-low in the Department of EmergencyMedicine at Harbor-UCLA Medical Cen-ter, has been awarded a two-year Indi-

For the first time, two Best Presenterrecipients were selected during theCPC Finals Competition, which washeld on October 22 during the ACEPScientific Assembly. Best ResidentPresenters are (L) Andrew Barton, MD,from Baystate Medical Center, and (R)Tricia Villanueva, MD, from Hahne-mann University. Kathleen Jobe, MD,from the University of Washington,was selected as the Best Discussant.

8

ETHICS CORNER

“Does Pain Medication Impair Ability to Give Informed Consent?”Catherine A. Marco, MDSAEM Ethics Committee

St. Vincent Mercy Medical Center

Editor’s Note: This is the first in a series of columns regarding ethical issues, written by members of the SAEM EthicsCommittee. These columns are provided as an educational service, and are not intended to serve as position statements orotherwise reflect policies or positions of SAEM. Readers are invited to submit ethical questions or cases to: saem@saem.org

Question:A 37 year-old male was being evalu-ated for right flank pain. He received 5milligrams of morphine sulfate intra-venously. Shortly thereafter, the deci-sion was made to perform an intra-venous pyelogram to evaluate possiblenephrolithiasis. Is it still possible to ob-tain informed consent, after narcoticadministration?

IntroductionWe routinely administer mind-alteringpharmaceutical agents, such as nar-cotics or benzodiazepines, in the prac-tice of Emergency Medicine. Often pa-tients will subsequently require diag-nostic or therapeutic interventions, forwhich informed consent from the pa-tient is desired. Can informed consenttruly be obtained after the administra-tion of such medications? The shortanswer is: yes.

Elements of Informed ConsentInformed consent, a term coined in1957, defines the roles of physicianand patient in medical decision-making.Ideally, informed consent is comprisedof the following elements:1. Patient capacity . The patient must

be capable of understanding andparticipating in the decision makingprocess.

2. Delivery of information. The phy-sician has a duty to deliver appropri-ate information regarding the pro-posed intervention, including risks,benefits, and expected outcome.

3. Voluntary participation. Thepatient should not be coerced in anyway, but should voluntarily agree tothe proposed intervention.

Case DiscussionNumerous clinical, organic, psychologi-cal, sociological, and pharmaceuticalfactors can affect a patient’s ability tocomprehend and participate in the in-formed consent process. Some exam-ples of factors which may impair patientcapacity include: pain, anxiety, deliri-um, age, mental capacity, language orcultural barriers, alcohol or drug intoxi-cation, administration of mind-alteringpharmaceutical agents, and a multitude

of others. There is no particular condi-tion which in all cases either guaran-tees or negates appropriate patient ca-pacity to participate in the informedconsent process.

Whenever informed consent is ob-tained, assessment of patient capacityis an essential step in the process.Regardless of the clinical scenario, thephysician must assess the patient’sability to comprehend clinical informa-tion, understand alternatives, andweigh risks and benefits.

In some cases, pain may be astronger deterrent to ability to consentthan pain control with narcotics orother agents. In others, adequate paincontrol may create confusion or som-nolence sufficient to impair appropriatemental capacity.

ConclusionsWhenever informed consent is ob-tained, the physician has the duty toassess decision-making capacity, andensure that the patient is able to com-prehend information, understand alter-natives to the proposed intervention,and weigh risks and benefits. Narcoticadministration may affect a patient’scapacity to provide informed consent.While a patient who has received nar-cotics or other agents is not automatic-ally unable to participate in the in-formed consent process, the effect ofthese medications on the individual pa-tient’s decision-making capacity mustbe strongly considered.

ReferencesBorak J, Veilleux S: Informed consentin emergency settings. Ann EmergMed 13:731-35, 1984.

Braddock CH, Edwards KA,Hasenberg NM et al: Informed decisionmaking in outpatient practice. JAMA1999; 282:2313-2320.

Drane J: Competency to give aninformed consent: a model for makingclinical assessments. JAMA 252:925-27, 1984.

Kaufman DM, Zun L: A quantifiable,brief mental status examination foremergency patients. J Emerg Med13:449-56, 1995.

Medtronic Physio-Control to Support

EMS ResearchFellowship

Deadline: December 15, 2000SAEM is pleased to announce that

Medtronic Physio-Control Corpor-ation will sponsor the 12th AnnualEMS Research Fellowship. Med-tronic Physio-Control provides$50,000 each year to fund an EMSFellow, so the funding for the 2001-2002 fellowship means that $600,000have been dedicated to support thefellowship. All funds are used to dir-ectly sponsor the fellowship.

The application materials for indi-viduals wishing to apply for the EMSFellowship commencing July 1,2001, can be found on the SAEMweb site at <www.saem.org> or fromthe SAEM office. The application,including personal statement andletters of reference, must be receivedby SAEM by December 15, 2000 .

Institutions interested in applyingfor consideration as a EMS Fellow-ship training site can also find appli-cation materials at www.saem.org orfrom the SAEM office. Additionally,previously approved institutionswhose programs have undergonesignificant changes must apply for re-newal. All materials must be receivedby SAEM by December 15, 2000 .

Notification to both prospectivefellows and institutions will be madeby January, 2001. The selectedEMS Fellow will then have a briefperiod to officially designate his/herfellowship site.

Moskop JC: Informed consent in theemergency department. Emerg MedClin N America 17:327-40, 1999.

Smithline HA, Mader TJ and CrenshawBJ: Do patients with acute medicalconditions have the capacity to giveinformed consent for emergencymedicine research? Acad Emerg Med1999; 6:776-780.

9

EMF Call for Grant Proposals

Call for PhotographsDeadline: February 15, 2001

Original photographs of the practice of emergency medi-cine are invited for presentation at the 2001 SAEM AnnualMeeting. The theme for the photographs is “Clinical Pearlsand Visual Diagnosis.” Original photographs of patients,pathology specimens, gram stains, EKG’s, and radiographicstudies or other visual data may be submitted. The deadlinefor receipt is February 15, 2001.

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

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

All photo submissions must be accompanied by a casehistory written as an “unknown” in the following format: 1. Chief complaint2. History of present illness3. Pertinent physical exam

4. Pertinent laboratory data 5. One or two questions asking the viewer to identify the

diagnosis or pertinent finding6. Answer(s) and brief discussion of the case, including an

explanation of the findings in the photo7. One to three bulleted take home points or “pearls”

The case history must be 250 words or less and fit on asingle page in 14 point font with at least one blank line be-tween sections. The case history should be submitted as ahard copy and as a file on a disk or as an email attachment.

Submissions will be judged by the Program Committeeand accepted based on their educational merit, relevance toemergency medicine, quality of the photograph and the casedescription. Submissions will also be reviewed to assure ap-propriateness for public display at a national meeting. SAEMwill mount accepted photos and display them at the 2001Annual Meeting in Atlanta. Contributors will be acknowl-edged and photos will be returned after the meeting.

Photographs must not appear in a refereed journal priorto the Annual Meeting. Appropriate masking of recognizablepatients or written consent is the responsibility of the con-tributor. Documentation of written consent must accompanysubmissions and include a release of responsibility. Allsubmissions will be considered for publication in AcademicEmergency Medicine. SAEM will retain the rights to usesubmitted photographs for use in future educational projects,with full credit given for the contribution.

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

EMF is accepting applications for its annual grants. Funding isfor research done within the academic year of July 1, 2001through June 30, 2002 unless otherwise specified. To requestan application, contact EMF, P.O. Box 619911, Dallas, Texas75261-9977 or call (972) 550-0911 ext. 3340. The following isa description of the awards and application deadlines:

Riggs Family/EMF Health Policy Research GrantBetween $25,000 and $50,000 for research projects in healthpolicy or health services research topics. Applicants may applyfor up to $50,000 of the funds, for a one- or two-year period.The grants are awarded to researchers in the health policy orhealth services area, who have the experience to conductresearch on critical health policy issues in emergency medicine.Deadline: January 8, 2001

EMF/FERNE Neurological Emergencies GrantA maximum of $50,000. This grant is sponsored by EMF andthe Foundation for Education and Research in NeurologicalEmergencies (FERNE). The goal is to fund research basedtowards acute disorders of the neurological system, such asthe identification and treament of diseases and injury to thebrain, spinal cord and nerves.Deadline: January 15, 2001

EMF/SAEM Medical Student Research GrantA maximum of $2,400 over 3 months for a medical student orresident to encourage research in emergency medicine.Deadline: January 29, 2001

EMF/SAEM Innovations in Medical Education GrantA maximum of $5,000 to support projects related to educa-tional techniques pertinent to emergency medicine training.Deadline: February 12, 2001

EMF/ENAF Team GrantA maximum of $10,000 to be used for physician and nurseresearchers to combine their expertise in order to develop,plan and implement clinical research in the specialty of emer-gency care.Deadline: March 5, 2001

EMF Established Investigator AwardA maximum of $50,000 to established researchers. An estab-lished investigator is one who has obtained significant extra-mural funding and made significant contributions to emergencymedicine research. Priority will be given to those who have beenprincipal investigators on federal and/or foundation grants.Deadline: March 19, 2001

CPC Finals Competition judges are pictured with theNational CPC Coordinator, Terry Kowalenko. (L-R) DougMcGee, Kevin Rodgers, Judith Brillman, Glenn Tokarski,and Dr. Kowalenko.

10

THE CLINICAL DIRECTOR OF AN ACADEMIC EMERGENCY DEPARTMENTFrank Zwemer, MDUniversity of Rochester

As much as academic Emergency Medicine has athree-part mission of education, research, and clinicalcare, it is the clinical operation that is generally mostvisible (and of course, most exciting for national tele-vision audiences). Running the operation takes a sig-nificant effort, and in most academic ED’s, that rolefalls primarily to the Clinical Director (CD).

The full responsibilities of the CD depend on the or-ganizational structure of the hospital and ED. In somesettings, the CD has supervisory authority over boththe physician staff, as well as the nursing and admin-istrative staff. More commonly, the CD supervises thephysicians, and has a limited advisory role for theother ED staff. This distinction is more than casual, assupervisory authority usually provides the ability tocarry out a plan.

As much as clinical care is centered at the bedside,the singularly most important role of the CD is to pro-vide the physicians to be at the bedside-and leads dir-ectly to the issue of physician scheduling. The struc-ture of the schedule is the key to the professional andpersonal satisfaction of faculty and residents. Thinkabout your own experience with no-shows on theschedule (gasp-not here!), or problems with sched-uling vacations, or getting that needed evening orweekend off. Maintaining control of the schedulingprocess is a core requirement for success of the CD.Being able to maintain control is a function of com-plexity of the schedule (number of institutions, numberof shifts/day, etc.), adequate bodies to fill the schedule(keeping in mind the entire academic year as thescheduling period, not just an individual month orweek), and being able to project and plan for the “pre-dictable crises” (extended medical leaves, change inprofessional plans, etc.).

The actual clinical activities of the ED are those that weall know and do. The CD’s role with ED clinical careranges from establishing intra-ED treatment plans andprotocols (ie, what ED staff is present for major traumapatients, which patients can go to Radiology off a moni-tor, how a point-of-care testing plan is going to beused), to selecting equipment for care, to dealing withthe usual day-to-day issues. Routinely there arematters of “missed findings” (Radiology and Laboratorycall-backs) that need follow-up and documentation.And then there is always the matter of comments andcomplaints from the various ED “customers,” whetherthey would be patients, or consultants, or inpatient

services, or hospital administration. As a generalstatement, the “daily stuff” takes 1-2 hours/day.

The CD is also the major liaison between the ED andthe other hospital departments. The CD representsthe ED for clinical issues, and will sit on interdepart-mental committees. The intensity of inter-depart-mental activity depends on the general state of affairs,or more likely, the “crisis of the week.” Radiology andLab are frequently the focus, as are the inpatientservices or specific units (ie, ICU’s).

As a generality, the effectiveness of the CD is relatedto direct presence in and around the ED. While amanager can choose to be formal or informal in style,there is no replacement for simply being around andavailable. Presence sets a tone and expectation forothers. Being specific about a daily routine, an effec-tive CD is present on a daily basis (expect 5 of 7days). There is also the matter of clinical time. Al-though quite individualized by institution, the CD willgenerally staff in the ED 10-20 hours/week.

Academic performance is required as well, and is ofcourse the reason that any of us choose an academiccareer. Resident conferences (presenting and attend-ing) have a weekly demand, as well as the other resi-dency-related activities. The publication requirementsfor faculty vary with institutional standards, but ingeneral one can expect to be working on a variety ofprojects with the goal of approximately two publica-tions/year. Collaboration is the key to success.

Planning to become the CD in an academic centercan take one in various directions. A prerequisite tomanaging a department’s care is clinical competence,and importantly clinical confidence. Generally gainingthis experience involves 2-3 years working beyondresidency, and it is beneficial to have worked in a vari-ety of settings (community and academic). Gainingthe managerial skills can take place in an informalprocess (eg, the most common way of learning it asyou go), in directed classes (ie, medical directortraining session, either proprietary or from other na-tional organizations), or even in formal degree pro-grams (master degrees). A very appropriate and prac-tical route is by being an Assistant CD, and learningby that route.

From a personal perspective, I see myself as being alucky person, being able to work as a clinician, as amanager, and as a scholar. Successfully combiningthe demands of CD administrative requirements, theclinical load, and academic productivity is a challenge.Doing the job well is tremendously satisfying.

ACADEMIC RESIDENTNews and Information for Residents Interested in Academic Emergency Medicine

Edited by the SAEM GME Committee

11

NOMINATIONS SOUGHT FOR RESIDENT MEMBER OF THESAEM BOARD OF DIRECTORS

Nominations are sought from the membership for the resident member of the SAEM Board of Directors.This is a rare opportunity for a resident to serve as a full, voting member of the SAEM Board. The residentBoard member is elected to a one-year term and is a full voting member of the Board. The deadline fornominations is January 1, 2001 .

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

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

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

A REPORT FROM THE RESIDENT MEMBER OF THE SAEM BOARDPatricia Short, MDResident Member, SAEM Board of DirectorsUniversity of Indiana

Have you ever wanted to be a fly on the wall in an importantmeeting? Well, here’s your chance. Only you will bewelcomed and treated as an equal member of the group,and not expected to hang out on the sheetrock. If thissounds appealing to you, I encourage you to apply for theresident position on the SAEM Board of Directors.

The resident member of Board of Directors was establishedthree years ago in an effort to increase resident participationin the leadership of SAEM and to encourage the choice ofacademics as a career. It is a one-year elected term as a fullvoting member of the Board.

The position provides many rewarding and educational op-portunities. It affords interaction with the leaders in aca-demic emergency medicine, which portends the devel-opment of leadership skills. Working with the members ofthe Board provides numerous role models and can lead tomentoring relationships. In addition, participation in theBoard’s activities offers a glimpse into the organizationalstructure and the enormous amount of work involved inoperating a professional society. Most importantly beingpart of the decision making process is engaging andenlightening. It’s the opportunity to help shape the directionin which the Society is moving. At times, being the onlyresident on the Board is intimidating. Additionally, thehistory behind an issue is often unknown to you, making theability to make informed comments difficult. That’s whenyou’re glad you can retreat to being a fly on the wall.

However, the feelings of intimidation are self-made, andquestions regarding the background of an issue encour-aged. You will be involved in major issues regarding the fu-ture of the specialty, an indelible role for a resident. Yourcomments are always welcome, regarded, and at timessolicited, especially when the issue involves residents. Inaddition to participating in three Board face-to-face meetingsand monthly conference calls, you will serve as the liaison toa task force/committee and an interest group. In this role youwill work with the committee or interest group chairperson toaid in the completion of their goals and objectives for theyear and facilitate communication to the Board regardingtheir concerns and ideas. Besides the above-mentioned

responsibilities, plan on using your email, a lot! Mostdocuments are distributed through cyberspace. Discussionsare usually initiated through email, then summarized andvoted upon during monthly conference calls.

Key Functions of the Position1. Full voting member of the Board2. Participation in Board meetings and conference calls3. Serving as Board liaison to task forces/committees and

interest groups

Highlights of the Position1. Excellent role models and mentoring opportunities2. Voice in key issues regarding the future of our specialty3. Insight into the administrative aspects of running an

organization4. Experience, experience, experience

Beware of the fly swatter, a.k.a. your residency director.The position takes a lot of time, time away from your usualresponsibilities at your residency program. You need yourresidency director’s full support prior to applying. Makesure he/she is willing to arrange the schedule such that youare able travel to all the face-to-face meetings and areavailable for monthly conference calls (that can last overtwo hours).

Though my year as the resident member of Board is onlyhalf over, it has already been a rewarding and enlighteningtime. The experience and exposure gained far out weighthe time consumed. I strongly encourage anyone with aninterest in academic emergency medicine who enjoys beinginvolved in leadership and administrative activities to apply.

Application ProcessThe position is one year in duration and is open to all mem-bers of accredited emergency medicine residency programswho will be residents during the entirety of their term. The ap-plication process involves submitting a letter of application,curriculum vita, and a letter of recommendation from yourprogram director. The letter of application should not onlyinclude a summary of your qualifications for the position butalso an understanding of the responsibilities and time com-mitment involved. The Nominating Committee will review allapplications and generally selects two nominees. Theelection will be held at the SAEM Annual Meeting in May inAtlanta. The deadline for application is January 1, 2001.

12

SAEM Board of DirectorsThe SAEM Board meets each

month, mostly via conference call. TheBoard convenes face-to-face meetingsat the SAEM Annual Meeting; in the fallat either the ACEP Scientific Assemblyor AAMC Annual Meeting; and in thewinter, usually in conjunction with anSAEM Regional Meetings. Most re-cently the Board met during the ACEPScientific Assembly in Philadelphia.This article will highlight some of theBoard’s actions of the past few months.

The Board approved a 2000 budgetthat included revenues of $1.94 millionand expenses of $1.57 million. TheBoard approved a contribution of$150,000 to FAEM. The Board approvedfunding in the amount of $5,000 to sup-port the AEM Consensus Conference onError in Emergency Medicine (seeNovember issue of AEM).

The Board approved funding of$9,000 to support the 2000 SAEMRegional Meetings. The Board re-iterated the policy that regional meetingprofits should be used by the regions tofund future regional meetings. By theend of the year the Board expects toact upon the Regional MeetingSubcommittee recommendations re-garding the 2001 Regional Meetings.

The Board reviewed and approvedmany manuscripts developed by com-mittees, task forces, and interestgroups. Once approved, the manu-scripts are submitted to AEM for con-sideration of publication. Recent manu-scripts approved by the Board include:the Women and Minorities Task Forcemanuscript, two Inservice Survey TaskForce manuscripts, the Diversity Posi-tion Statement developed by the Diver-sity Interest Group, the Public HealthTask Force manuscript on preventivescreening, the GME Committee manu-script on residency downsizing, and theEthics Committee manuscript ondecision-making.

The Board reviewed a proposed out-line of the joint ACEP/SAEM ultrasoundmanuscript. The Board asked that themanuscript focus on evidence basedissues and define a research agenda.A draft of the manuscript is expected tobe submitted for review and approvalby the ACEP and SAEM Boards in thenext few months.

The Board approved the EMRA/SAEM Academic Career Guide, editedby Cherri Hobgood, MD, and BrianZink, MD. EMRA and SAEM will sharethe cost of printing the Guide. SAEMhas provided the administrative supportand posted the Guide on the SAEMweb site and provided it to the EMRAweb site at no cost. The Board agreedto provide an additional $2,000 toreprint copies of the Guide if needed.

The Board approved the request from

ACEP/EMF to double the support of theEMF/SAEM Medical Student Grantsfrom $4,800 to $9,600. The Boardselected Don Yealy, MD, to serve asone of SAEM’s two representatives onEMF.

The Board approved the FAEM Neu-roscience Research Fellowship thatwas developed with funding providedby an unrestricted educational grantfrom AstraZeneca. The Board ap-pointed a subcommittee to develop poli-cies and procedures for to further de-velop FAEM.

The Board approved the establish-ment and funding of list-servs for all in-terest groups that wished to developlist-servs. The Board agreed that inter-est groups should have at least 20members to obtain a list-serv.

The Board asked the Program Com-mittee to survey the membership and in-vestigate the issue of the future of theBanquet held at the SAEM Annual Meet-ing. Subsequently, the Board approvedthe Program Committee’s recommenda-tion to continue the Banquet, but to holdit earlier, rather than the last evening ofthe Annual Meeting. Additional detailsabout innovations in the plans for the2001 Annual Meeting will be published inthe SAEM Newsletter and web site inthe coming months.

The Board selected Mark Angelos,MD, to represent SAEM at the PULSEConference; Arthur Sanders, MD, toserve as the SAEM representative tothe National Acute Myocardial InfarctionProject; and Dan DeBehnke, MD, toserve as the SAEM representative torevise the 1995 Competency Statementon Electrocardiography. The Board ap-proved the Public Health Task Force toprovide SAEM representation (EdBernstein, MD, Linda Degutis, MD, andLynne Richardson, MD) at the HealthyPeople 2010 Conference in November.The Board approved a proposal for Dr.Zink and Dr. Hoekstra to visit the ACEPWashington Office. The Board ap-proved funding for these representa-tives for expenses incurred in attendingvarious meetings.

As a sponsoring organization of theAmerican Board of Emergency Medi-cine, the SAEM Board was asked toconsider ABEM’s proposed Bylawsamendments. The Board approvedABEM’s proposed amendments, includ-ing the expansion of the number ofABEM seats selected by ABEM, and de-creasing the number of ABEM seatsselected by slates of nominees sub-mitted by the sponsoring organizations.

The Board approved a set of slides onthe topics of screening and a brief nego-tiated interview developed by theSubstance Abuse Interest Group. TheBoard approved a Domestic Violence

web site developed by the DomesticViolence Interest Group. The DomesticViolence web site and the substanceabuse slide set have been posted on theEducational Resources section of theSAEM web site.

The Board approved the documentdeveloped by representatives of theFederation of State Medical Boards(FSMB), AAEM, CORD, and SAEM.The document recommends the devel-opment of a “dependent practice” li-cense (which would require supervisionand working only in the specialty forwhich they are in training). The docu-ment also recommended developmentof instance electronic resident licensesand that institutional GME offices, notresidency directors, handle reporting tostate medical boards. Further detailswil l be published in the SAEMNewsletter.

The Board reviewed and approvedthe Model of the Clinical Practice ofEmergency Medicine, developed by theCore Content Task Force. It is antici-pated that the Model will be approvedby the other participating organizations(ABEM, ACEP, CORD, and EMRA) andwill replace the Core Content documentapproved approximately five years ago.The Model document will be publishedin the peer-reviewed literature in thecoming months and will be periodicallyevaluated and revised.

The Board developed an applicationfor satellite symposia to accompany theSatellite Symposia Policy developedlast year. The Board also made minoreditorial changes in the Satell i teSymposia Policy, the CommercialSupport Policy, and the Meeting Spon-sorship/Cosponsorship Policy. All poli-cies, and the new satellite symposia ap-plication, are posted on the SAEM website.

The Board reviewed and approvedan Editorial Independence Policy forAEM. The Board agreed to review andrevise the AEM Policies first developedwhen the journal was established. Afinal version of the AEM Policies isexpected to be approved by the end ofthe year and will be posted on the AEMand SAEM web sites.

The Board asked the Constitution andBylaws (C&B) Committee to develop anumber of amendments to the SAEMConstitution and Bylaws, includingamending the voting procedures to pos-sibly convene elections by mail or elec-tronic ballot, rather than at the AnnualBusiness Meeting at the SAEM AnnualMeeting. In addition, the C&B Committeewas asked to review the SAEM Bylawswhich provides for ad hoc members(from EMRA, CORD, and AACEM) tothe SAEM Board. The Board asked the

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positions and respond to legislative andregulatory mandates for the benefit ofour members, but not for their individualfinancial gain. Almost all SAEM inputinto the national dialogue on emer-gency care focuses on threats to thequality of patient care, teaching, and re-search in academic ED’s. In this regardwe can be proud of our positions andpass the test of how a professionalmedical association should behave,according to Pellegrino and Relman.

Later in the same JAMA article, theauthors state that: “To avoid conflicts ofinterest, the professional medicalassociation should not seek or acceptsupport from companies that sell healthcare products or services.” SAEM isclearly in violation of this recommenda-tion. We have a longstanding relation-ship with Medtronic PhysioControl, Inc.,which funds our successful EMS Re-search Fellowship, and have recentlypartnered with AstraZeneca to fund, viathe Fund for Academic EmergencyMedicine (FAEM), a Neuroscience Re-search Fellowship. We have acceptedunrestricted educational grants to helpfund our Annual Meeting and RegionalMeetings. Yet, despite these dallianceswith the corporate world, I believe weare on solid ethical and moral ground,and believe that Pellegrino’s andRelman’s advice in this case is too re-strictive. Training grants help advancethe mission of SAEM, and eventuallyhelp patients and society by providinghigh quality academic emergencyphysicians. If corporate participation in

President’s Message (Continued)these grants caused SAEM to supportthe products of these companies in abiased manner, if we lost objectivity inour educational or research sessionsthat deal with cardiac care or neurosci-ence, or if emergency patients per-ceived a conflict of interest in our in-volvement, then we could not justify thispartnership. Both corporations who sup-port the SAEM fellowships have statedthat they seek to improve patient carethrough their products. The corporationsdo not participate in the solicitation orreview of applications, the selection offellows, type of training, location oftraining, or type of research project(s)that the fellow chooses. Fellows whofinish training will, like other physicians,have to make ethical and moral choicesabout whether they will selectively usethe products of the corporation thatfunded their fellowship, accept gifts, orbuy stock in the company, or acceptgifts from any biomedical company.SAEM provides members with edu-cation on ethics and professionalismthat can help them make good choices.

Questions about SAEM’s interactionwith the biomedical industry come upon almost a weekly basis. As ourInterest Groups have grown in number,size and activities, they have found in-ventive and interesting ways to interactwith the biomedical industry. Other or-ganizations and corporations wish tocapitalize on the success of the AnnualMeeting by hosting sessions in conjunc-tion with the meeting. Some of thequestions that arise from these interac-

tions fall into gray zones that are notexplicitly covered in our policies. Wehave rewritten our policies, but still findsituations where a clear answer is diffi-cult to find. In these cases, the Board ofDirectors must act like a SupremeCourt, with all the discomfort one wouldexpect when a group of doctors has toact like lawyers. The Board’s approachin assessing proposed SAEM interac-tions with the biomedical industry hasbeen to fol low the advice of D.H.Lawrence who said in his Selected Es-says: “Try to find your deepest issue inevery confusion, and abide by that.” Inthis “confusion” the deepest issue is thetrust of our patients. If SAEM approves,endorses, or hosts interactions with thebiomedical industry that limit academicfreedom, objectivity, or have bias, or ifthe financial relationship causes a con-flict of interest, then we may erode thetrust that emergency patients have inus. In an address at the 2000 AAMCAnnual Meeting, AAMC PresidentJordan Cohen pointed out that publictrust fuels public support for academicmedicine. At a time when we are enjoy-ing increased federal (i.e. public) sup-port for research, and we are facing in-creasing scrutiny about ethical behaviorin clinical research, we must be espe-cially careful not to violate public trust.

Dr. Cohen also noted in his addressthat “conflict of interest is a state ofaffairs, not a kind of behavior.” Most ofthe biomedical industry interaction grayareas that are presented to SAEM do

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C&B Committee to consider how SAEMshould define its relationship with emer-gency organizations since the Societycurrently is inconsistent. The Board isexpected to review the C&B Committeerecommendations before the end of theyear and further information will be pub-lished in the SAEM Newsletter.

The Board approved a proposal fromthe National Affairs Task Force to de-velop an educational session on Errorin Emergency Medicine at the AAMCAnnual Meeting. The Board approvedthe development of a 24 Hours in theED project being developed by thePublic Health Task Force. The PublicHealth Task Force has submitted theproposal to the Robert Wood JohnsonFoundation for possible funding.

The Board approved the Undergradu-ate Committee’s proposed medicalschool curriculum assessment survey.The Board approved the funding of theMedical Student Interest Group grants.The Board doubled the number offunded grants from three to six, upon the

SAEM Board of Directors (Continued)recommendation of the Grants Commit-tee. The Board approved the develop-ment of an Ethics Consulting Service.

The Board approved a proposal toparticipate in the National AlcoholScreening Day (NASD) on April 5,2001. A NASD working group will beestablished to collect findings from 40participating emergency departmentsand the results will be submitted toAEM for publication.

The Board approved a resolutionpromoting ED-initiated approach to im-proving asthma care. The resolutionwas proposed by Carlos Camargo, MD,the SAEM representative to the Na-tional Asthma Education and Preven-tion Program.

The Board approved Dr. Zink’s pro-posal to develop a Patient Safety TaskForce and a Grants Committee. TheBoard approved Dr. Zink’s proposal thatthe EMS Research Task Force be dis-continued this year and that an EMS In-terest Group be developed in order toprovide an opportunity for more

members to participate in EMS issues. The Board approved an initial propo-

sal from the Program Committee to postthe Photography submissions on theSAEM web site as a teaching tool. TheBoard requested a more detailed pro-posal addressing the issues of copyrightand appropriate release of the images.

The Board approved the proposalfrom the Foundation for the Educationand Research in Neurological Emergen-cies (FERNE) to convene a satellitesymposium at the 2000 Annual Meeting.

The Board conferred emeritus mem-bership status on James Bouzoukis,MD, and Ernest Ruiz, MD. Both Dr.Bouzoukis and Dr. Ruiz provided manyyears of membership and service to theSociety.

The next meetings of the Board areexpected to be held at the CORD/AACEM Faculty Development Confer-ence in March in Washington, DC andat the SAEM Annual Meeting in Atlantain May. All SAEM members are invitedto attend the Board meetings.

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President’s Message (Continued)not involve blatant, behavioral conflictsof interest. Rather, they are due to a“state of affairs” that introduces a con-flict of interest that threatens objectivityor introduces bias. Members who pro-pose these interactions are almost al-ways well-intended, dedicated, passion-ate, and committed to their researcharea or proposed project. Perhaps thebest way to demonstrate some of thedecisions that the Board has to makeon commercial support is to providesome examples.

Case 1. The Program Committeereceived a proposal to hold a lunch ses-sion at the Annual Meeting where in-vited pharmaceutical company repre-sentatives were to meet with SAEMmembers to discuss aspects of spon-sored research and general informationand tips on how investigators can bestposition themselves to participate inclinical trials. This session was ap-proved because it did not involvepromotion of particular products or asingle company, but was a discussionof the process of clinical research. Ifthe session had involved a single com-pany promoting its own drugs or clinicaltrials, it most likely would not have beenapproved, as the session would beprone to bias and a lack of objectivity.

Case 2. An Interest Group (IG) pro-posed that during its meeting at the An-nual Meeting, an invited expert speakerwould be brought in to give a presenta-tion on a particular disease process.The IG noted that the speaker was partof the company’s speaker’s bureau andproposed that his travel, lodging, andan honorarium be funded by a pharma-ceutical company that makes a drug fortreatment of this disease. The pharma-ceutical company also wanted to pro-vide funds for the lunch. This requestwas not approved by the Board of Dir-ectors because it was felt that the con-flict of interest with a speaker who waspaid by a pharmaceutical companywould introduce apparent bias or re-duce objectivity in the presentation,even if it were disclosed. One couldargue that our IG members could sniffout bias in a presentation on their own,and that SAEM does not need to limitthis type of presentation. This is pro-bably true for experienced members,but resident and medical students arealso members of IG’s, and they may notbe as aware of bias. Another approachthat the IG could have taken to meetthe same objective would be to submita project proposal form to the SAEMBoard to host a session at its IG meet-ing. A speaker could be invited, but theIG would request that SAEM fund his orher travel, lodging, and a reasonablehonorarium. The speaker would dis-close in advance, and at the session,that he/she had a conflict of interest as

a member of a speaker’s bureau for apharmaceutical company. The IGwould ensure that a balanced presenta-tion was given that did not promote asingle drug or product.

Case 3. This is a hypothetical case,but based on discussions with our IGChairs, it is very likely to arise in thenear future. An IG wishes to develop aneducational curriculum and teachingprogram that includes the developmentof monograph, slide set, and web-based teaching aids. The total cost ofthe program is around $10,000. The IGhas links with a company that wil lprovide funding for the program, andwants this to be acknowledged in thematerials. Direct funding of this pro-gram by the company would violate theSAEM Policy on Commercial Support,even though the end product could beconsistent with SAEM’s mission. Thereason for the violation would be thebias and potential loss of objectivity andacademic freedom in the creation of theproduct due to knowledge of how it wassupported. However, if the companyprovided an unrestricted educationalgrant to SAEM, the IG could submit aproposal for the educational programrequesting that SAEM fund the pro-gram. SAEM could then publicly ack-nowledge the unrestricted grant, but itwould not be tied to the specif icproduct. If the SAEM Board agreed tosupport this program after receiving anunrestricted educational grant from acompany, one could argue that this is acase of money laundering — the com-pany is not permitted to directly fundand receive credit for funding a specificprogram, but SAEM accepts “unre-stricted” money and is then able to fundthe program. The purpose of this ap-proach is to reduce potential bias in thedevelopment of the program, and tomake sure that the eventual users ofthe educational program can feel com-fortable that it was prepared without un-due conflict of interest. It is also a testof the true intentions of the company. Acompany that is primarily focused onimproving the knowledge of physicianswill often provide unrestricted support,with the understanding that the com-pany may eventually benefit by havingknowledgeable physicians use its pro-ducts. A company that has a more shortterm focus of increasing sales of its cur-rent product by promoting an educa-tional program that includes that pro-duct, will be less likely to provide unre-stricted support.

It is understandable that someSAEM members will find SAEM’s ap-proach to commercial support to be toorestrictive, but it should not be con-strued that SAEM is against commer-cial support of research and education.SAEM recognizes the crucial role that

the biomedical industry plays in fundingemergency medicine research and edu-cational programs. We hold in high re-gard those members who have, in aprofessional and ethical way, advanceda research area by participating inindustry-supported research.

Professional medical associationsand individual physicians are facing in-creasing scrutiny of our professionalismand ethical behavior, particularly inclinical research. SAEM has lead theway in discussing and defining profes-sionalism for academic emergency phy-sicians.(2) It is essential that we as anorganization adhere to the same stan-dards of ethical and professional be-havior as we advocate for our individualmembers. Over the past decade, SAEMhas navigated the seas of commercialsupport, and tried to avoid murkywaters. Our ship is currently safe in itsharbor, but we may have potentiallymissed some opportunities for produc-tive collaboration with the corporateworld. We believe that the risk of violat-ing our members’ and patients’ trust inus to maintain objectivity and promoteacademic freedom outweighs this downside perhaps missing some opportuni-ties. Other professional organizationswho have less restrictive policies oncorporate interactions have had theirreputations damaged by the presenceor appearance of conflict of interest orbias.

SAEM hopes that the future will pro-vide more opportunities for interactionwith the biomedical industry, and thatthese interactions will help support im-proved research and education inemergency medicine. While we maysometimes irk members by turningdown a small proposal for a corporateinteraction that we judge violates ourpolicies, we are working (perhaps withthe same company) to develop larger,long-lasting funding relationships tohelp build FAEM and support traininggrants. We will continue to debate howbest to forge interactions with the cor-porate world while maintaining thehighest ethical standard for our profes-sional organization. We welcome mem-bers comments on this issue.

References1. Pellegrino ED, Relman AS: Profes-sional medical associations — ethicaland practical guidelines. JAMA282(10): 984-986, 1999.2. Adams JA, Schmidt T, Sanders A, etal: Professionalism in emergency med-icine. Acad Emerg Med 5(12): 1193-1199, 1998.

Acknowledgements: Dr. Zink wishes tothank Dr. Roger Lewis, Dr. MichelleBiros, and Dr. Susan Stern for theirreview and suggestions for this article.

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FACULTY POSITIONSGEORGIA: The Department of Emergency Medicine at the Medical Col-lege of Georgia has an opening for a full-time emergency attending.Candidates must be board certified or prepared in emergency medicine.Established emergency medicine residency program with eight residentsper year. Spacious ED facilities. Children’s hospital and beautiful pedi-atric ED. Over 50,000 visits per year. Level I trauma center for pediatricand adult patients. Energetic young faculty with diverse academic back-grounds. Augusta is an excellent family environment and offers a varietyof social, cultural, and recreational activities. Compensation and benefitsare excellent and highly competitive. Please contact: Larry Mellick, MD,Chair and Professor, Department of Emergency Medicine, 1120 15th St.AF 2036, Augusta, GA 30912; 706-721-7144; e-mail: Lmellick@mail.mcg.edu EOE/AA

The Division of Emergency Medicine at the UNIVERSITY OF COLO-RADO SCHOOL OF MEDICINE is seeking a residency-trained andboard-certified (or prepared) emergency physician to join our faculty.Fellowship training, research experience, or other post-graduateeducation is preferred. All faculty are expected to participate ineducation, research, and clinical activities. Salary is negotiable.Minorities and women are encouraged to apply. UCHSC is an equalopportunity employer. Mail CV and cover letter stating interest to:Benjamin Honigman, MD, UCHSC, Campus Box B215, 4200 E. 9thAvenue, Denver, CO 80262. You may e-mail inquiries to:Joline.Constance@UCHSC.edu

UNIVERSITY OF CONNECTICUT: Community Faculty. Excellent newopportunity for clinically inclined EM physician looking for communitypractice with teaching affiliation. New hospital with modern 38,000 visitED, 9-hour shifts, dictation, and Fast Track coverage by PAs. Centrallocation allows easy access to beaches, cities, schools, countryside andall other benefits of New England lifestyle. Clinical and academicrelationship with EM residency and tertiary care hospital. Inquiries toRobert D. Powers, MD, MPH, Professor & Chief, HartfordHospital/UCONN Emergency Medicine. Please use email:Rpowers@Harthosp.org.

Mayo ClinicRochester, Minnesota

EMERGENCY PHYSICIANThe Department of Emergency Medicine is seeking a full-timeacademic emergency physician. Opportunities include:m Clinical practice in a Level 1 Trauma Center with 77,000

visits/year.m Involvement in a recently accredited Emergency Medicine

Residency Program.m Supervising and teaching Emergency Medicine residents, off-

service residents and medical students.m Research and administrative support and intramural funding

available.m Prehospital/aeromedical care in base station hospital for para-

medics, 2 helicopters/1 jet.m Academic appointment in Emergency Medicine at Mayo

Medical School.

Candidates must be: residency trained emergency medicine spe-cialists; ABEM board certified or eligible; individuals with estab-lished track records in academic emergency medicine as provenby performance in residency training, fellowship training, orfaculty positions; Minnesota medical license or eligible. Competi-tive salary with excellent benefit package. For further informa-tion, contact:

Thomas Meloy, MDChair, Department of Emergency Medicine

Saint Marys Hospital — Mayo Clinic1216 Second Street, SWRochester, MN 55905Phone: (517) 255-4399

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

Emergency Medicine at NorthwesternUniversity School of Medicine

Applications are invited for full-time faculty in the Division of EmergencyMedicine (open rank). The Attending Physician, Emergency Medicine is re-sponsible for clinical practice in the Emergency Department of North-western Memorial Hospital, for the teaching of residents and medical stu-dents, and for demonstration of academic productivity. The newly build(1999) Emergency Department serves over 60,000 patients/year andserves as a Level 1 Trauma Center for the city of Chicago. The residencyprogram has enrolled its 27th class, currently accepting 7 EM residents/year. The hospital is committed to service excellence and innovation. Appli-cants for this faculty position must have completed residency training inemergency medicine. Preference will be given to applicants with demon-strated research interest and to those who will serve as exceptional rolemodels for residents and medical students. Women and minorities areencouraged to apply. Salary is commensurate with experience. Proposedstart date is September 1, 2000. To ensure full consideration, please send acurriculum vitae, along with a brief description of career interests, prior toSeptember 1, 2000, at:

JAMES ADAMS, MDNORTHWESTERN UNIVERSITY SCHOOL OF MEDICINE

DIVISION OF EMERGENCY MEDICINE216 E. SUPERIOR STREET, SUITE 100

CHICAGO, IL 60611

Northwestern University is an Affirmative Action/Equal Opportunity Employer. Hiring iscontingent upon eligibility to work in the United States.

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Open Rank: The University of Cincinnati Departmentof Emergency Medicine has a full-time academicposition available with research, teaching, and patientcare responsibilities. Candidate must be residencytrained in Emergency Medicine with boardcertification/preparation. Salary, rank, and trackcommensurate with accomplishments andexperience. The University of Cincinnati Departmentof Emergency Medicine established the first residencytraining program in Emergency Medicine in 1970.The Center for Emergency Care evaluates and treats76,000 patients per year and has 40 residents involvedin a four-year curriculum. Our department has a longhistory of academic productivity, with outstandinginstitutional support.Please send Curriculum Vitae to:

W. Brian Gibler, MDChairman, Department of Emergency MedicineUniversity of Cincinnati Medical Center231 Bethesda AvenueCincinnati, OH 45267-0769.

UNIVERSITY OF FLORIDA/JACKSONVILLE is expanding its EmergencyMedicine operations. Full and part-time clinical opportunities availableat Orange Park Medical Center and Shands Jacksonville (formerlyMethodist Medical Center and University Medical Center). Positions arenon-tenure accruing; salary is negotiable. Full-time (1.0 FTE) positionsoffer faculty appointments to the University. Part-time positions paycompetitive hourly rates. If interested, fax current CV to Dr. RobertLuten, Chairman, Search Committee, (904) 549-5666 or e-mail luten.robert@ufl.edu. Application deadline: 4/30/01, anticipated start date8/1/01. The University of Florida is a stable and reliable health careemployer (EEO/AA) in Northeast Florida (Jacksonville).

UNIVERSITY OF MISSOURI-KANSAS CITY/TRUMAN MEDICAL CEN-TER, Department of Emergency Medicine seeks academic faculty for afull-time appointment at the assistant or associate professor level.Candidates must be board-certified or board-eligible in EM and havedemonstrated research interests. TMC is the primary teaching hospital forthe UMKC School of Medicine; fully accredited EM residency since1973. Current research in infectious disease surveillance, trauma, EDultrasonography, asthma, EMS, public health, and clinical process im-provement. Contact Robert A. Schwab, MD, Truman Medical Center,2301 Holmes S., Kansas City, MO 64108. (816) 556-3250. Schwabra@trumed1.trumanmed.org. An equal opportunity employer.

UNIVERSITY OF TEXAS MEDICAL BRANCH in Galveston, Texas isseeking candidates for full-time faculty positions in emergency medicine.Candidates must be BE/BC in emergency medicine or in a primary carespecialty with emergency medicine experience. Opportunities forclinical care, teaching of housestaff and students, and research. TheEmergency Department has a diverse, high acuity patient populationwith an annual census of 72,000. UTMB is an equal opportunity/affirma-tive action employer m/f/d/v. UTMB hires only individuals authorized towork in the US. Send inquires to: Paul W. English, MD, Co-Director,Emergency Medicine, UTMB-Galveston, 301 University Blvd., Galves-ton, TX 77555-1173; Phone: 409-772-1425; Fax: 409-772-9068.

NORTH CAROLINA:Instructor/Assistant Professor in EmergencyMedicine. The Department of Emergency Medicineof the Wake Forest University School of Medicineis seeking a Research Director. This is a well-established training program with full RRCapproval. The hospital itself is a Level I TraumaCenter seeing in excess of 57,000 patients per yearand a full compliment of residency trainingprograms in addition to Emergency Medicine. Theresidency training program itself is configured as aPGY-I through PGY-III program with ten residentsper year. All academic positions are tenure tractwith Wake Forest University School of Medicine.Salary and benefits are extremely competitive.Candidates must be residency trained and eitherBoard Certified or eligible to sit for the boards inEmergency Medicine. Interested applicants shouldcontact: Earl Schwartz, M.D., Chairman,Department of Emergency Medicine, MedicalCenter Boulevard, Winston-Salem, NC 27157-1089., Phone (336) 716-4626, FAX: (336) 716-5438 or E-mail eschwart@wfubmc.edu. EqualOpportunity Affirmative Action Employer.

North Carolina: Opening for Director ofEducation/Assistant Residency Director at Wake-Med, a private level II trauma center in Raleigh.Join an independent democratic group of board cer-tified emergency physicians staffing 2 hospitals in-cluding a large trauma center and a community hos-pital. WakeMed emergency department sees over90,000 visits annually, includes a separate Chil-dren’s Emergency Department, and is a major teach-ing site for emergency medicine residents. Affiliatedwith the University of North Carolina at ChapelHill emergency medicine residency. Academic ap-pointment based on credentials. Excellent mix ofclinical, research, educational, and administrativeduties. Excellent compensation and benefit packagewith ample protected academic time. Interestedapplicants should send CV to Lance Brown, MD,MPH, Interim Director of Education, Departmentof Emergency Medicine, WakeMed, PO Box 14465,Raleigh, NC 27520-4465. (919) 350-8823, fax(919) 350-8874; e-mail: LBROWNMD@AOL.com.

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UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER ATDALLAS: Unique academic opportunity in EM. EM faculty will have anopportunity to be involved in the establishment of a first-rate EM divisioncommitted to excellence in patient care, education and clinical research.Full-time and part-time openings BC/BP faculty for the University of TexasAffiliated Emergency Medicine Training program, comprised of ParklandHospital and Children’s Medical Center. An equal opportunity employer.Respond in full confidence to Paul E. Pepe, MD, Chairman, Division ofEmergency Medicine, UT Southwestern Medical Center at Dallas, 5323Harry Hines Blvd., Dallas, TX 75390-8579, (214) 646-3916.

WEST VIRGINIA UNIVERSITYEMERGENCY MEDICINE CHAIR

The West Virginia University (WVU) School of Medicine is seeking aChair of the Department of Emergency Medicine at the Robert C. ByrdHealth Sciences Center. The Department of Emergency Medicine is anestablished academic department with strong teaching programs andleadership in research in rural emergency medicine. The WVU HospitalSystem includes a Level 1 Trauma Center and an active aero-medicalprogram serving a large geographical area. The position requires an in-dividual with strong leadership skills, experience in academic medicineand administration, and a commitment to service, teaching, and re-search. He/She must have a vision for the future of medical education inthe context of a changing health care delivery system. Applicants shouldsend a curriculum vitae and the names and addresses of three references.These materials should provide evidence of qualifications as noted above.Review of applications will begin after October 16, 2000. The position willremain open until filled. Applications should be directed to:

C.H. Mitch Jacques, M.D., Ph.D.Chair, Department of Family Medicine

Chair, Emergency Medicine Chair Search CommitteeRobert C. Byrd Health Sciences Center

West Virginia University School of MedicineP.O. Box 9152

Morgantown, West Virginia 26506-9152304-598-6920

jacquesm@rcbhsc.wvu.eduWVU is an Equal Opportunity/Affirmative Action Employer.

Women and minorities are encouraged to apply.

DDISTRICTISTRICT OFOF CCOLUMBIAOLUMBIA

The Department of Emergency Medicine at The GeorgeWashington University Medical Center is seeking

applications for full-time faculty physicians. EmergencyMedicine is a full academic Department in theUniversity. The Department provides physician staffingfor the Emergency Unit (annual patient volume 45,000)and Hyperbaric Medicine Service at The GeorgeWashington University Hospital. The Department alsosponsors an Emergency Medicine Residency and multiplestudent programs.

Under the auspices of its Ronald Reagan Institute ofEmergency Medicine, the Department manages educa-tional, research, and consulting programs in the areas of In-ternational Emergency Medicine, Injury Epidemiology/Vio-lence Prevention, Health Policy and Disaster Medicine.

We are currently seeking physicians who will activelyparticipate in our clinical and educational programs andcontributed to an area of the Department’s research/con-sulting agenda. We are particularly seeking candidateswith backgrounds in medical informatics or bedsidediagnostic imaging.

Physicians should be residency trained or boardcertified in Emergency Medicine. Please submit yourcurriculum vitae to Robert Shesser, MD, MPH, Chair, De-partment of Emergency Medicine, The George WashingtonUniversity Medical Center, 22140 Pennsylvania Ave., NW,Washington, DC 20037. E-mail: emdrfs@gwumc.edu.

WEST VIRGINIA UNIVERSITYDepartment of Emergency Medicine

OPEN RANK: The Department of Emergency Medicine atWest Virginia University has a full-time faculty position avail-able. The qualified emergency physician will have patient careand teaching responsibilities. The WVU Hospital System in-cludes a Level I Trauma Center with 38,000 annual patients, awell-established Emergency Medicine residency and an activeaeromedical program. The Department has eighteen EM resi-dents involved in a 1,2,3 program and sixteen Physician Assis-tants enrolled throughout the country in a graduate program inEmergency Medicine. Duties include direct patient care andthe supervision of medical student’s, physician assistants, andresidents. Significant research opportunities with an emphasison injury control are available through the affiliated Center forRural Emergency Medicine. The department has obtainednearly seven million dollars in grant and foundation moniessince 1992. Morgantown has scenic beauty and low-cost livingthat is within commuting distance of Pittsburgh, PA. The localarea offers nearby lakes, hiking trails, skiing, whitewatersports, and numerous other outdoor activities. Preferred can-didates will be residency trained in emergency medicine andboard certified/eligible. Salary and rank commensurate withaccomplishments and experience. This position will remainactive until filled. Applicants should forward a letter ofinterest, curriculum vitae, and names and addresses of threeprofessional references to Ann S. Chinnis, MD, Interim Chair,Department of Emergency Medicine, Robert C. Byrd HealthSciences Center, PO Box 9149, West Virginia University,Morgantown WV 26506-9149. West Virginia University is anAffirmative Action/Equal Employment Opportunity Employer.

Geriatric Emergency MedicineResident/Fellow Grants Available

SAEM with funding from the John A. HartfordFoundation and the American Geriatric Society (AGS),is pleased to announce the availability of grants tosupport resident/fel low research related to theemergency care of the older person. Investigations mayfocus on basic science research, clinical research, pre-ventive medicine, epidemiology, or educational topics.Awards may be up to $5,000 for each project.

Applications for the Geriatric Emergency MedicineResident/Fellow Grant will be sent to each residencyprogram or may be obtained from the SAEM office orthe website at <www.saem.org>. The deadline forreceipt of a complete application at the SAEM office isMarch 5, 2001 with notification of selections by May 7and funding awarded by July 1.

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MICHIGAN: EMS Medical Directorsought by Saginaw Cooperative Hospitals Department ofEmergency Medicine. The successful applicant will beBC/BP in emergency medicine, eligible for faculty appoint-ment (Michigan State University College of HumanMedicine [MSUCHM}), and have completed an EMS fel-lowship or have extensive EMS experience. Saginaw Coop-erative Hospitals is a not-for-profit educational corporationsponsoring multiple residencies, including a PGY 1-3emergency medicine residency with 24 residents and is acampus of MSUCHM. The EMS Medical Director will pro-vide direction for a high-performance EMS provider(48,000 runs annually) providing service to urban, subur-ban, and rural populations in 7 counties. In addition, thisindividual shall be a full-time faculty member of theemergency medicine residency, responsible for the EMSportion of the curriculum, and provide clinical services inthe 2 ED training sites. Mid-Michigan provides an excel-lent family oriented environment with 4 season recreation,affordable housing, and good schools. Contact: Robert W.Wolford, MD, Dept. of Emergency Medicine, SaginawCooperative Hospitals, 1000 Houghton Ave., Saginaw, MI48602. Telephone: (517) 583-6817, fax: (517) 754-2741,email: rwolford@concentric.et, web: www.schi.org.

Duke UniversityDuke University Health System

EXCITING OPPORTUNITY FORRESIDENCY DIRECTOR

The Division of Emergency Medicine atDuke University Medical Center is workingto develop an Emergency Medicine Resi-dency Program. We are currently seekingan Emergency Medicine Residency Direc-tor to start and develop a residency train-ing program in Emergency Medicine. DukeUniversity Medical Center Emergency De-partment is a Level 1 Trauma Center inDurham, North Carolina, with an annualvolume of 65,000 patient visits. Competi-tive salary and benefits. Qualified facultyare invited to apply.

Please contact:

Kathleen J. Clem, MD, FACEP

Chief, Division of Emergency Medicine

DUMC 3096, Durham, NC 27710

email: clem0002@mc.duke.edu

ACADEMIC EMERGENCY MEDICINE

The Department of Emergency Medicine, WrightState University School of Medicine seeks a facultymember at the Instructor, Assistant or AssociateProfessor level. Faculty rank and salary arecommensurate with the candidate’s professionalqualifications and School of Medicine standards.Faculty activities include medical education at alllevels, curriculum coordination, administration andpatient care. An interest and ability in clinical andclassroom education are preferred. Requirementsfor appointees include: Instructor, Board prepared;Assistant, Board Certified; Associate, BoardCertified and 5 years Emergency Medicineexperience. All must be graduates of EmergencyMedicine Residency and eligible for Ohio License.Applicants should send curriculum vitae and namesof three references to:

Glenn C. Hamilton, MD, Professor and ChairDepartment of Emergency Medicine

Wright State University School of Medicine3525 Southern Blvd.Kettering, Ohio 45429

Consideration of applications begins November 15, 2000, and willcontinue until position is filled. Wright state University is anAffirmative Action and Equal Opportunity Employer.

NORTH SHORE-LONG ISLANDJEWISH HEALTH SYSTEM

North Shore University Hospital at Manhasset, a 700 plusbed tertiary care teaching hospital seeks board certified,residency trained career emergency physicians to augmentits staff. We have an active and fully accredited EmergencyMedicine Residency Program affiliated with the NYU Schoolof Medicine. We are seeking faculty with a demonstratedrecord of achievement in clinical and academic activity. Weoffer the opportunity to work with a dynamic group ofresidents and faculty in a high acuity, Level 1 traumafacility. We maintain a comprehensive educational programand a substantial research structure supporting bothclinical and basic science research. We are particularlyinterested in faculty for the following positions:

Director, Emergency Medicine Trauma and CriticalCare Faculty, Ultrasound Medicine

An excellent salary in association with an outstandingbenefit package is available with the potential for growth.Academic rank for faculty appointment at the NYU Schoolof Medicine will be determined by credentials.

Please forward resumes and inquires to:Andrew Sama, MD, Chairman

Department of Emergency MedicineNorth Shore University Hospital

300 Community DriveManhasset, NY 11030

(516) 562-3090 Phone • (516) 562-3680 FaxE-Mail: asama@nshs.edu

19

Academic and Private Practice Emergency MedicinePositions Available

Jackson, MSThe Department of Emergency Medicine at the University of Mississippi MedicalCenter is expanding and has positions available for academic emergency medicinecareers, private practice emergency medicine and combination tracts. Academicpositions are available at the assistant or associate professor level. Excellentsupport is provided to young faculty interested in starting a career. The departmenthas a fully accredited residency program accepting eight residents per year.Applicants should be highly motivated toward teaching and academic pursuits. Ourprogram has full departmental status with a medical toxicology division andexcellent institutional support. Our current faculty have active research programs inacute coronary care, toxicology, medical informatics and ED ultrasound. Thedepartment has its own well-equipped research laboratory. All faculty are trained inED ultrasound. The department has two ultrasound machines as well asbiomedicine monitors for non-invasive cardiac hemodynamics monitoring.Mississippi has a funded state wide trauma system and we are the only Level 1trauma center in the entire state. We also have an active air ambulance program.Because of its excellent standing in the community, the Department of EmergencyMedicine at the University of Mississippi Medical Center was asked to assumemanagement and staffing of two of the three major private emergency departmentsin Jackson. Excellent opportunities are available for qualified individuals interestedin a private career in emergency medicine. It is also possible to combine thesepositions with academic work at University Medical Center.Jackson, Mississippi offers small city atmosphere with the cultural benefits of astate capital. It has a low cost of living and very affordable housing. Outdoorrecreation is plentiful in Mississippi, with boating, fishing, and hunting topping thelist. Good area schools, churches and regional youth sports programs make this anexcellent place to raise a family.If interested in either of these opportunities, please contact Robert Galli, MD, Chairand Professor, Department of Emergency Medicine, 2500 North State Street,Jackson, MS 39216-4505; 601-984-5572. EOE, M/F/D/V

Newsletter AdvertisingThe SAEM Newsletter is mailed every other month to the5,000 members of SAEM. Advertising is limited to fellow-ship and academic faculty positions. All ads will beposted on the SAEM web site at no additional charge.

Deadline for receipt: January 1 (Jan/Feb issue), March 1(March/April issue), May 1 (May/June issue), July 1(July/August issue), September 1 (Sept/Oct issue), andNovember 1 (Nov/Dec issue). Ads received after thedeadline can often be inserted on a space available basis.

Advertising Rates: Classified Ad (100 words or less)Contact in ad SAEM member ...............................$100Contact in ad non-SAEM member ........................$125

1/4-Page Ad (camera ready)3-1/2” wide x 4-3/4” high .......................................$300

To place an advertisement , e-mail, fax or mail the ad,along with contact person for future correspondence,telephone and fax numbers, billing address, ad size andNewsletter issues in which the ad is to appear to:Jennifer Mastrovito at <Jmastrovito@saem.org>, via faxat 517-485-0801 or mail to 901 N. Washington Avenue,Lansing, MI 48906. For more information or qustions,call 517-485-5484 or <Jmastrovito@saem.org>.

NEWSLETTERNEWSLETTERNewsletter of The Society For Academic Emergency Medicine

Board of DirectorsBrian Zink, MDPresidentMarcus Martin, MDPresident-ElectRoger Lewis, MD, PhDSecretary-TreasurerSandra Schneider, MDPast PresidentJames Adams, MDMichelle Biros, MS, MDCarey Chisholm, MDJudd Hollander, MDPatricia Short, MDSusan Stern, MDDonald Yealy, MD

EditorDavid Cone, MDDavid.Cone@yale.edu

Executive Director/Managing EditorMary Ann Schroppmschropp@saem.org

Advertising CoordinatorJennifer MastrovitoJennifer@saem.org

Society for AcademicEmergency Medicine901 N. Washington AvenueLansing, MI 48906-5137

The SAEM newsletter is published bimonthly by the Society for Academic EmergencyMedicine. The opinions expressed in this publication are those of the authors and donot necessarily reflect those of SAEM.

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Lansing, MI

Permit No. 485

CALL FOR ABSTRACTS2001 Annual Meeting

May 6-9 — Atlanta

The Program Committee is accepting abstracts for review for oral and poster presentation at the 2001 SAEMAnnual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine includ-ing, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/health care policy, air-way/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technolo-gies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obste-trics/gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENTdisorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.The deadline for submission of abstracts is January 9, 2001 at 3:00 pm Eastern Time and will be strictlyenforced. Only electronic submissions via the SAEM online abstract submission form will be accepted.The abstract submission form and instructions will be available on the SAEM web site at www.saem.org inNovember. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via faxat 517-485-0801.Only reports of original research may be submitted. The data must not have been published in manuscript orabstract form or presented at a national medical scientific meeting prior to the 2001 SAEM Annual Meeting.Original abstracts presented at other national meetings within 30 days prior to the 2001 Annual Meeting will beconsidered.Abstracts accepted for presentation will be published in the May issue of Academic Emergency Medicine, theofficial journal of the Society for Academic Emergency Medicine. SAEM strongly encourages authors to submittheir manuscripts to AEM. AEM will notify authors of a decision regarding publication within 60 days of receiptof a manuscript.

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