PRESIDENT’S MESSAGE

Medical Education:Revolution, Evolution

or Adrift?The past 5 years have wit-

nessed many profound changes inthe medical education system at allthree levels: medical school, grad-uate and post-residency. Theforces that sparked these changesare complex and multiple: the IOMMedical Error report, a nebulous

societal call for “accountability”(spending? outcomes? services rendered?), a perceptionthat the product (the practicing physician) was broken, theburgeoning health care budget, and a “rediscovery” of pro-fessionalism. The facts fueling this movement are scarce inmany areas, and data are often equivocal when present.There is no doubt that medical error does occur, and thatthose errors are usually not reported or analyzed due to theculture of medical (and legal) practice. The historic fixationremains on the culpability of the individual, rather than theindividual’s role within a delivery mechanism that facilitatesor compounds error producing situations, or lacks adequatefailsafes to protect that practitioner and patient. Yet theforces of change are now systematic and dramatic for all lev-els of medical education.

Medical students now must pass an OSCE, delivered ata remote testing site, as part of their USMLE Step 2 exami-nation. The Dean’s letter has been replaced by the MedicalStudent Performance Evaluation, complete with quartile orquintile comparisons to their peers. Attestations of meetinglevels of competency abound. For instance, IndianaUniversity (IU) presents a one page description to the read-er about the 9 competencies, each having 3 levels. Every IUgraduate must attain “Level 2” in all 9, but “Level 3” isrequired in only 3 of the 9…each individual student candecide which of the 6 aren’t important in their future career.Each competency’s definition has a brief paragraph descrip-tor. An example is competency III “Using Science to GuideDiagnosis, Management, Therapeutics, and Prevention.”Here’s the definition: “The competent graduate knows andcan explain the scientific underpinnings, at the molecular,cellular, organ, whole body, and environmental levels forstates of health and disease based upon current under-standing and cutting-edge advances in contemporary basicscience. The graduate uses this information to diagnose,manage and present the common health problems of indi-viduals, families, and communities in collaboration withthem. The graduate develops a problem list and differentialdiagnosis, carries out additional investigations, chooses andimplements interventions with consultation and referral as

Carey Chisholm, MD

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SAEM

Newsletter of the Society for Academic Emergency MedicineMarch/April 2005 Volume XVII, Number 2

901 N. Washington Ave.Lansing, MI 48906-5137

(517) 485-5484saem@saem.orgwww.saem.org

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

Medical Student Excellence AwardEstablished in 1990, the SAEM Medical Student

Excellence in Emergency Medicine Award is offered annu-ally to each medical school in the United States andCanada. It is awarded to the senior medical student at eachschool (one recipient per medical school) who best exem-plifies the qualities of an excellent emergency physician, asmanifested by excellent clinical, interpersonal, and manualskills, and a dedication to continued professional develop-ment leading to outstanding performance on emergencyrotations. The award, presented at graduation, conveys aone-year membership in SAEM, which includes subscrip-tions to the SAEM monthly Journal, Academic EmergencyMedicine, the SAEM Newsletter and an award certificate.

Announcements describing the program and applica-tions have been sent to the Dean's Office at each medicalschool. Coordinators of emergency medicine student rota-tions then select an appropriate student based on the stu-dent's intramural and extramural performance in emergencymedicine. The list of recipients will be published in theSAEM Newsletter.

Over 100 medical schools currently participate. Pleasecontact the SAEM office if your school is not presently par-ticipating.

Call for ApplicationsGeriatrics Education for Specialty

Residents Program Deadline: April 8, 2005

The American Geriatrics Society, through a program funded byThe John A. Hartford Foundation, entitled "Geriatrics Educationfor Specialty Residents" (GESR) addresses the urgent need tocreate a structure for developing leaders in geriatrics in relatedmedical specialties. The GESR allows interested specialists towork in collaboration with the geriatrics program in their institu-tion, thereby enhancing their knowledge and skills in teachinggeriatrics principles to specialist residents. Applications to develop, initiate and evaluate programs designedto increase education for residents in the geriatric aspect of theirdisciplines are sought. The disciplines targeted by the grantinclude Emergency Medicine. Eight two-year grants of $16,000per year will be awarded to institutions that demonstrate in theirproposals the most promise for success. No funds will be provid-ed in support of indirect costs. For additional information or to receive an application, contact:http://www.americangeriatrics.org/2005GESR.shtml or contactEllen Baumritter at ebaumritter@americangeriatrics.org or 212-308-1414.

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SAEM Scholarly Sabbatical Grant Awarded to Dr. Timothy Mader The SAEM Scholarly

Sabbatical Grant for 2005-2006will be awarded to Dr. TimothyMader at Baystate Health Center.This grant awards up to $60,000or $10,000 per month for 2-12months to an individual emer-gency physician. The intent ofthe award is to allow a facultymember the opportunity toacquire new research skills thatwill enhance their productivity

and career. It is envisioned that this award will allow travel toother institutions and work with other investigators not usuallyavailable to the applicant. It is also expected that the applicantis beyond the beginning stages of their career when morecomprehensive research training would be appropriate.SAEM selects one award each year.

Dr. Mader is an Associate Professor of Emergency Medicineand Associate Director of Research for the Department ofEmergency Medicine at Baystate Health Center. For his sab-batical, Dr. Mader plans to work with Dr. James Menegazzi atthe University of Pittsburgh to acquire the skills necessary forperforming large animal resuscitation experiments. Dr. Maderalready has experience with clinical resuscitation research,having participated in prior trials of drug therapy for cardiac

arrest. In order to extend his studies of resuscitation pharma-cology, Dr. Mader will need to perform large animal resuscita-tion studies. Although Dr. Mader’s own institution can providesurgical facilities for this type of experiment, there are no localinvestigators who can facilitate the development of an animalmodel.

Dr. Menegazzi will serve as the host mentor for Dr. Mader.Dr. Menegazzi has used swine models of cardiac arrest andresuscitation for 15 years. His prior work includes the devel-opment of novel pharmacological treatments for cardiacarrest, and the use of quantitative ECG analysis to guideresuscitation. The Department of Emergency Medicine at theUniversity of Pittsburgh has a large commitment to resuscita-tion research at all levels.

One challenge of the sabbatical is the development of along-distance training relationship. Dr. Mader plans to executea research study over the course of several visits toPittsburgh. Each physical visit will consist of several days per-forming animal experiments. Specific goals for each visit areincluded in his training plan. Additional didactic training ongrant writing skills for these types of studies is also planned.Dr. Menegazzi has successfully trained many research fellowsduring his tenure at the University of Pittsburgh. In addition tocompleting one study of drug therapy in the Pittsburgh animalmodel, it is expected that this experience will allow Dr. Maderto initiate a series of investigations at Baystate.

SAEM Selects Francis Guyette as Emergency Medical Services ResearchFellow

The Emergency MedicalServices (EMS) ResearchFellowship for 2005-2006 will beawarded to Dr. Frank Guyette.Dr. Guyette will begin his secondyear of EMS fellowship at theUniversity of Pittsburgh. Thisgrant awards $60,000 over oneyear to the training institution.Fellows are selected from theirown application and are expectedto complete fellowship training at

one of the approved EMS fellowship sites. Institutions applyseparately to be listed as approved sites and current sites arelisted on the SAEM website (www.saem.org/awards/03ems.htm). The goal of this program has been to developfuture leaders of EMS as well as to stimulate training pro-grams in EMS. The award is funded by Medtronic EmergencyResponse Systems, Inc., which placed no restrictions on theselection of awardees.

Dr. Guyette is a 2004 graduate of the University ofPittsburgh Residency in Emergency Medicine. During his fel-

lowship, he will serve as medical director of two local EMSsystems, complete the second year of an MPH program, andinitiate a new project in airway management. His proposalwas evaluated by the SAEM Grants Committee based ondemonstrated commitment to EMS, teaching and academicactivities. A proposal for a research project is also a centralpart of the EMS fellowship application. Dr. Theodore Delbridgewill serve as the fellowship director for this program.

The research project proposed by Dr. Guyette will focus onthe ability of basic life support-trained first responders to usethe laryngeal mask airway (LMA). The potential significance ofthis work to the EMS community is high. First responders arelimited to the difficult task of bag valve mask ventilation cur-rently. While paramedics are able to perform endotrachealintubation, there are conflicting data about the safety of thatprocedure and the cost of interrupting other resuscitation inter-ventions for laryngoscopy. It is possible to imagine future EMSsystems in which an intermediate airway is secured during ini-tial resuscitation or stabilization and pending definitive endo-tracheal intubation later. Dr. Guyette intends to begin this lineof investigation by training and testing EMS providers usingpatient simulators.

3

Dr. Michelle Charfen Selected for SAEM Research Training GrantDr. Michelle Charfen, Research

Fellow at Harbor-UCLA MedicalCenter was selected for the 2005-2006 Research Training Grant. Thisgrant awards $75,000 per year for twoyears to be used to enhance theresearch training of an emergencyphysician. Detailed use of the budgetis determined by the institution,although it is expected that the awardwill reduce the required clinical dutiesto allow formal research training. The

grant application process and criteria are modeled after theresearch training grants (“K” awards) offered by NIH. SAEMselects one recipient of this award each year.

Dr. Charfen is a 2004 graduate of the Harbor-UCLA MedicalCenter Emergency Medicine Residency. She is currently inplace as a research fellow. Her mentors for the award includeDr. Roger Lewis of Emergency Medicine and Dr. Eli Ipp ofMedicine. The curriculum for research training includes anestablished series of courses offered by the UCLA School ofPublic Health. Successful completion of the program will leadto an MPH degree.

The proposed research project will identify high risk clinicaland laboratory factors for undiagnosed diabetes in emergencydepartment patients. Undiagnosed diabetes and risk factorsfor subsequent development of diabetes (prediabetes or meta-bolic syndrome) are now recognized as major contributors tolong-term morbidity. Moreover, health interventions forpatients at risk may reduce long-term cardiac and vascularcomplications of these disorders. Interventions may be rela-tively simple and low-cost such as dietary adjustments.

It is unknown to what extent screening of patients in theemergency department, who have concurrent acute illness,might identify patients with diabetes or at risk for diabetes.Determining the validity of random blood samples or clinicalinformation in this population requires subsequent confirma-tion of the diagnosis. Therefore, Dr. Charfen plans to prospec-tively identify subjects in the emergency department. Subjectswill subsequently undergo formal glucose tolerance testingand evaluation in the General Clinical Research Center atHarbor-UCLA. The results should help guide rational selec-tion of patients in the emergency department for referral or fur-ther counseling. Whether that type of screening affects long-term health will remain for future investigations.

SAEM Institutional Research Training Grant Awarded to Oregon HealthSciences University

Dr. Robert Lowe, the Directorof Research in the Department ofEmergency Medicine at OregonHealth & Science University(OHSU) and the Director of theCenter for Policy and Researchin Emergency Medicine will bePrincipal Investigator for the2005 SAEM InstitutionalResearch Training Grant. Thisgrant awards $75,000 per yearfor two years to an institution to

foster training of emergency physician fellows. SAEM selectsone award each year, and bases its selection on the ability ofthe institution to provide a meaningful research training expe-rience. Selection of a particular fellow is left to the discretionof the institution, but SAEM does not release funds until aresearch fellow is in place.

The primary research focus for OHSU’s department ishealth services, with a specific focus on access to emergencymedical care. The Center for Policy and Research inEmergency Medicine was established in 2002. This centerhas four full-time faculty and a research fellow in training. Itsgoals are to foster and support research in emergency medi-

cine and to partner with and advise health policy makers. Thisprogram has already acquired other extramural funding thatenhances the potential training of research fellows.

Formal didactic training will take advantage of the HumanInvestigations Program which is offered in conjunction with theDepartment of Medical Informatics and Clinical Epidemiology.The course and activities of this program will move fellowstowards an MPH degree. This program also provides anoth-er potential source of mentors for the fellow.

The OHSU Department of Emergency Medicine has devel-oped strong collaborative relationships within its institution,and potential mentors are identified for variety of topics. Thetopic areas for specific ongoing research activities includemedical economics, informatics, ethics, women’s health andcommunity health and preventive medicine. A unique aspectof this program is its close relationship with the Oregon HealthPolicy Institute, which will expose a research fellow to the flowof information from research to policy.

OHSU has an outstanding academic faculty, and thisdepartment already has secured over $4 million in extramuralfunding. Given the epidemiological flavor of the research pro-gram, fellows are likely to undertake studies using existingdatasets. The strong institutional infrastructure guaranteesexcellent formal research training.

Call for Medical Student VolunteersThe Program Committee for SAEM is soliciting a request

for medical students who are interested in working at the 2005Annual Meeting in New York City on May 22-25. The ProgramCommittee will waive the registration fee for a limited numberof medical students willing to assist with some administrativeduties. Each medical student will be responsible for coordinat-ing evaluations at assigned didactic sessions during two half

days and one luncheon session. The Annual Meeting providesa unique opportunity for medical students to familiarize them-selves with the research and educational interests of emer-gency medicine. In return the students will receive a compli-mentary registration fee. Interested medical students shouldcontact SAEM at saem@saem.org and include “MedicalStudent Volunteer for Annual Meeting” in the subject line.

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Program Committee Update: Scientific Abstracts Selected for PresentationJudd E. Hollander, MDUniversity of PennsylvaniaChair, 2005 Program Committee

The SAEM Annual Meeting is taking shape. This year 1006abstracts were submitted. There will be 502 abstracts present-ed at the New York Meeting.

The abstract review process is rigorous. Each abstractreceives peer review by approximately 6 abstract reviewers:typically two program committee members and four ad-hocreviewers who must meet standards to be considered an“expert” in that field. Each expert grades each abstract on 9individual components that are totaled to give a final abstractscore that ranges from 0 to 20. An average abstract score iscalculated for each abstract. Before final decisions are madethe system has several quality checks so that we may attemptto find abstracts scored spuriously low. Within each category,we review the mean scores for each reviewer to make surethat one category does not contain exceptionally hard or easyreviewers. We review the range of scores within each catego-ry and compare that to the study designs submitted withineach category to reduce biases for or against a particular typeof research. We review a report of all the scores for each indi-vidual abstract to try to make certain that an abstract with asingle low score did not end up with an average below the cut-point. Abstracts that receive one spuriously low score have themean abstract score calculated without that reviewer. If it fallsnear the meeting cut-off, it is reviewed by a panel of 2-4 peo-ple who oversee the scoring system. A final decision is thenmade about whether that abstract should be accepted or not.Additionally, the PC reviews a report of all comments sent inby abstract reviewers to look for data splitting or duplicate sub-missions. These are just a sample of the reports that wereview to make the abstract submission process as valid aspossible.

Once again, there were a large number of abstracts sub-mitted in each abstract submission category reflecting thebreadth of our specialty (table 1).

Over the years, the quality of our science has alsoimproved. The abstract submission process requires eachsubmitter to self report a study design category for their work.The table below reports this year’s (2005) reported studydesigns, as well as a comparison of 2003 and 2004 studydesigns. The table includes only the abstracts accepted forpresentation.

Thus more than half of the science to be presented at theAnnual Meeting is conducted in a prospective manner. Cohortstudies are becoming more common in our field, as we devel-op the research infrastructure to follow patients over time.Surveys are becoming more difficult to get accepted at themeeting, as most research questions can be better answeredthrough more sophisticated study designs.

The meeting will include a litany of great research thatspans the full spectrum of academic emergency medicine,including clinical disease, laboratory investigation and educa-tional initiatives. The outstanding didactic sessions, photogra-phy exhibits, and innovations in medical education exhibitsshould make this meeting another great one. I hope you allplan on joining us in New York City May 22-25.

Category Number of abstracts submittedAbdominal/GI/GU 21Administrative 126Airway 49Cardiovascular (non-CPR) 83Clinical Decision Guidelines 16Computer Technologies 7CPR 20Diagnostic Tech/Radiology 48Disease/Injury Prevention 60Education/Prof Development 88EMS/Out-of-Hospital 86Ethics 11Geriatrics 22Infectious Disease 34Ischemia/Reperfusion 18Neurology 35Obstetrics/Gynecology 10Pediatrics 61Psychiatry/Social Issues 31Research Design/Meth/Stats 18Respiratory/ENT Disorders 32Shock/Critical Care 22Toxicology 36Trauma 56 Wound/Burns/Orthopedic 15

Research Design 2003 2004 2005Randomized controlled trial 44 48 39Nonrandomized comparison 6 23 17Prospective cohort study 58 79 92Cross sectional study 17 20 17Prospective observational study 104 84 95Before and after trial 19 13 20Retrospective case control 12 21 25Retrospective case series/cohort 66 87 78Survey 35 32 29 Other 30 41 45Basic Science 58 55 36

SAEM Membership as of 1-31-05

Active - 2386Associate - 252Resident - 2337

Fellow - 90Medical Student - 420

Emeritus - 21Honorary - 6

TOTAL: 5,512

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Call for AEM ReviewersSAEM members are invited to submit nominations to serve as peer reviewers for Academic Emergency Medicine. As an

indicator of familiarity with the peer-review process, the medical literature, and the research process in general, peer-reviewers areexpected to have published at least two peer-reviewed papers in the medical literature as first or second author. Some of thesepapers should be original research work. Other scholarly work or experience will be considered as evidence of expertise (i.e.,informatics experience demonstrated by network/database/desktop development).

AEM peer-reviewers are invited to review specific manuscripts based on their area(s) of expertise. Once a reviewer hasaccepted an invitation to review a manuscript, the reviewer is expected to complete the review within 14 days of receipt of themanuscript.

To provide feedback to reviewers, reviewers receive the consensus review from each manuscript that they review. In addition,each review is evaluated by the decision editor in the areas of timeliness, assessment of manuscript strengths and weaknesses,constructive suggestions, summarizing major issues and concerns, and overall quality of the review. Scores are compiled in theAEM database. Each year the Editor-in-Chief designates Outstanding Reviewers for public acknowledgment of excellentcontributions to the peer-review process. Most appointments as peer reviewer are for three years. Reviewers who consistentlyfail to respond to requests to review, who are unavailable to perform reviews, or who submit later or incomplete reviews may bedropped from the peer reviewer database at any time, at the discretion of the Editor-in-Chief.

Individuals interested in being considered for appointment as an AEM peer reviewer must send a letter of interest includingareas of expertise as defined on the reviewer topic survey and a current CV. The reviewer topic survey can be found atwww.saem.org/inform/resurvey.htm. All applications must be submitted electronically to aem@saem.org by March 22, 2005.

Board of Directors UpdateThe SAEM Board of Directors meets

monthly usually by conference call.This report includes the highlights fromthe December 14 and the January 18Board conference calls. The Board willmeet on March 5 during the CORDMeeting in New Orleans.

The Board completed the develop-ment of a new five-year plan for theSociety. This will assist the Board andthe membership to focus on theSociety's mission, goals, and objectives.More information on the five-year planwill be published in the May/June issueof the Newsletter.

The Board approved the recommen-dations of the Grants Committee,chaired by Callaway, MD, to fund the2005-06 SAEM grants program.Funding was approved for $150,000 fora two-year Institutional ResearchTraining Grant, a $150,000 two-yeargrant for the Research Training Grant, aone-year $60,000 Scholarly SabbaticalGrant, and a $60,000 EMS ResearchFellowship Grant, which is funded byMedtronic. The Board also approvedthe Grants Committee recommenda-tions regarding approved sites for EMSResearch Fellowship grants. SAEMfunds its grants program through theResearch Fund. Detailed informationregarding the grant recipients is pub-lished in this issue of the Newsletter.

The Board approved a proposal tosponsor a booth at the March meetingof the Student National MedicalAssociation (SNMA) in St. Louis. TheBoard approved the proposed fourthyear medical student curriculum, whichwas developed by a multi-organization-al task force including representativesfrom AACEM, ACEP, CORD, EMRA,

and SAEM. The Board approved the position

statement developed by the NationalAffairs Committee entitled, "Principlesfor Measuring Quality and ReportingIncidents and Adverse Events." Theposition statement is published in thisissue of the Newsletter.

In keeping with accounting bestpractices standards, the Boardapproved the funding for an audit of theSociety. The Board approved a 2005budget that includes revenues in theamount of $2,088,500 and expenses inthe amount of $1,700,000.

The Board approved a proposal fromMichelle Biros, MD, the Editor-in-Chiefof Academic Emergency Medicine topublish a May issue of AEM, and todevelop the Annual Meeting abstractsas a supplement to the May issue. TheBoard also approved Dr. Biros proposalto fund an additional 100 editorial pagesin AEM in 2005 and approved increasedfunding for staff support.

The Board appointed Rita Cydulka,MD, to serve as the SAEM representa-tive to the National Asthma Educationand Prevention Program. The Boardagreed to send representation to theAAMC Conference on WorkforceIssues, which will be held inWashington, DC in April.

The Board approved three evalua-tion tools developed by the NominatingCommittee. The Board also approvedthe development of a "mini-bio" form,which will be completed by potentialcandidates requesting consideration asa nominee for elected position within theSociety.

The Board agreed to assist ABEM inthe solicitation of "readings" for the

Lifelong Learning and Self-AssessmentTest. Further information, asking SAEMmembers to consider submitting pro-posed "readings" is published in thisissue of the Newsletter.

The Board agreed to provide fundingin the amount of $500 to help supportthe memorial service planned for Dr.Wiegenstein on February 21 in Lansing,Michigan. The service is being coordi-nated by the Michigan Chapter of ACEP.

The Board agreed to participate inthe multi-organizational task force toreview, revise and update the Model ofClinical Practice document. The firstmeeting of the task force, coordinatedby ABEM, will be held during the SAEMAnnual Meeting. ACEP, CORD, EMRA,and SAEM will participate in this project.

The Board approved a Web Policyand a policy regarding requests for let-ters of support. Both policies are pub-lished in this issue of the Newsletter.The Board also approved a revisedClerkship Directors Survey, which wasdeveloped by the UndergraduateCommittee.

The Board approved the regionalmeeting application of the 5th AnnualNew York State Regional Meeting,which will be held on April 3 in Brooklyn.Information on upcoming regional meet-ings is published in this issue of theNewsletter.

The Board approved the develop-ment of a joint grant proposal with theAmerican College of EmergencyPhysicians to receive up to $10,000 infunding from the American GeriatricSociety. The funds, if approved, will beused to convene a geriatric consensusconference.

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SAEM Research FundThe SAEM Research Fund –Growing Strong

The year end status of the SAEMResearch Fund was very encouraging.The Fund now sits at 3.7 million dollars.The response of SAEM members to ourmost recent member appeal has beenthe best ever. To date, we have raisedover $33,000 dollars from SAEM mem-bers in the 2005 member appeal, andmore contributions continue to come in.As we see the overall amount of moneyin the Research Fund rise, we comecloser to our eventual goal of having aself-sustaining endowment to fundnumerous research training grants eachyear. SAEM also believes strongly thata big part of supporting its mission is tocontribute a large percentage of annualrevenues to the Research Fund. Thishas resulted in over $650,000 in Fundgrowth from SAEM organizational con-tributions in the past three years. If youwould like to make a contribution, youcan make a donation on line atwww.saem.org. What Are We Investing In?

SAEM is using Research Fund con-tributions to support the ResearchTraining Grant, Institutional ResearchTraining Grant, and ScholarlySabbatical Grant. The 2005-2006 grantrecipients and their research projects

are publicized in this issue of theNewsletter.

What if we could fund a list threetimes this long in 2010? What if by 2015one hundred emergency physicians hadrealized the benefit of a two-yearresearch fellowship, supported by theSAEM Research Fund? Our emer-gency patients would benefit from thescientific discovery, our residents wouldbenefit from the increased knowledge ofemergency care, and our faculty wouldbenefit from having successful col-leagues with fine research credentials.And these numbers, with a little workand dedication, are not a pipe dream.SAEM is committed to building theResearch Fund to this level.Have We Said Thank-You Lately?

SAEM wants to acknowledge andthank donors to the Research Fund.Last year we kicked off what will become an annual special reception at theAnnual Meeting. This year the recep-tion will feature a speaker and report onthe Fund. The reception will be on May23 at 5:00-6:00 pm. Dr. Brian Zink willprovide a brief session of the history ofacademic emergency medicine entitled,“The Strange and Strenuous History ofAcademic Emergency Medicine.” A for-mal invitation to donors is forthcoming.Also, SAEM Research Fund donors will

have a special designation at theAnnual Meeting – details will beannounced in the coming months.These small tokens of our appreciationare meant to say thanks, but we knowthat the reason you give is your beliefthat training in research is a cornerstoneof progress in emergency medicine. A New, Quiet Approach to RaisingMoney – the Silent Auction

This year the SAEM DevelopmentCommittee will roll out what we hope willbe a fun, exciting event at the AnnualMeeting in New York City to benefit theResearch Fund - a Silent Auction.SAEM members, businesses and otherdonors have already contributed itemsof value to the auction, and you get todecide how valuable these items are.The items or descriptions will be postedon the SAEM website beginning inMarch and will be on display at theSAEM meeting. Many items can beused or redeemed in New York City.We need your help in two ways – first bymaking a donation of an item to theAuction, and second, by participating inthe Auction at the Annual Meeting. Forideas on what you might contribute, andfor a sneak preview on what has alreadybeen donated, contact Mary AnnSchropp, the SAEM Executive Directorat saem@saem.org.

Research Fund: 2005 Membership Campaign ReportThe 2005 Member Campaign of the Society for Academic Emergency Medicine (SAEM) Research Fund is off to an impres-sive start. To date, contributions total approximately $33,000. To those members who have contributed, we thank you. Ifyou have not had the opportunity to contribute, please consider joining your fellow members in contributing to this worthyeffort. The mission of the SAEM Research Fund is three-fold: to improve the care of patients in the Emergency Departmentand prehospital setting through medical research and scientific discovery; to enhance research capability within the field ofEmergency Medicine; and to support investigators in pursuit of the skills necessary to conduct ethical and important researchto create new knowledge for the benefit of all patients in the Emergency Department.

The emphasis of the SAEM Research Fund is to support research training grants, open to all members who seek such train-ing. One hundred percent of your contributions go directly to the Fund; the administrative costs of maintaining the fund areborne separately by the SAEM operating budget. Remember, your donation is 100% tax deductible.

We would like to have 100% participation of the membership in supporting the SAEM Research Fund. Please consider mak-ing a donation equal to two to three hours of work. Make your check payable to "SAEM Research Fund" and mail it to:Society for Academic Emergency Medicine, 901 N. Washington Ave., Lansing, MI 48906. You can also make your donationon-line by going to www.saem.org and click on the "Click here to contribute to the Research Fund" link.

Professor ($2500+)Gabor Kelen, MD

Mentor ($1000-$2499)John Becher, DOGlenn Hamilton, MDJerris Hedges, MD, MS

Jeffrey Kline, MDJohn Marx, MDBrian O'Neil, MDPeter Van Ligten, MD

Sponsor ($500-$999)Brent Asplin, MD

William Barsan, MDCarey Chisholm, MDTheodore Christopher, MDSteven Dronen, MDJames Hoekstra, MDJudd Hollander, MDKenneth Iserson, MD, MBA

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Mark Langdorf, MDScott Syverud, MDRon Walls, MD

Investigator ($250-$499)Todd AllenMichael Bohrn, MDKris Brickman, MDE. Martin Caravati, MD, MPHDaniel Danzl, MDEric Dickman, MDSusan Gin-Shaw, MDLewis Goldfrank, MDJames Holmes, Jr., MDCharlene Babcock Irvin, MDJames Jones, MDPaul Paris, MDGene Pesola, MD, MPHStephen Pitts, MDMichael Runyon, MDBrian Zink, MD

Supporter ($100-$249)Susan Ambrose, MDJames Amsterdam, DMD, MDAmy Archer-Uyenishi, MDLydia Baltarowich, MDRichard Barry, MDCarol Barsky, MDJames Bouzoukis, MDMark Brautigan, MDMichael Brown, MDPatrick Brunett, MDCarlos Camargo, Jr., MD, DrPHChristopher Carpenter, MDDouglas Char, MDStanley Chartoff, MDAmy Church, MDWendy Coates, MDJeffrey Cukor, MDChristopher Dong, MDDavid English, MDJay Falk, MDKelly Anne Foley, MDRobert Frank, MDSteven Frei, MDSusan Fuchs, MDE. John Gallagher, MDRobert Galli, MDGregory Garra, DOLowell Gerson, PhDMichael Gibbs, MDJuan Gonzalez-Sanchez, MDLouis Graff, MDMichael Greenberg, MD

John Griswell, MDJason Haukoos, MD, MSMark Henry, MDBrian Hiestand, MDDavid Hnatow, MDRobert Hockberger, MDDee Hodge, III, MDAnita Hodson, MDDebra Houry, MD, MPHFrank Illuzzi, MDJennifer Isenhour, MDEdward Jauch, MDSharhabeel Jwayyed, MDDavid Karras, MDKaren Kerner, MDSorabh Khandelwal, MDSteven Krug, MDJoseph Kuchinski, DONathan Kuppermann, MD, MPHThomas Kwiatkowski, MDEvan Leibner, MDE. Brooke Lerner, PhD, EMT-PPhillip Levy, MDJoseph Lex, Jr., MDLouis Ling, MDJeffrey Love, MDRobert Lowe, MD, MPHStephan Lynn, MDAnil Mahajan, MDBrian Daniel Mahoney, MDCatherine Marco, MDMarcus Martin, MDEduardo Marvez-Valls, MDJon Mason, MDAmal Mattu, MDDale McNinch, DOJames Menegazzi, PhDJohn Mertz, MDGlenn Mitchell, MDDaniel Morris, MDGerald O'Malley, DONorman Paradis, MDMichael Paul, MDPeter Peacock, Jr., MDSteven Polevoi, MDSusan Promes, MDMichael Radeos, MDPhillip Rice, Jr., MDRaul Rodriguez, MDRobert Rosenbloom, MDRobert Rosenthal, MDWinston Ryan, MDJoseph Salomone, III, MDAndrew Sapira, MDAugusta Saulys, MD

Robert Schafermeyer, MDDaniel Schelble, MDKathleen Schrank, MDRobert Schwab, MDLawrence Schwartz, MDHosseinali Shahidi, MDNeal Shipley, MDPaul Sierzenski, MDPaul Silka, MDMarco Sivilotti, MD, MScDavid Sklar, MDEarl Smith, III, MDLinda Spillane, MDKarl Sporer, MDLawrence Stock, MDJudith Tintinalli, MD, MSThomas Tsou, MDAlan Tuttle, II, MDPhyllis Vallee, MDKeith Van Meter, MDAnnette Visconti, MDDavid Vukich, MDMarvin Wayne, MDRobert Wears, MD, MSChristopher Weaver, MDEllen Weber, MDDan Wiener, MDMildred Willy, MDStephen WolfBrian Zachariah, MD

OtherSteven Bird, MDAndrew Butterfass, MDRussell Clark, MDRobert Darling, MDCory Duncan, MDDaniel Girzadas, Jr., MDShantall HallFred Harchelroad, Jr., MDLinda Herman, MDTerry Kowalenko, MDChristopher Linden, MDDarrell Looney, MDJames MayoRon Medzon, MDFrancis Mencl, MDSamuel NaySean-Xavier Neath, MD, PhDBruce Quinn, MDMarcelo Sandoval, MDMichael Sayre, MDStephen Schenkel, MDMichael Slater, MDAnita Ziemak, MD

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Ethical Conduct of Resuscitation ResearchAcademic Emergency Medicine Consensus Conference

May 21, 2005New York City

8:00-8:45 Opening Remarks: A Historical Perspectiveon the Final Rule for Conducting Researchusing Exception from Informed Consent,Michelle Biros, MD, MSThis session will also include an electronicsurvey of the participants.

8:45-9:30 Panel: Update of Existing Research aboutthe Rules, Lynne Richardson, MD, TerriSchmidt, MD, Roger Lewis, MD, PhDThis session will provide an overview ofresearch that has been published on the effectiveness of the current rules.

9:45-11:15 Breakout Sessions: Protecting Subjects11:15-12:00 Reports of Breakout Sessions12:00-1:30 Lunch and Keynote Address1:30-3:00 Breakout Sessions: Impact on Research3:15-4:00 Reports of Breakout Sessions4:00-4:30 Electronic Survey of Participants4:30- 5:00 Closing and Consensus Process

Morning breakout sessions: Protecting Subjects

Communicating with communities● What constitutes effective community consultation and

public disclosure?● How is this measured?● What is known about the best methods of community

consultation and notification?● How should community consultation and public

disclosure address language barriers, ethnic minoritiesand cultural diversity?

● What are the future research directions that should betaken to further study the regulations?

Communicating with subjects● What is known about whether or not emergency

department patients can ever give informed consent?● Who can/should consent for subjects? (Patient,

surrogate?)● Can research assistants adequately consent subjects?● What is known about readability and subject

understanding of consent documents?● What are the future research directions that should be

taken to further study the regulations?

Research without consent with subjects with diminishedcapacity

● What if any, special safeguards should apply beforeenrolling children into studies using exception toinformed consent?

● Can prisoners ever be enrolled?● What special safeguards are needed for other special

groups (elderly people, persons with mental illness)?● What are the future research directions that should be

taken to further study the regulations?

Determining how well the rules are currently protectingsubjects

● What is empirically known about whether or not thecurrent rules provide adequate protection of subjects inresuscitation research?

● What is known about the best methods of communityconsultation and notification?

● What are the future research directions that should betaken to further study the regulations?

Afternoon breakout sessions: Impact on Research

Using the regulations in research ● What evidence exists that research is hindered by these

regulations?● What evidence exists that research has successfully

used these regulations?● What are the future research directions that should be

taken to further study the regulations?

Researchers understanding of the guidelines● What is known about the direction that has been

provided to researchers about how and when to useexception to consult?

● What more is needed to interpret the guidelines? ● What are the future research directions that should be

taken to further study the regulations?

Research conditions that qualify for exception to consent● What is the definition of life-threatening condition?● How is equipoise determined?● What level of evidence is required before an

intervention can be tested?● What is empirically known about whether or not the

current rules create undue barriers to performingimportant resuscitation research?

● What are the future research directions that should betaken to further study the regulations?

Issues related to IRBs Review● How do IRBs balance the risk to subjects in the

proposed research with the potential benefit?● What criteria should IRBs use in evaluating the

community consultation and public disclosure plan for astudy?

● What are the future research directions that should betaken to further study the regulations?

The AEM Consensus Conference is designed to attract abroad audience including resuscitation researchers, ethicists,IRB members and regulators. The goals of this conference aretwofold. First, the conference is designed to provide anoverview of the current status of the regulations in order toincrease understanding of how the rules are currently working.Secondly, this is a consensus conference with the goal ofdeveloping consensus on the important issues for subjectsand researchers surrounding these regulations. Severalinnovative methods will be used to develop consensus. Each

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of the small groups will be asked to discuss and developconsensus statements on broad questions. In addition, theday will begin and end with participant surveys usingsophisticated electronic tools to gather and report participateopinions in real time. The final product of the conference willbe a special issue of Academic Emergency Medicinepublished in November, 2005. This conference is partially

funded by a special grant from Association of AmericanMedical Colleges (AAMC) and the Office of Research Integrity.

Interested people can register for the conference athttp://www.saem.org/meetings/05regisform.html. The registra-tion fee is only $50 and includes lunch.

Academic Emergency Medicine Call for Papers"Conducting Ethical Resuscitation Research"

Clinical research hinges on the ability of investigators toidentify, recruit and enroll human subjects into clinical trials.The process of informed consent for research participation isdesigned to protect potential research subjects by educatingthem about the trial and their rights as participants, allowingthem to ask questions regarding the study and their role, andassisting them in making an informed decision about researchparticipation.

There is evidence that even when done under the most con-trolled clinical circumstances, potential study subjects do notalways fully comprehend or even recall the issues presentedto them. In the ED, this possibility is even greater because oftime pressures to enroll patients when study interventionshave narrow therapeutic windows, when patients have lan-guage and reading skills discordant with the investigators, andwhere investigators are often clinicians with competing atten-tion demands.

An additional circumstance, faced by emergency and resus-citation researchers, involves patients who are eligible forenrollment into studies but who cannot provide consentbecause of their critical clinical condition. Current regulationsfor waiver of and exception from prospective informed consentare cumbersome and have not often been successfullyapplied. The methods for fulfilling the requirements of the reg-ulations have not been well defined, and individual IRBs havedifferent levels of comfort in allowing these studies to proceed.

It is also not certain if the patient safeguards built into theseregulations, actually provide the protections they were intend-ed to.

The AEM Consensus Conference will be held on May 21,2005 the day before the SAEM Annual Meeting. It will addressissues of informed consent for research participation as it isprovided and obtained in the ED, problems arising wheninformed consent is waived, and challenges when attemptingstudies with exception from informed consent. It is our hopethat the conference will result in recommendations, a researchagenda, and a call for action from the emergency researchcommunity on how to ensure patient safety as research sub-jects while providing reasonable and practical guidelines forrefining current regulations on waiver of and exception fromprospective informed consent.

Original contributions describing relevant research or con-cepts in this topic area will be considered for publication in theSpecial Topics issue of AEM, November 2005, if received byMarch 1, 2005. Proceedings of the conference will alsoappear in the November Special Topics issue. All submissionswill undergo peer review by guest editors with expertise in thisarea. If you have any questions, please contact Michelle Birosat biros001@umn.edu. Watch the SAEM Newsletter and theAEM and SAEM websites for more information about theConsensus Conference.

Medical Student Educators HandbookDouglas Ander, MDEmory University

The SAEM Undergraduate EducationCommittee and the SAEM MedicalStudent Educators Interest Group haveworked collaboratively to complete aMedical Student Educators Handbook,which can be found on the SAEM web-site at http://www.saem.org/TOC1.htm.The Handbook was edited by DouglasAnder, MD, Wendy Coates, MD andDavid Manthey, MD. Experts in the fieldof education have written chapters toaddress key topics that pertain to med-ical student education. Although theHandbook was designed as a resourcefor undergraduate medical educators,many of the topics can be applied in any

educational venue. The purpose behind the creation of

this handbook was to assist the facultyplaced in the position of teaching anddirecting medical students. Many ofthese faculty are not formally trained aseducators, and may not have the back-ground that enables them to organize aclinical rotation, design a curriculum andevaluation system, and chair an emer-gency medicine course. Guidance inundergraduate medical education is lim-ited and resources developed for othermedical specialties do not always reflectour learning environments.

The chapters provide insight and

guidance to the medical student educa-tor. Topic areas include: the develop-ment of curricula, different teaching ven-ues, evaluation techniques, and variousadministrative topics such as budgetissues and dealing with difficult stu-dents. The authors offer generic recom-mendations that can be adapted forindividual institutional climates. Weexpect that this guidebook will be avaluable tool for all medical educators.Whether you are the junior faculty mem-ber assigned to running the medical stu-dent rotation or the more senior facultylooking for innovative techniques, thishandbook should be on your shelf.

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The 2005 SAEM Annual Meeting: A Guide for StudentsKimberly SchertzerPenn State UniversitySusan E. Farrell, MDBrigham and Women's HospitalChristopher S. Russi, DOUniversity of IowaCherri Hobgood, MDUniversity of North Carolina Chapel HillFor the SAEM Undergraduate Committee

The 2005 Annual SAEM AnnualMeeting will be held May 22-25, 2005 inNew York City. The meeting providesan extraordinary environment for stu-dents interested in emergency medi-cine, by providing a glimpse into manyof the topics and issues relevant to thespecialty today, and an opportunity tonetwork with residents and faculty fromacross the country. The registration feeis dramatically reduced for students($25 member/$50 non-member for reg-istration before April 15).

Approximately 35% of allopathic med-ical schools do not have academicdepartments of Emergency Medicine.As a result, medical students exposureto EM is often limited and without guid-ance or mentorship. This article offers a“must see” at the SAEM Annual Meetingfor medical students, in order to maxi-mize their experience and gain knowl-edge about residencies and careers inthis specialty.

The SAEM Medical StudentSymposium

The Medical Student Symposium isperhaps the most useful conferenceevent for students. It will be held onSaturday, May 21, 2005, and is a fullday of activities and didactics designedsolely for medical students. The regis-tration fee is $75. This symposium isintended to help medical studentsunderstand potential career paths inEM, and to provide guidance in planningfor residency application. It is a “must-do” for students who are planning their3rd and 4th year electives, preparingpersonal statements, and deciding howto apply to different residencies. It isalso an excellent opportunity for firstyear students to gain exposure to facul-ty leaders who are invested in medicalstudents interested in emergency medi-cine. There is a considerable amount ofplanning required in order to maximizemedical school opportunities and pre-pare for the residency applicationprocess. This day’s session helpsanswer questions and offers advice oncoordinating a successful 4th year.

Formal Lectures – The morning’s lec-tures are intended for all studentsregardless of their level of training. Thelectures open with a discussion of howto select the right residency for you,including issues of geographic location,residency length, and patient demo-graphics. This is followed by a talkabout how to get good advice aboutyour future residency and careeroptions, and what to do if there is no EMadvisor at your school. Navigating theresidency application process discuss-es the nuts and bolts of residency appli-cation, explains the ERAS application,and gives tips on how to successfullyinterview. The dean’s letter discussiondetails the components of the Dean’sletter, which are reviewed by programsas part of the application process.Afternoon lectures provide valuable tipsfor optimizing your learning and beingsuccessful on a 4th year EM clerkship,including where and when to do an“audition” elective. The final group lec-ture of the afternoon will address poten-tial career paths in emergency medi-cine, academics, dual residency train-ing, and fellowship.Lunch – While generally delicious, anadded benefit of lunch at the studentsymposium is that it provides the oppor-tunity to meet with program directors inan informal, small group setting. It is agreat time to ask questions, learn direct-ly from program directors, and to meetstudents from other schools, as well.Breakout Groups – There will be foursmall group sessions, focusing on top-ics for specific audiences. One sessiondiscusses the intricacies of balancingcareer and personal life, and providesvaluable advice on the importance offinding balance. A second session dealswith finances, budgeting and managingstudent loan debt. A third sessionaddresses how to optimize the 4th yearschedule, and provides useful insightinto electives, research, and USMLEtiming. The fourth session is designedspecifically for students at schools with-out emergency medicine residencies

and will employ a Q &A session to guidestudents through the complicated mazethat leads to a residency and career inEM.Residency Fair – Each year SAEMsponsors a residency fair, this year heldat the end of the medical student sym-posium day. All EM residency pro-grams, both allopathic and osteopathic,are invited to participate. In 2004, therewere 69 programs participating in thisevent and over 150 students attended.Most programs in attendance have atleast one representative at their table,often a program director, faculty mem-ber and/or a resident, and they are morethan willing to answer questions.Residency program tables are arrangedin rows geographically. To participate,students must be registrants of themedical symposium. The residency fairprovides an excellent opportunity tomeet with representatives of programsfrom across the country on this one day,especially useful when considering res-idencies in different geographic areas. Itis a great chance to meet people, askabout 4th year clerkships, and pick upliterature about each residency pro-gram.

The SAEM Annual MeetingThere is much to do at the remainder

of the conference. Lecture sessionsmay provide a glimpse into “hot topics”in Emergency Medicine, which fre-quently come up during residency inter-views. Understanding these topicsdemonstrates an interest and maturityabout Emergency Medicine that pro-gram directors seek. These sessionsare led by nationally recognized facultyin EM. This year’s topics include edu-cation research, introductory statistics,space medicine, diagnostic testing, andgrantsmanship.

Lectures of potential interest to studentsinclude:

● Understanding Diagnostic Testing(May 22)

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2005 SAEM Meeting…(continued from page 16)

● The Top 10 Errors in EmergencyMedicine Research (May 22)

● Knowledge Translation andEmergency Medicine: Bridging theGap from Evidence to ClinicalPractice (May 23)

● Public Health Research:Challenges and Solutions for theFuture (May 23)

● Introduction to Statistics (May 24)● Emergencies in Space (May 24)● Spivey Lecture: Developing the

Leader within You (May 25)

In addition, there are oral paper pre-

sentations, poster sessions and lunchsessions every day, and an opportunityto meet with Emergency Medicinephysicians from across the country. Thepapers and posters being presentedcompile current research in EM. Forthose students interested in research,these sessions may stimulate researchideas, to take with you to residency andbeyond.

One of the most fascinating parts ofthe meeting is the visually stimulatingphotography display. This display is aunique opportunity to see interestingradiographs, ECGs, and photos from

around the country. The photo presen-tation is completely informal and allowsfor “testing” your knowledge. The photodisplays will be set up in the Exhibit Halland available for viewing throughout theAnnual Meeting.

The SAEM Annual Meeting providesa fantastic opportunity for medical stu-dents to explore Emergency Medicine,and for a $25 early registration fee, itshould not be missed.

For more information, refer towww.saem.org, and click on the 2005Annual Meeting link.

SAEM/ACMT Michael P. Spadafora Medical Toxicology ScholarshipDr. Michael P. Spadafora was an academic emergency physician and medical toxicologist who was a member of

SAEM and the American College of Medical Toxicology (ACMT) and was dedicated to resident education. After hisdeath in October 1999, donations were directed to SAEM for the establishment of a scholarship fund to encourageEmergency Medicine residents to pursue Medical Toxicology fellowship training. ACMT has graciously agreed todonate matching funds.

Two recipients will be chosen to attend the North American Congress of Clinical Toxicology (NACCT), which willbe held September 9-14, 2005 in Orlando. Each award of $1250 will provide funds for travel, meeting registration,meals, and lodging. Any PGY-1 or 2 (or PGY-3 in a 4 year program) in an RRC-EM or AOA approved residency pro-gram is eligible for the award. The deadline for application is May 1, 2005. Scholarship recipients will be announcedat the annual SAEM and NACCT meetings. Each recipient will also be required to submit a summary of the meetingfor publication in the SAEM Newsletter and the ACMT Newsletter. The articles of the inaugural recipients of theScholarship, Dr. Lindgren and Dr. Ferguson are published in this issue of the Newsletter.

Applications must be submitted electronically to saem@saem.org and include:1. Curriculum Vitae of applicant2. Verification of employment and letter of support from the applicant’s program director3. Letter of nomination from an active member of SAEM and/or ACMT4. 1-2 page essay describing the applicant’s interest and background in Medical Toxicology

New York Symposium on International Emergency MedicineKumar Alagappan, MDLong Island Jewish Medical Center

The Second Annual New YorkSymposium on International EmergencyMedicine will be held on May 20, 2005.This program is a satellite conference ofthe 2005 SAEM Annual Meeting. Thisone-day conference is sponsored byNorth Shore-Long Island Jewish, NewYork University-Bellevue EmergencyServices and the New York Chapter ofACEP, and will be awarded 7 category 1CME credits.

This one-day symposium will bringtogether national and internationalexperts on international EM. The morn-ing session will lead off with a keynoteaddress from Dr Michael Van Rooyenfrom Harvard University and this will befollowed by several lectures fromexperts both nationally and internation-ally. In the afternoon there will be 5 sep-arate tracks on International EM. Thetracks will include a panel

discussion/workshop on internationalresearch, international funding, NGO’sand a showcase of EM from countriesaround the globe. There will also be atrack with original research presentedas either poster or oral presentations.For more information contact MaryStrong at 516-465-2500 or go towww.nyacep.org and click on theInternational Symposium link.

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Position Statement: Principles for Measuring Quality and ReportingIncidents and Adverse Events

The following position statement was developed by the SAEM National Affairs Committee, chaired by Dr. Michael Baumann. Theauthors are Jack Kelly, MD, Robert Wears, MD and Brad Weir, MD. The SAEM Board approved the position statement duringthe January 18, 2005 Board of Directors conference call.

Healthcare quality is the application of "best practice" toachieve optimal outcome for every patient. Emergency physi-cians face several unique medical challenges, such as highpatient acuity, lack of medical information or prior relationshipswith patients, frequent interruptions, Emergency Departmentovercrowding and diversion, and essential patient care inter-actions with physicians of other specialties. The principlesdescribed herein are integral to the Society for AcademicEmergency Medicine (SAEM) mission to improve patient careby advancing research and education in Emergency Medicine.

● Measuring healthcare quality starts with defining opportuni-ties for improvement and defining actionable steps.

● Measurement should be honest and transparent with adefined benchmark.

● Incidents, defined as situations of potential harm (near miss-es), and Adverse Events, in which actual harm occurred,

should include all events in which care in the ED played arole.

● Incidents and Adverse Events should be reported within ablame-free, voluntary, and anonymous system, which hasbeen shown to promote reporting.

● Each Incident or Adverse Event should be described in anarrative form to include the context in which it occurred(e.g., overcrowding, high acuity, lack of prompt consultantback-up) to encourage improvements to the practice ofEmergency Medicine.

● Reporting of quality measurements, Incidents and AdverseEvents should focus on advancing education and improvingpatient care in Emergency Medicine.

● Investments in reporting should be accompanied by equal orgreater investments in research and analysis for under-standing and learning.

Policy: Letters of SupportDuring the October 17, 2004 meeting of the SAEM Board of Directors, the following policy was approved by the Board ofDirectors.

Given the mission of SAEM to advance research and education in emergency medicine, many Society members may submitresearch grant proposals to various institutions. SAEM clearly supports research efforts by its members. However, SAEM doesnot provide letters of support or endorsement for such purposes.

NewsletterSubmissionsWelcomed

SAEM invites submissions to theNewsletter pertaining to academicemergency medicine in the followingareas: 1) clinical practice; 2) educationof EM residents, off-service residents,medical students, and fellows; 3) fac-ulty development; 4) politics and eco-nomics as they pertain to the academ-ic environment; 5) general announce-ments and notices; and 6) other perti-nent topics. Materials should be sub-mitted by e-mail to saem@saem.org.Be sure to include the names and affil-iations of authors and a means of con-tact. All submissions are subject toreview and editing. Queries can besent to the SAEM office or directly tothe Editor at david.cone@yale.edu.

Drs. JT Finnell and his wife Maria were recently invited to the White House Christmas Reception. Dr. Finnell worked with President Bush last May as

part of his initiative to assure better delivery of healthcare through information technology. He will complete his fellowship in medical

informatics this summer.

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Academic AnnouncementsSAEM members are encouraged to submit Academic Announcements on promotions, research funding, and other items ofinterest to the SAEM membership. Submissions must be sent to saem@saem.org by April 1 to be included in the May/Juneissue.

Steven B. Bird, MD, has received a$612,000 grant from the NationalInstitute of Environmental HealthSciences. His study, funded under aKO-8 mechanism, applies the use offunctional MRI to evaluate neuro-chemical changes produced by acuteorganophosphate poisoning. Dr. Birdis an Assistant Professor in theDepartment of Emergency Medicine,and a recent graduate of the MedicalToxicology fellowship, at theUniversity of Massachusetts.

Valerie De Maio, MS, MD, AssistantProfessor of Emergency Medicine atthe University of North Carolina atChapel Hill, received a Junior FacultyAward for her project, "Developmentof an EMS Research Database."

To better address the acute medicalneeds of the growing number of adultsaged 75 and older, New York-Presbyterian Hospital/Weill CornellMedical Center has created aGeriatric Emergency MedicineFellowship, a first-of-its-kind programfor physicians who have completedtheir residency training emergencymedicine. The fellowship will be ledby Neal Flomenbaum, MD, Professorof Clinical Medicine at Weill CornellMedical College and Dr. Mark Lachs(Professor of Medicine at WeillCornell) and Dr. Ron Adelman(Associate Professor of Medicine atWeill Cornell).

The Centers of Disease Control andPrevention (CDC) is developing anagency-wide public health researchagenda that will provide guidance forresearch that supports CDC's healthimpact goals. Robert Galli, MD,Chair, Department of EmergencyMedicine, University of Mississippi,has been named co-chair of theResearch Agenda SteeringWorkgroup Advisory Committee to theDirector of the CDC. The Committeewill provide advice and guidance to

the Office of Public Health Researchon efforts to build the CDC researchagenda.

Paul Hinchey, MBA, MD, chief resi-dent in Emergency Medicine at theUniversity of North Carolina at ChapelHill, was named a consultant to theNorth Carolina Office of EMS. He willassist in the development of EMS per-formance indicators. He alsoreceived a scholarship to attend theNAEMSP Pediatric Research Forum,which was held in January.

An academic Department ofEmergency Medicine has been estab-lished at the University of Alberta andBrian Holroyd, MD, has been namedActing Chair. The University ofAlberta is the fourth Canadian univer-sity to create an academicDepartment of Emergency Medicine.

James H. Jones, MD, has beenelected to the Board of Directors ofthe American Board of EmergencyMedicine, from a slate of nomineessubmitted by SAEM. Dr. Jones isAssociate Professor of ClinicalEmergency Medicine and Vice-Chairman, Department of EmergencyMedicine, Indiana University.

Greg Mears, MD, AssociateProfessor of Emergency Medicine atthe University of North Carolina atChapel Hill and Medical Director ofthe North Carolina Office of EMS, hasreceived a 1.5 million dollar HRSAHospital Bioterrorism PreparednessGrant for the North CarolinaPrehospital Medical InformationSystem; a Duke Endowment Awardfor 3 years ($300,000 per year) for theEMS Performance ImprovementToolkit Project; $240,000 from theAmerican Heart AssociationEmergency Cardiac Care EducationalGrant for the support and implementa-tion of the National EMS InformationSystem; and $320,000 from the

National Highway Traffic and SafetyAdministration for the National EMSInformation System project.

Kevin Rodgers, MD, has beennamed the Residency Director of theYear by the American Academy ofEmergency Medicine. Dr. Rodgers isAdjunct Professor of ClinicalEmergency Medicine and co-directorof the Emergency MedicineResidency Program, IndianaUniversity.

Robert L. Rogers, MD, has beenappointed the Director of MedicalStudent Education at the University ofMaryland School of MedicineEmergency Medicine Residency. Hehas also been named the ProgramDirector of the combined emergencymedicine/internal medicine residency.

Matt Scholer, MD, AssistantProfessor of Emergency Medicine atthe University of North Carolina atChapel Hill, received a Junior FacultyDevelopment Award for his project,"Development of an EmergencyDepartment Research Database."

Susan Stern, MD, has been appoint-ed Associate Chair for Education inthe Department of EmergencyMedicine at the University ofMichigan. She began this positionNovember 1, 2004.

Stephen Trzeciak, MD, AssistantProfessor, Department of EmergencyMedicine and the Section of CriticalCare Medicine at UMDNJ-RobertWood Johnson Medical School inCamden, Jersey, has received athree-year research grant from theAmerican Heart Association for hisproject, "Investigation ofMicrocirculatory Blood Flow in EarlyGoal-Directed Therapy of Sepsis-Induced Hypoperfusion States inHumans."

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ACADEMIC RESIDENTNews and Information for Residents Interested in Academic Emergency Medicine

Edited by the SAEM GME Committee

Developing a Mentorship RelationshipJeffrey Hackman, MDTruman Medical CenterFor the SAEM Graduate Medical Education Committee

Teacher, guide, counselor. Regardless of what they arecalled, many people consider a mentor essential to a profes-sional’s success. This may be especially true for people con-templating or entering a career in academic medicine.

The difference between a mentor and an advisor or supervi-sor may be blurred sometimes, but the difference should beclear in your mind. Residency programs generally assignfaculty advisors to residents to keep them on track in the pro-gram and answer questions about the residency itself. Amentor, on the other hand, is someone you seek out yourselffor guidance on the “big picture” issues: entering academicsor private practice, becoming the type of physician you wantto be, and “style of medicine” issues. A mentor is someonewho has a great deal of interest in you professionally and per-sonally. You will discover that a mentor is someone who’sopinion you will always seek, who’s advice you will often takeand who’s relationship you value. Residents often find thatsomeone is mentoring them even before they realize theyhave developed such a relationship. While virtually any fac-ulty member can serve as a mentor, some may be more ableor willing. Program Directors and senior faculty often fill thisrole. Perhaps your faculty advisor will evolve into a mentor,but that may not be the case. Rather than being somethingyou fall into, developing a mentorship relationship should bea deliberate process.

A mentor relationship may take the form of a traditionalapprentice/expert affiliation. On the other hand, you may findyour situation is better suited for a more open mentorship. Inthis model you work with multiple people, each of whomexcels in a particular area. This allows you to draw from theexperiences and expertise of several people. Successfulindividuals often have personal and professional mentorsalthough a single individual can work in some relationships.

You should first decide what you want from a mentor. Are youlooking for someone to assist you form your style as an emer-gency physician? Are you seeking an experiencedresearcher to help you get started with a career in research?On the other hand, do you want an experienced educator toguide you into a career in academic medicine? A clear targetwill help you determine who will be able to get you where youwant to be. Your mentor may provide advice and direction foreverything from your contact negotiations to financial advice.

You then need to identify the people who have the skill setsyou want, or the people who embody the type of physicianyou want to become. If you are just getting started this may

be the hardest part of the process because you may not knoweach person’s specific talents. Your program director, chair,or faculty development chair can be invaluable in identifyingthe person or people right for you.

Your next step should be to analyze your strengths to deter-mine what you have to offer a prospective mentor. If you canoffer your services as a budding researcher or just yourenthusiasm as a new physician, it is important to recognizethat the most effective relationship with a mentor will be a twoway street. It is critical to recognize that mentors mentorbecause they get personal and professional satisfaction fromthe relationship.

Finally, you should connect with the person or people youhave identified. Take with you the information you have gath-ered thus far to be prepared to discuss your objectives foryour mentorship relationship. Do not be offended if he or sherecommends you work with someone else. This may happenif the person you have chosen feels unable to help with yourgoals, either because of preexisting time commitments or aperceived lack of expertise. Most likely he or she will beeager to help a new physician.

As you approach residency graduation review some of theexcellent articles on mentorship available on the SAEM web-site and elsewhere, as your needs may change once youenter practice. Establishing a mentorship relationship will notonly help you achieve your goals but will make your residen-cy and future career more enjoyable.

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Southeast Regional SAEM MeetingApril 8-9, 2005Chapel Hill, NC

This year’s Southeastern Regional SAEM meeting willtake place at the Friday Center in Chapel Hill, NorthCarolina on April 8 and 9. Dr. Hobgood and Dr. Promes, theProgram Co-Chairs have put together an exciting program.We are delighted to have Dr. Ian Steill giving the openingaddress on Friday morning entitled “Applied ClinicalResearch.” Dr. Steill will also be participating in a panel dis-cussion with Dr. Kline on Clinical Decision rules. Dr. GlennHamilton, President-elect of SAEM, will be speaking to theparticipants on the second day about “Future Directions ofSAEM.” There will be over 100 research presentations inaddition to didactic sessions and hands on practical ses-sions. There will be interactive sessions on “How to Read aBrain CT”, “Regional Anesthesia”, “Suturing Workshop” and“Vascular Ultrasound”. There will be multiple faculty devel-opment sessions, as well as a session for EmergencyMedicine Residency Directors.

The fee for attending physicians is $125 and includes theeducational sessions, breakfast and lunch each day, as wellas an Opening Reception on Friday, April 8. Medical stu-dents as well as Emergency Medicine residents are encour-aged to attend. There is a special reduced conference feefor these individuals. The program committee has devel-oped a special session on April 8 specifically for medical stu-dents.

To register for the conference, please call 866-924-7929or 503-635-4871. The host hotel is the Courtyard byMarriott. The room rate is $94/night. Room reservationsmust be made by March 17, 2005 to get this rate.

We hope to see you at this exciting conference! You willdefinitely learn something and have fun while you are doingit. This is a great opportunity to spend some time minglingwith friends and academic leaders in the Southeast.

New York State Regional SAEMConference 2005

April 3, 2005Brooklyn, NY

The Research Directors of New York State invite you tojoin us for our regional SAEM conference on April 3, 2005,at SUNY-Downstate Medical Center in Brooklyn. The con-ference will focus on Evidence Based Medicine with a pres-entation from keynote speaker; Dr. Dan Mayer of AlbanyMedical College and a workshop with Dr. Peter Wyer ofColumbia University on “Using Online Interactive Resourcesto Enhance, Teach and Evaluate EBM Skill Sets.”

The conference will also feature a firsthand report fromIraq by internationally recognized expert in DisasterManagement, Dr. Almeida from Portugal. The President-Elect of SAEM, Dr. Glenn Hamilton, will address the gather-ing as well. Oral presentations of all accepted abstracts willbe offered in multiple concurrent sessions. For more infor-mation call 718-245-2973 or email: nephron1@bellatlantic.net. Please join us for this productive and stimulatingday.

9th Annual SAEM New England RegionalMeeting

April 27, 2005Shrewsbury, MA

The meeting will take place April 27, 2005, 8:00 am – 3:30 pmat the Hoagland-Pincus Conference Center in Shrewsbury, MA.For information: www.umassmed.edu/conferencecenter/. Send registration forms to: Linda Quattrucci, ResearchAssistant, Department of Emergency Medicine; Rhode IslandHospital, Coro West, Suite 106, One Hoppin Street,Providence, RI 02903. Email contact islquattrucci@lifespan.org.Registration Fees: Faculty = $100; Residents/Nurses = $50;EMTs/Students = $25. Late fee after April 8, 2005 = add $25.Make checks payable to Brown Medical School, Department ofEmergency Medicine.

SAEM Western Regional MeetingApril 9-10, 2005

Marina Del Rey, CAThe 8th Annual Western Regional SAEM Research Forum

will be held April 9 and 10, 2005 at the beautiful Marina Del ReyMarriott, located in the residential community of Marina Del Reyacross from the world's largest man-made harbor. The hotel isonly five miles from LAX international airport and three blocksfrom Venice Beach. World famous outdoor shopping is availableon the Third Street Promenade, located a short distance fromthe hotel. Local attractions include the Getty Museum, UniversalStudios, and Disneyland.

Accepted posters will be previewed on Saturday April 9, andmoderated poster sessions will be on Sunday April 10. Therewill also be an oral plenary session for the region’s best 4 or 5abstracts. The conference’s didactic segments will focus onexploring, understanding, and managing the role of uncertaintyin multiple aspects of clinical and academic EM practice. Theconference will conclude with a fun and interactive game showformat with audience participation! Please contact the confer-ence chair, Dr. Pam Dyne at pdyne@ucla.edu for more infor-mation.

Registration and fees may be sent to Mr. Wayne Hasby,Residency Coordinator, UCLA/Olive View-UCLA EM Residency,924 Westwood blvd, Suite 300, Los Angeles, CA 90024. Hisemail is whasyb@mednet.ucla.edu. Registration fees are $125faculty, $50 residents, nurses, and paramedics, and $10 formedical students. Make checks payable to UCLA Division ofEmergency Medicine. Please contact the Marriott directly at 1-800-228-0209 or 310-301-3000 to make your hotel reserva-tions. Reservations must be made before March 15 to takeadvantage of the discounted rate of $149.

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What is Educational Research?Gloria Kuhn, DO, PhDWayne State UniversityChair, SAEM Educational Research SubCommittee of the Research Committee

On behalf of the EducationalResearch Subcommittee

That question, asked by a medicalcolleague, is the impetus for this article.The simple answer is that it is investiga-tion about educational outcomes.Educational research is not a mysteri-ous thing - it is investigation of educa-tional outcomes. So how is that differ-ent than clinical research? Well, it’s notdifferent, really. Clinical outcomes, edu-cational outcomes... it doesn't reallymatter, except that the measurement ofmany clinical outcomes is much moreprecise than many educational out-comes. Therefore, the educationalresearcher has to be aware of thingslike psychometrics. In clinical researchthe investigator examines diagnosticproperties of clinical tests (false posi-tives, false negatives, sensitivity, speci-ficity....) while educational researcherslook at the psychometric properties ofeducational tests (validity and reliabili-ty). In educational research, the effectsof instruction on thinking and behaviorare of interest.

We, as both physicians and educa-tors, are really interested in learningabout and understanding that portion ofeducational research that specificallyrelates to medical education. In con-trast to educational research, which isextremely broad and researches theinstruction and education of all learners,medical education research is confinedto the study of adult learners who areengaged in learning and practicingmedicine and the educational methodsused by their teachers. It may usemany of the principles generated as aresult of educational research, but it hasboth a specific target population of sub-jects and specific environments in whichit is conducted.

A more helpful way to answer my col-league’s question is to examine medicaleducation research within the perspec-tive of scientific and clinical researchwith which we, as physicians, are allfamiliar. Areas of discussion include:examination of the field of medical edu-cation research, examining the chal-lenges of performing good educationalresearch, determining how it differs fromclinical research, and examining someof the future trends in this discipline.

Related questions whose answers willbe of value include how to get started inperforming medical education research,and deciding what is good educationalresearch. This article will discuss all ofthese questions. It is divided into twoparts, with part 1 (this issue) providingan overview of the field of medical edu-cation research, and part 2 (next issue)discussing how to get started in thisarea.

Much of the information in this articlecomes from the October 2004 issue ofAcademic Medicine, which is devoted tothe topic of medical education research.Reading this issue will allow anoverview of the field to be quicklyacquired.

The Field of Medical EducationResearch

Part 1Definitions

There are several definitions ofresearch including 1: careful or diligentsearch2: studious inquiry or examination;especially: investigation or experimen-tation aimed at the discovery and inter-pretation of facts, revision of acceptedtheories or laws in the light of new facts,or practical application of such new orrevised theories or laws3: the collecting of information about aparticular subject.Psychometrics is defined as the psy-chological theory or technique of mentalmeasurement.1

In essence, any type of research isthe careful and systematic examinationof phenomena to answer questionsabout an area of interest. Using theabove definitions, research can be, andis, conducted in almost all fields, fromarchitecture, to education, to medicine,to zoology. The content of study will dif-fer and the methods will be chosen tobest answer a specific question in a par-ticular discipline, but research is the dis-covery of new information or the revi-sion/interpretation of existing knowl-edge in light of new information.Research may be theoretical or appliedbut it should be as unbiased as possibleand attempt to answer a question askedby those conducting the research asaccurately as possible. It is an ongoingquest to discover the “truth”. It is how

knowledge is advanced and in manycases allows practitioners to becomemore effective in their actions.

In clinical research, the effect of dis-ease, diagnostic interventions, and ther-apies on humans is studied. There aremultiple research designs and method-ologies, some much more effective thanothers. The double-blind randomizedclinical trial (RCT) is at the “top of theheap” but in reality, when all clinicalresearch is considered, is rarely con-ducted because it is so difficult andexpensive. The medical communitycontinually and passionately debates 1)the merits of research methods andindividual research studies, and 2)whether to accept the results of a studyand change behavior as a result of theconclusions of a study. Educators andmedical educators carry on similardebates regarding educational andmedical education research.Medical Education Research

Medical education as a specialty, andformalized research in the area, beganover 30 years ago with the founding ofthe first office in medical education byGeorge Miller in the early 1960s. Thiswas followed by efforts in other universi-ties, all of which started master’s levelprograms in medical education.2

Norman notes that the most importantevidence of progress in the field is that“…we are now more likely than beforeto demand evidence to guide education-al decision making.” Pg 15603 He seesthis as a cultural change becausebefore the 1970s persuasion and poli-tics were the guiding forces behind edu-cational changes rather than evidence.

Very simply and broadly stated, med-ical education research examines anyfacet of the education of physicians,students, or residents and the change inbehavior or cognitive processes oflearners as a result of that education.Teaching methods, faculty develop-ment, how medical students, residents,and physicians learn, what their practicebehaviors are, how technology impactslearning, assessment of learner per-formance, and a host of other topics areall studied and the results reported.

Medical education research maydraw upon methods and information

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Call for AdvisorsThe SAEM Virtual Advisor Program

has been a tremendous success.Hundreds of medical students havebeen served. Most of them attendedschools without an affiliated EM resi-dency program. Their “virtual” advisorsserved as their only link to the special-ty of Emergency Medicine. Some stu-dents hoped to learn more about aspecific geographic region, while oth-ers were anxious to contact an advisor

whose special interest matched theirown.

As the program increases in popu-larity, more advisors are needed. Newstudents are applying daily. Pleaseconsider mentoring a future colleagueby becoming a virtual advisor today.We have a special need for osteo-pathic emergency physicians toserve as advisors. It is a brief timecommitment – most communication

takes place via e-mail at your conven-ience. Informative resources and arti-cles that address topics of interest toyour virtual advisees are available onthe SAEM medical student website.You can complete the short applicationon-line at http://www.saem.org/advisor/index.htm. Please encourageyour colleagues to join you today as avirtual advisor.

ABEM Requests Suggestions for Lifelong Learning and Self-AssessmentReadings

A cornerstone of ABEM's new EMCC program is the conceptof Lifelong Learning Self-Assessment (LLSA), which is devel-oped to promote continuous learning on the part of ABEMdiplomates. ABEM facilitates this learning by identifying anannual set of readings to guide diplomates in self-study ofrecent Emergency Medicine (EM) literature. You can have avoice in the identification of these readings.

ABEM welcomes and requests that EM organizations andABEM diplomates submit suggestions for readings. As a resultof these efforts, over the past three years, ABEM has receiveda significant number of recommended quality readings. Thereis concern, however, that the number of suggested readingsmay naturally diminish over time as organizations and individ-uals are increasingly busy.

Developing high-quality LLSA tests is dependent on high-qual-ity readings.

ABEM urges SAEM and its members to participate actively inthe selection of LLSA readings. As the publisher of EM’s aca-demic journal and a leading academic organization in EM,SAEM is in a uniquely positive position to identify important,high quality readings.

Submission Criteria for LLSA ReadingsABEM has established the following criteria for LLSA readings:1. Focused on recent advances or current clinical knowledge

in Emergency Medicine;2. Clinically oriented in content;3. Drawn from peer-reviewed EM journals, peer-reviewed

journals from related primary specialty fields, textbookchapters, or updated practice guidelines;

4. Published in printed or electronic form within the immediatefive years preceding the LLSA test in which it will be used;

5. Related to either the designated content areas for a givenyear (approximately 50%), or to the remaining contentareas (approximately 50%) of the EM Model "Listing ofConditions."

Content of the 2007 LLSA TestAlthough readings for the second LLSA test in 2006 havealready been selected, ABEM welcomes reference sugges-tions for future LLSA tests from the larger EM community on anongoing basis.

Currently, ABEM is soliciting readings for the 2007 LLSA test,for which the designated content areas will be Signs,

Symptoms, and Presentations and PsychobehavioralDisorders. ABEM will select approximately 50% of the read-ings for the 2007 LLSA from these two designated areas, whileapproximately 50% of the test content will be drawn from theremaining content areas of the EM Model Listing of Conditions.

How to Submit Recommendations for LLSA ReadingsFor each reference submitted, ABEM must receive the follow-ing two items:

1. Lifelong Learning and Self-Assessment ReferenceFormComplete an LLSA Reference Form for each reference thatyou recommend to ABEM. Be sure to provide all request-ed information for each reference, including the article titlecompletely written out, the journal name, etc. Do not useabbreviations. Do not alter the form in any way, except toadd the requested information in the space provided. TheLLSA Reference Form is available from ABEM and mayalso be downloaded as an MS Word document from theABEM website, www.abem.org. The form can be comput-er-printed or typewritten.

2. One Paper Copy of the Article, Chapter, or Other TextOne paper copy of the article, chapter, or other text forwhich you have submitted a reference must be mailed orfaxed to ABEM to be considered for inclusion. Electroniccopies of readings cannot be accepted due to copyrightrestrictions.

References received by June 1, 2005, will be consideredfor inclusion in the 2007 LLSA module. Materials submittedafter that date will be considered in the future.

Recommendations may be submitted via fax or mail: FAX:517.332.3943; Mail: LLSA References, American Board ofEmergency Medicine, 3000 Coolidge Road, East Lansing, MI48823

If you have specific questions or comments regarding theprocess for recommending references for the LLSA compo-nent of the EMCC program, please contact Timothy J. Dalton,Examination and Evaluation Project Specialist, at the ABEMoffice, telephone 517.332.4800. If you have questions of amore general nature regarding LLSA or about the overallEMCC program, please contact Robert C. Korte, Ph.D., SeniorPsychometrician.

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from any or all of the disciplines of edu-cation, clinical medicine, or psychology.Both theoretical and practical educa-tional literature may need to be consult-ed when researchers are designingmethods of study. Both educationaland medical education research arebroad based endeavors which draw onmethods and knowledge from many dis-ciplines and their findings are of use inalmost all fields.Current Status of Medical EducationResearch Publications

There has been an increase in boththe quantity and variety of publicationsin medical education research. In 1980there were just over 1300 articles deal-ing with research in medical education,while in 2003 the number was 2,907.From 1994 to 2003 there were 24,028articles in the English language on med-ical education research.

The journal Academic Medicine is theleading publisher of articles in this area(11%), followed by Medical Education(approximately 6%). Family Medicineand the British Medical Journal eachpublished about 3% of these articles.Academic Medicine, Medical Education,and Family Medicine have a combinedcirculation of only 14,000, which is smallwhen you consider that JAMA, whichpublished only 1.5% of the articles inmedical education research, has areadership of 332,337.4 Medical spe-cialty and subspecialty journals sporad-ically publish articles related to educa-tion. Although they usually deal withresearch relating to education withintheir particular discipline of medicine,they may publish material of interestdepending upon the project being con-sidered by a researcher.Funding of Medical EducationResearch

Funding of research in medical edu-cation has been small and remains sowhile support for this activity has beensporadic. This is mirrored by what hashappened in education in general. In1998 the total education budget in theUnited States was $300 billion dollars,but only 0.01% of this funding was spenton research in education.5 Similarly, in1994 spending on health care profes-sions education research was 0.001%of the total amount of direct federalspending on graduate medical educa-tion, for a total of $1.1 million annually.In contrast, the government spentapproximately $11 billion for biomedicalresearch. In fiscal year 1995 theincrease of National Institutes of Health(NIH) appropriations for research was

400 times the total allocation for educa-tion research.6

In essence, in the United States, wespend a lot of money on education,demand quality and results from educa-tional endeavors, but are unwilling tospend money on research which couldtell us how to get the most value for ourmoney. Certainly there has been nosystematic plan for conducting researchin medical education, and there hasbeen no central agency comparable tothe NIH to help lead, support, and guideefforts. Without adequate funding, per-forming educational studies that arecomparable in quality and scope tothose performed in clinical medicine isimpossible.

This lack of funding and support mayexplain why some of the weaknesses inmedical education research exist. Abroad and overarching criticism of med-ical education research efforts was lev-eled by Wartman and O’Sullivan whostated that “programmatic research inhealth professions education had notbeen established as part of the aca-demic mainstream, and that the processof health profession education wasfraught with unexamined assumptionsat virtually every level.” pg 9104 Theycalled for a national center for healthprofessions education research.7 Thatcall was never answered, and noprogress has been made in supporting,leading, or coordinating research effortsin the field.

Carline5 reviewed a sample ofresearch reports from AcademicMedicine and Teaching and Learning inMedicine (two of the leading journals inpublication of research in medical edu-cation in the United States) in order todetermine funding sources. He chosethe May issues of Academic Medicinefrom 2000 to 2004 and the spring issuesof Teaching and Learning in Medicinefrom 1999 to 2003. Of the 70 articlespublished within this timeframe, 45 didnot list any funding. Of the 25 articleswhich listed funding, five were support-ed by departmental or institutionalawards, while 20 articles listed externalfunding. Eight of the 20 articles withexternal funding received US federalfunding or funding from the CanadianInstitutes of Health, seven got fundingfrom national organizations such as theAmerican Association of MedicalColleges (AAMC) or National Board ofMedical Examiners, and four authorsobtained funding from the Robert WoodJohnson Foundation or the W.K.Kellogg Foundation. The remaining 11

citations had funding from a number ofprivate foundations, each mentionedonce. Carline concluded that theresearch which did not report fundingwas performed as part of the author(s)employment duties and supportingfunds were derived from operationalbudgets.

The result of this lack of large scalefunding is that studies tend to occur inone institution, are small in scale withsmall numbers of subjects, and areshort term. This situation leads to manyof the criticisms of educationalresearch, namely that methodology ispoor, numbers are small, findings arenot generalizable, and conclusions aresuspect as a result of these shortcom-ings. These studies cannot have thepower and robustness of the multi-cen-ter, randomized double blind studies, orlongitudinal studies which researchersin clinical medicine are fond of perform-ing and quoting and which cost millionsof dollars to fund.

The rigorous process of review whichthe NIH conducts on any application forresearch funds tends to improve thestudy proposal through peer review byexperts in the field. Researchers canuse the advice from peer reviewers whoare experts in the area to improve thedesign of their studies. Additionally, theNIH guides the type of research per-formed by allocating funds to someareas of research and not others.

In many cases funding by the NIH isextremely generous. Examples of theamounts of money provided by the NIHfor medical research they agree to fundinclude $12.5 M to Stanley Prusiner forprion research, $9.9 M to Alfred Gilmanfor cell signaling studies, and $4.9 M toMichael Gimbrone for studies on vascu-lar endothelium.8 While some may criti-cize the philosophy and methods of theNIH it does have money to spend andsupport to give to research, medical noteducational research.Progress in Medical EducationResearch

Yet progress has been made in med-ical education research. Norman3

reviewed the advances in medical edu-cation research over the past 30 yearsand noted progress in the followingareas: basic research in acquisition ofmedical expertise, problem basedlearning, methods of assessment, con-tinuing medical education, recertifica-tion, and licensure. Several of theseareas, which Norman has cited, will bediscussed in more detail as they impact

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heavily on both the teaching of medicineand our clinical practice.Acquisition of Expertise

Research in the acquisition of medicalexpertise has used many of the meth-ods developed by cognitive psycholo-gists and has demonstrated that med-ical expertise is dependant on the accu-mulation of a rich knowledge basewhich is both didactic and experiential innature. This is in direct contrast to anearlier incorrect belief that medicalexperts possessed more efficient “clini-cal problem solving” skills. The value ofmuch of the literature on expertise is itsproof of the generalizability of methodsof instruction which cross domains.“Deliberate practice” is engaged in by allwho wish to become experts, and thetime to gain expertise is 10 yearswhether the domain studied is medicineor chess (for a detailed discussion ofdeliberate practice and expertise seeEriccson, A. Attaining ExcellenceThrough Deliberate Practice: “Insightsfrom the Study of Expert Performance”in The Pursuit of Excellence ThroughEducation ed. Ferrari, M ).9

What has been missing in medicine isan implementation of methods ofinstruction used for deliberate practiceand systematic studies of the effects ofthese practices. We continue to use the“apprentice” model in resident educa-tion and do not customize educationand training to the needs and learningstyles of residents. Performance Assessment

A great deal of research has beenconducted in performance assessmentand has shown that performance aswell as cognitive knowledge can be reli-ably and validly assessed, but only ifmultiple sampling strategies are usedon multiple occasions. One of the mostimportant results of this research is thedevelopment of assessment strategiesusing standardized patients and theobjective standardized clinical exam,and demonstration of both reliability andvalidity for assessment of performanceusing these and other methods.Continuing Medical Education

The areas of continuing medical edu-cation (CME) and the need to find meth-ods of instruction which are more effec-tive than standardized lecturers are adirect result of research which looked atchange in behavior of physicians afterattending courses in CME.10,11

RecertificationBoth Canada and Britain have shown

that licensed, practicing physicians maynot be able to demonstrate competency

when tested. A change in culture isoccurring as medical specialty boardsadopt a requirement for periodic recerti-fication of their members and licensingboards require proof of competency forrelicensure of physicians. (For a moredetailed discussion of these areas ofmedical education research seeNorman, G Research in MedicalEducation: Three decades of ProgressBMJ 2002)

Regehr12 examined four key journalswhich publish medical educationresearch, Academic Medicine,Advances in Health SciencesEducation, Medical Education, andTeaching and Learning in Medicine,looking for the trends in medical educa-tion research. He found extensiveresearch in the following four areas: cur-riculum and teaching issues, skills andattitudes relevant to the medical profes-sion, characteristics of medical stu-dents, and evaluation of medical stu-dents and residents.

Prystowsky13 looked at medical edu-cation from 1996 through 1998 using anoutcomes research paradigm. Usingthis perspective he suggested a threedimensional framework for analyzingmedical education research in whichparticipants (trainees, faculty, patients,and providers), outcomes (perform-ance, satisfaction, professionalism, andcost) and level of analysis (geographic,system, institution, and individual) couldall be studied. He used four datasources, Academic Medicine, MedicalEducation, Teaching and Learning inMedicine, and all papers presented atthe Research in Medical Education(RIME) conferences held annually atthe AAMC. He required that articles bedata driven and look at some aspect ofthe educational environment.

There were 599 publications meetingthese specifications. When looking atparticipants, trainees were most com-monly studied (n=413, 68.9%), followedby faculty (n=116, 19.4%). Providers(n=49, 8.1%) and patients (n=21, 3.5%)were rarely studied. The most common-ly studied outcome measure was per-formance (n=296, 49.4%). The per-formance (i.e. performance on a paperand pencil test or examination of a stan-dardized patient) of the trainee, faculty,or provider accounted for the vastmajority of studies (n=292, 48.7%) whileclinical outcomes of patients, presum-ably the most important measure ofeffective medical education, was theleast studied parameter (n=4, 0.7%).Satisfaction of the learner was the sec-

ond most common primary outcomemeasured (n=204, 34.1 %). Most analy-ses were performed at either the indi-vidual level (n=235, 39.2%) or the insti-tutional level (n=220, 36.7%).

Although it is of value to study traineeperformance and satisfaction, there arefew studies of the ability of trainees tocare for patients and almost no studiesof cost of education, provider behavior,or patient outcomes, all areas whichcould provide valuable informationregarding the efficacy of medical educa-tion. One of the greatest values of thetype of overview of medical educationresearch provided by Norman, Regehr,and Prystowsky is that it dramaticallydemonstrates the gaps in medical edu-cation research and fruitful areas forfurther study.Criticisms of Medical EducationResearch

Yet, despite progress, there are anumber of critics and criticisms of thestate of medical education research.The comments of Wartman andO’Sullivan have already been men-tioned.7 Bordage14 performed a contentanalysis of reviewers’ comments, bothpositive and negative, of 151 manu-scripts which were submitted to the1997 and 1998 RIME conference pro-ceedings. The main strengths of accept-ed manuscripts included: the impor-tance or timeliness of the problem(s)studied, excellence of writing, andsoundness of study design. The top tenreasons for rejection included inappro-priate or incomplete statistics; overinterpretation of results; inappropriate orsuboptimal instrumentation; sample toosmall or biased; text difficult to follow;insufficient problem statement; inaccu-rate or inconsistent data reported;incomplete, inaccurate, or outdatedreview of the literature; insufficient datapresented; and defective tables or fig-ures. These criticisms are not minor butare major deficits of the research sub-mitted. Interestingly, they sound similarto the criticisms that reviewers level atsubmitted manuscripts of medicalresearch. Difficulties in Conducting Research

Educational researchers oftenencounter difficulties that medicalresearchers have been able to over-come, in the areas of blinding, use ofcontrol groups, and controlling for con-founding variables. The clinical goldstandard of the double-blind random-ized clinical trial can rarely be conduct-ed in educational or medical education

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research. Bias and confounding variables are

potentially the biggest problems inresearch of any kind. Medicalresearchers overcome potential bias byblinding both the investigator and thesubject whenever possible. A simpleexample to illustrate this point would bea study on control of hypertension com-paring a new drug with a placebo.While the “control group” patients mightcheat and use medications other thanthe placebo they receive, there is littlemotivation to do this because they areblinded as to whether they are receivingthe placebo or experimental drug. Theinvestigator is also blinded so thatresults and adverse outcomes are hon-estly reported. To ensure compliance inthe experimental group researchershave resorted to watching the subjecttake the medication, counting pills left inpill bottles, and other devices to controlcompliance. Most clinical trials show ameasurable advantage of one interven-tion over another but this is rare in edu-cation where “no significant difference”is the rule rather than the exception duein part to the inventiveness of learners.15

Overcoming bias and confoundingvariables is difficult or impossible ineducational research. In most casessubjects as well as educators knowwhat the intervention is, and this factleads to the possibility of bias. Medicaleducators have not yet developed a“placebo” for instruction because the

learner will often overcome perceived orreal deficits in instruction. Motivatedlearners will find a way to learn thematerial they perceive as necessary fortheir success, overcoming any deficit incurriculum or instructional strategy.This often leads to finding “no differ-ence” between the experimental andcontrol groups. Both Norman and tenCate have concluded that true blind-ness in randomization in education isimpossible.3,16 This fact makes it difficultto use control groups in the same man-ner as they are used in medicalresearch. As long as motivated studentshave access to printed or electronicinformation there is no way to constraintheir learning unless the educationaltreatment and testing occur with littleintervening time. Some researchershave utilized this methodology but itprevents long term studies or study ofinstructional strategies and learning out-comes in the work place setting.

Learners have confounding variablesother than motivation to learn.Previously acquired knowledge andvariable efficiency in learning can affectoutcomes. This may be explained bythe fact that, as ten Cate has noted, aneducational intervention will tell moreabout students’ inventiveness aboutconstructing their own learning programthan about the educational interven-tion.16 (For an in-depth discussion ofstudents’ learning strategies and the dif-ferences between expert and non

expert learners see Thomas J andRohwer W, Proficient AutonomousLearning: Problems and Prospects inCognitive Science Foundations ofInstruction, ed Rabinowitz M)17

One solution to some of these prob-lems is to use a randomized controlgroup pre-test/post-test design so thatthe learner, even if not blinded, acts ashis own control. However, the pre-testitself may affect the post-test by allow-ing subjects to “guess” what they aresupposed to learn, allowing them toacquire knowledge as a result of takingthe pre-test, or being primed for learningas a result of taking the pre-test. TheSolomon four-group design, in whichnot all groups are given a pre-test, isone solution to this problem. This is avery powerful experimental design con-trolling well for both internal and exter-nal potential sources of error or ambigu-ity. One disadvantage of using theSolomon’s four group design is that itrequires a larger group of subjects, butit illustrates some of the ingeniousmethods educational researchers havedeveloped to overcome difficultiesencountered. (For an in-depth discus-sion of this and other research designssee Campbell, D.T., & Stanley, J.C.Experimental and Quasi-ExperimentalDesigns for Research. Houghton)18

Part 2 of this article will be published inthe May/June issue of the Newsletter.

AACEM to Meet at SAEM Annual Meeting The Association of Academic Chairs of Emergency Medicine (AACEM) will meet on the day before the SAEM Annual Meeting,on May 21, 2005 at the New York Hilton. All AACEM members are encouraged to attend. Here is the preliminary schedule ofevents:

8:00-9:00 am AACEM/University of Cincinnati/Dr. Levy International Visiting Professor Lecture

9:00-11:00 am Leadership Challenges in Complex Academic Environments

11:00-12:00 noon Open Discussion of AACEM issues

12:00-1:30 pm AACEM Annual Business Meeting and Lunch (AACEM members only are invited to attend)

1:30-4:00 pm New and Future Chairs Workshop (all interested individuals are invited to attend. Contact AACEM throughthe SAEM office for registration information. Registration fee is $0 for AACEM members and $100 for non-members).

6:00 pm AACEM Reception and Dinner at Explorer's Club (active members and spouses only)

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needed, determines outcome goals,recognizes and utilizes opportunities forprevention, monitors progress, sharesinformation and educates, and adjuststherapy and diagnosis according toresults.” Sure…why not? After all, whocould argue with that?

Moving next to graduate (residencylevel) medical education, we see ourprogram directors in all specialtieswrestling with a system to implementteaching of, and assessment of, 6 “corecompetencies” under the ACGME man-date of 2002. The method utilized forthis process was fascinating andclever…rather than define what thesecompetencies were and how they couldbest be implemented into already burst-ing curricula, the ACGME “allowed”each specialty to chart its own course.The ACGME will later decide how tomeasure the implementation strategies.Hmmm….and at the same time, the rad-ical discovery that tired humans aremore likely to be irritable, lack empathyand more prone to error swept the GMEcommunity, resulting in the 80-hourworkhours implementation across allspecialties (let’s see, I believe it was1985 for EM to take such a boldstep….). Draconian threats of the lossof entire institutional accreditation fornon-compliers has spawned new indus-tries in resident workhour accounting,while other schools simply added addi-tional reporting forms onto their busyresidents.

The certification process for newgraduates has garnered less attention,but this is most likely only temporary.Pressure to “prove” procedural compe-tency in addition to the other ACGMEcore competencies will have an impacton this process. Our current systemmandates a signature from the gradu-ate’s program director that the residentmet all curricular elements, followed bysuccessfully passing a multiple choiceexamination and then an oral examina-tion that effectively assess cognitivecomponents (at the expense of reinforc-ing behaviors known to promote clinicalmedical error).

Not to be ignored, attention also fil-

tered to the practicing physician.Concerns were being raised that practi-tioners failed to adopt the most current“best practices” into their patient care,or were unduly influenced by bioindustrypromotional efforts as opposed to the“best evidence”. Traditional CMEprocesses (largely the traditional lectureformat) were acknowledged for theiruniversal lack of effectively changingphysician behavior, yet the financialramifications for overhauling thisprocess provided little professional soci-ety incentive for change. The ABMSweighed in with a mandate to all 23 spe-cialty organizations to develop a 4 com-ponent “Maintenance of Certification”process. The ABMS initiative (in theory)will protect society from poor or outdat-ed practitioners by providing incentivesto maintain a life long learning processand self assessment. ABEM facesmany challenges in developing a mean-ingful yet practical system.

So, are we in the midst of a revolu-tion involving all phases of medical edu-cation that will ultimately address socie-tal concerns (real or perceived)? Theimplication of a “revolution” is that thestatus quo is so dysfunctional that anoverwhelming overhaul in entirety istime critical. Perhaps we are witnessingan acceleration of a logical evolution inthe process of training tomorrow’semergency practitioners? Or are weadrift in the ocean, without a compassand a clearly articulated (or realistic)destination for tomorrow’s practitioners?

I would ask us to step back to ourphysician scientist roles (see Nov/Dec2004 Newsletter) as educators. Couldwe do better preparing future physi-cians? Of course! Was the product uni-versally broken? I remain unconvinced.Will the changes described abovemeaningfully assure the preparation of amore capable practicing physician? Iam a skeptic.

Shouldn’t profound systemschanges in medical education undergoa similar process of hypothesis genera-tion, testing through methodologicallysound means, analysis, and refine-ment? Shouldn’t we insist that there are

at least “pilot studies” demonstratingmeasurable efficacy (or even effective-ness) before deconstructing the existingprocess? Isn’t it important to articulatea measurable endpoint before forgingahead? Isn’t it important to gather dataabout unanticipated side effects of oureducation system changes? Forinstance, workhours mandates univer-sally appear to be a no-brainer. Yet theyhave created a new layer of resident“service-only” (the “night float”) experi-ence that appears to be counter-intuitiveto our goals of improving education.The Draconian enforcement has takenpersonal choice away from motivatedadult learners. And while workhours arecapped, the mandated curriculum forevery specialty has grown every year,with little being removed. The latest isthe mandated teaching in the 6 corecompetencies, but many more havepreceded such as ultrasonography,wellness and cultural competence.Important? Absolutely. But what shouldwe remove? Should we scale back onour pediatric airway management? Weknow that it takes 40,000 patientencounters in order to attain expert-ise…will we and should we considerextending the training time required toassimilate the skills necessary for suc-cessful practice of EM? Is it time for a 4year edict? Will uniform limits of work-hours in every specialty during residen-cy result in a graduate poorly preparedfor the rigors of post-graduate practice,or will these graduates adopt a differingpractice pattern mirroring residency?

And please do not misinterpret mythoughts above as constituting a univer-sal dismissal of the changes in medicaleducation. In fact, the universe of cre-ativity mandated in these changes hasbeen professionally rewarding. I simplyam uncomfortable with a process thatchanges so many variables simultane-ously without a clear destination or aneye towards unintended adverse sideeffects. Unless a revolution is trulyrequired, we should apply our scientisttraining to the changes in medical edu-cation.

President’s Message…(continued from page 1)

Residency Vacancy ServiceThe SAEM Residency Vacancy Service was established to assist residency programs and prospective emergencymedicine residents and is posted on the SAEM website at www.saem.org. Residency programs are invited to list theirunexpected vacancies or additional openings by contacting SAEM. Prospective emergency medicine residents are invitedto review these listings and contact the residency programs to obtain further information. Listings are deleted only whenthe residency program informs SAEM that the position(s) are filled.

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FACULTY POSITIONSALABAMA: The University of Alabama at Birmingham, Department ofEmergency Medicine, in Birmingham, AL, seeks a full-time Medical Toxicologistto assist in providing clinical emergency and toxicological care to patients ofnorthern and central Alabama. Immediate availability by July 2005 is required.Prevailing wage and benefits available. Must have residency training in emer-gency medicine, AL license, DEA, and U.S. BC/BE in Medical Toxicology. SendCV and letter of interest to: Thomas E. Terndrup, MD; Professor and Chair,Department of Emergency Medicine; JTN 266; 619 19th St. South, Birmingham,AL 35249-7013.

INDIANA: Indiana University School of Medicine, Department of EmergencyMedicine is recruiting a clinician teacher to provide care at public hospital EDlocated on medical center campus. Wishard Hospital is Level One TraumaCenter, base for busy pre-hospital emergency transport services, and regionalburn center. The ED recorded 108,000 visits in 2003. Wishard complementsMethodist in providing clinical experiences for IUSM EM residents. Enthusiasmfor medical education, clinical research, and patient care in busy public hospi-tal ED are expectations. Residency training, certification/preparation in EM arerequired. Rank and tenure dependent upon qualifications. Apply to Jamie JonesMD (jhjones@iupui.edu) or Rolly McGrath MD (rmcgrath@iupui.edu), FAX(317)656-4216. IU is an EEO/AA Employer, M/F/D.

MICHIGAN: Director of Research position available for BC EM physician in aca-demic setting at 92,000 annual visit Level II Trauma Center. The 39,000 squarefoot ED housing 76 beds, includes an ED, adult and pediatric ambulatory carecenters, chest pain observation unit, & an on-site Medflight air ambulance. St.Joseph Mercy Hospital is an approved EM Residency program sponsored by this600-plus bed hospital and the University of Michigan Medical Center. Clinicalresearch experience (3 years) is required; dedicated protected time provided.Employed positions offer excellent remuneration plus faculty stipend, produc-tivity bonus, paid malpractice, full benefits, & relocation allowance. Please con-tact Nancy Ely @ (800) 466-3764, ext.337 or nely@epmgpc.com. Visit us atwww.epmgpc.com.

NEW YORK: Columbia University – Attending Emergency Physician – HarlemHospital Center Emergency Services affiliated with Columbia University, seeksresidency-trained or ABEM-certified Emergency Physicians who have excellentclinical skills, a strong interest in teaching and a commitment to public medi-cine. We are a 290-bed, Level 1 trauma center, regional burn center, EMS-basedstation with over 75,000 annual visits. An appointment to the faculty of theColumbia University College of Physicians and Surgeons is anticipated at theInstructor or Assistant Clinical Professor level, commensurate with experience.Competitive salary and benefits package provided. Submit CV to: ReynoldTrowers, M.D. Director of Emergency Medicine Services, Harlem HospitalCenter, 506 Lenox Avenue, New York, N.Y. 10037. Call him at (212) 939-2253or e-mail at RLT2@columbia.edu. Columbia University takes affirmative actionto ensure equal opportunity.

OHIO: The Ohio State University - Assistant/Associate or Full Professor.Established residency training program. Level 1 Trauma center. Nationally rec-ognized research program. Clinical opportunities at OSU Medical Center andaffiliated hospitals. Send curriculum vitae to: Douglas A. Rund, MD, Professorand Chairman, Department of Emergency Medicine, The Ohio State University,146 Means Hall, 1654 Upham Drive, Columbus, OH 43210, emailDailey.1@osu.edu, or call (614) 293-8176. Affirmative Action/EqualOpportunity Employer.

PENNSYLVANIA: University of Pittsburgh: Full-time emergency medicine fac-ulty positions are available at the Instructor through Associate Professor levels.Candidates must be residency trained and board certified/prepared in emer-gency medicine. We offer career opportunities as a clinician-investigator or cli-nician-teacher. Our faculty have local, national and international recognition inresearch, teaching and clinical care. The ED serves a primarily adult populationwith a volume of approximately 50,000 per year, and is a Level I trauma centerwith both toxicology and hyperbaric medicine treatment programs housed with-in our Department. Salary is commensurate with experience. For further infor-mation write to: Donald M. Yealy, MD, Vice Chair, Department of EmergencyMedicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite500, Pittsburgh, PA 15213. The University of Pittsburgh is an Affirmative Action,Equal Opportunity Employer.

WASHINGTON, DC: Washington Hospital Center (WHC), GeorgetownUniversity Hospital (GUH), Franklin Square Hospital (FSH), and UnionMemorial Hospital (UMH) in the Washington, D.C. – Baltimore, MD corridorseek physicians board-certified or residency-trained in emergency medicine tojoin their faculty. WHC is the largest Washington, DC hospital, seeing more than67,000 annual visits; GUH is a renowned academic institution; and FSH andUMH emergency departments in Baltimore are very busy. Contact Mark Smith,MD, FACEP, Chairman of Emergency Medicine, at 202-877-0808, fax 202-877-2468 or write to him at the Washington Hospital Center, Department ofEmergency Medicine, 110 Irving Street, NW, Washington, D.C. 20010.

EMERGENCY MEDICINEAcademic Positions

Available in the

Department of Emergency Medicineof

Allegheny General Hospital, Pittsburgh, PA

Practice Emergency Medicine in Western Pennsylvania’sMost Dynamic Emergency Department

✩ Emergency Medicine Residency Training Program✩ Level I Trauma Center✩ Level I HAZMAT Receiving Facility✩ 20% Pediatrics✩ Medical Toxicology Treatment Center✩ Fellowships - EMS, Sports Medicine, Administration, Research,

Toxicology, Patient Safety✩ Salary Commensurate with Experience

Contact:Fred Harchelroad, M.D.via Michelle Malsch, Executive Asst.(412) 359-3961mmalsch@wpahs.org

✩✩ West Penn Allegheny Health System, an Equal Opportunity Employer ✩✩

University of PittsburghThe Department of Emergency Medicine offers fellowshipsin the following areas:

• Toxicology• Emergency Medical Services• Research• Education

Enrollment in the Graduate School is a part of all fellowshipswith the aim of obtaining a Master’s Degree. In addition,intensive training and interaction with the nationally-knownfaculty of the Department of Emergency Medicine, withexperts in each domain, is an integral part of the fellowshipexperience. Appointment as an Instructor is offered and fel-lows assume limited clinical responsibilities in theEmergency Department at the University of PittsburghMedical Center and affiliated institutions. Each fellowshipoffers the experience in basic and/or human research andteaching opportunities with medical students, residents andother health care providers. The University of Pittsburgh is anEqual Opportunity Employer, and will welcome candidatesfrom diverse backgrounds. Each applicant should have anMD/DO background or equivalent degree and be board certi-fied or prepared in emergency medicine (or have similarexperience). Please contact Donald M. Yealy, MD, Universityof Pittsburgh, Department of Emergency Medicine, 230McKee Place, Suite 500, Pittsburgh, PA 15213 to receiveinformation.

23

Boston Harvard Affiliated Teaching Hospital

The Department of Emergency Medicine of the HarvardMedical Faculty Physicians at Beth Israel DeaconessMedical Center has positions available for faculty commit-ted to academic Emergency Medicine. Board certifi-cationor prepara-tion in Emergency Medicine with four years oftraining or experience are prerequisites. The base hospi-tal is Beth Israel Deaconess Medical Center, a Level I trau-ma center, with an ED that sees nearly 50,000 patients ayear, and the seat of a three year emergency medicine res-idency. Our community practice, Beth Israel DeaconessNeedham, sees 12,000 patients a year. We provide need-ed direction for three 911 systems. Academic opportuni-ties include access to lab space, international programs,and teaching at Harvard Medical School. Salaries arehighly competitive for the community and are incentivebased. We are currently seeking faculty with interests inacademics, EMS, basic science, or postgraduate educa-tion.

Beth Israel Deaconess Medical Center and HarvardMedical School are Equal Opportunity Employers. Womenand minorities are particularly encouraged to apply.Please send applications or nominations, together with acurrent curriculum vitae, to:

Richard E. Wolfe, M.D., Chief of Emergency MedicineBeth Israel Deaconess Medical CenterOne Deaconess Road (W/CC2) Boston, MA 02215

Department of SurgeryDivision of Emergency Medicine/South Texas

Poison CenterThe Division of Emergency Medicine/South Texas PoisonCenter at University of Texas Health Science Center at SanAntonio is recruiting 1-2 residency trained, BC/BE EmergencyMedicine Clinician-Investigators committed to developing anacademic career. We have full-time positions available for theacademic year commencing August 2005. Preference is given toindividuals with fellowship training or research experience.Candidates who have toxicology training will also have theopportunity to work with the South Texas Poison Center.Adequate protected time is provided and start-up funding isavailable. The University Hospital Emergency Center is a level1 trauma center which evaluates and treats 70,000 patients annu-ally. The hospital serves as our major teaching facility. There is80 hours of physician coverage daily. UTHSCSA offers a com-petitive salary, a comprehensive insurance package, and a gener-ous retirement plan. South Texas is a great place to raise a fam-ily and accentuate a career. For more information visit our website at www.uthscsa.edu. All faculty appointments are designat-ed as security sensitive positions. UTHSCSA is an EqualEmployment Opportunity Affirmative Action Employer.

Contact Information: Please contact or send your CV to DavidHnatow, MD, Chief of Emergency Medicine/South Texas PoisonCenter, 4502 Medical Drive, TX 78229

E-Mail: hnatow@uthscsa.eduPhone: 210-358-2078Fax: 210-358-1972

University of Alabama at Birmingham Fellowship Opportunity

Resuscitation/Critical CareFellowship Co-Directors: Thomas Terndrup, MD tterndrup@uabmc.edu; Jason Begue,MD jbegue@uabmc.edu; Fellowship Length: 1 -2 years. Salary: negotiable, competitive;Deadline for Applications: Rolling, No Deadline; Eligibility: Completion of residencytraining in Emergency MedicineThe Department of Emergency Medicine (DEM) at UAB is seeking physicians residency

trained in Emergency Medicine (EM) for its one or two year Resuscitation Fellowships.The training program was developed and is run by the DEM with the intent of trainingemergency physicians, but is highly multidisciplinary, and now is supported by NIH forresuscitation science training. The objectives of this program are three-fold; (1) to learnadvanced resuscitation and critical care techniques with a concentration on their appli-cation to critically ill patients in the emergency department, (2)to receive training in clin-ical or fundamental research, and (3) to conduct clinical or bench research in resuscita-tion or critical care. Join a multidisciplinary team of investigators from EM, Cardiology,Trauma, and the Joint Health Sciences who will provide mentorship and training. Fundedresearch is supported by NHLBI and HRSA. Degree seeking candidates will require 24months of training.The program is flexible depending on the individual training needs. Currently it consists

of two tracks: (1) clinical directed rotations through various critical care units to includesurgical, medical, trauma/burn, neonatal, neurological, and heart transplant, with facultyfrom other programs serving as facilitators. In additional, opportunity is available for train-ing in various specialty areas (i.e. echocardiography, advanced airway techniques). (2)research directed research training through MPH/MSPH degree at UAB School of PublicHealth, resuscitation interest group mtgs., and participation in research activities underNHLBI Resuscitation Outcomes Consortium grant. UAB has additional resources for con-ducting both clinical and basic science research and training.Interested parties are encouraged to send a curriculum vitae and letter of intent to:

Thomas E. Terndrup, MD, Professor and Chair, Department of Emergency Medicine,Director, UAB Center for Emergency Care and Disaster Preparedness, The University ofAlabama at Birmingham, Department of Emergency Medicine, 619 19th Street South,Birmingham, Al 35249-7013, E-mail (preferred): tterndrup@uabmc.edu, Fax:205.975.4662

University of Alabama at Birmingham Fellowship Opportunity

Disaster Medicine

Fellowship Co-Directors: Thomas Terndrup, MD tterndrup@uabmc.edu; JasonBegue, MD jbegue@uabmc.edu; Fellowship Length: 1 -2 years. Salary: nego-tiable, competitive; Deadline for Applications: Rolling, No Deadline; Eligibility:Completion of residency training in Emergency MedicineWe are seeking applicants for our fifth research fellowship position in DisasterMedicine within the Center for Emergency Care and Disaster Preparedness(CECDP) in the Department of Emergency Medicine. The CECDP is a multidisci-plinary research and service center established in 1999 and has received broadsupport from ~60 faculty members, and funding from the Department ofDefense, AHRQ, FEMA, Department of Homeland Security, CDC, and others.Appropriate training in research methodology, operational experiences, publica-tion and grant preparation are provided. Excellent collaborative research oppor-tunities and advanced training is provided with other investigators at UAB.Candidates must be physicians and those who are eligible or board-certified inEmergency Medicine are preferred. Experience in coordinating multi-disciplinaryconferences and research projects preferred. Other formal educational opportu-nities at UAB are available. Most fellows have completed a single year, but theduration is flexible and compensation is competitive.

Interested parties are encouraged to send a curriculum vitae and letter of intentto: Thomas E. Terndrup, MD, Professor and Chair, Department of EM, Director,UAB Center for Emergency Care and Disaster Preparedness, The University ofAlabama at Birmingham, Department of EM, 619 19th Street South, Birmingham,Al 35249-7013, E-mail (preferred): tterndrup@uabmc.edu, Fax: 205.975.4662

24

Academic Emergency MedicineResearch Faculty Position

Due to an expansion of the faculty, the University of Florida,Department of Emergency Medicine is seeking a full-timeAssistant/Associate Professor with an interest in researchto join our faculty practicing at Shands Teaching HospitalEmergency Department. The Department emphasizes activeinvolvement with emergency medicine residents and medicalstudents. Qualified applicants will be board certified/eligiblein emergency medicine and ability to develop a fundedresearch program is prefered. Faculty will provide clinicalguidance and supervision of treatment delivered in the ED.Shands at UF is the hub of a multi-hospital network.Emergency Medicine medically directs county EMS and hos-pital transport including the ShandsCair helicopter andNASA Medical Support. Excellent compensation, great ben-efits package, great city! Join a progressive, democratic,superb, 13 person faculty group of team players withemphasis on quality emergency care with dedicated cus-tomer service. Anticipated Start date is July 2005.Application deadline is April 30, 2005.

Please send personal statement and CV to :

David C. Seaberg, MD, FACEP, Professor & Associate Chair,Department of Emergency Medicine, University of Florida,PO Box 100186, Gainesville, FL 32610-0392.

Women and minorities are encouraged to apply.

University of Florida is an Equal Opportunity Employer.

25

The SAEM Newsletter is mailed every other month to approxi-mately 6000 SAEM members. Advertising is limited to fellowshipand academic faculty positions. The deadline for the May/Juneissue is April 1, 2005. All ads are posted on the SAEM websiteat no additional charge.

Advertising Rates:Classified ad (100 words or less)

Contact in ad is SAEM member $100Contact in ad non-SAEM member $125

Quarter page ad (camera ready)3.5" wide x 4.75" high $300

To place an advertisement, email the ad, along with contact per-son for future correspondence, telephone and fax numbers,billing address, ad size and Newsletter issues in which the ad isto appear to: Elizabeth Webb at elizabeth@saem.org

University of IowaFaculty Positions

The Department of Emergency Medicine at the University ofIowa is actively seeking clinical and tenure track faculty mem-bers to fill newly created core faculty positions. Competitiveapplicants will have completed an ACGME accredited emergencymedicine residency-training or pediatric emergency medicineprogram and be actively participating in research or residencytraining. Successful applicants interested in either basic scienceor clinical research careers will be aligned with an appropriateNIH funded mentor(s) and receive considerable start up funds tojump-start their academic career. Qualified individuals willreceive significant release time to develop their academic inter-ests. Clinical duties will be performed at the University of IowaHealth Care’s Emergency Treatment Center; the regions onlyLevel I Trauma Center. Individuals selected for these positionswill be involved in Iowa’s only Emergency Medicine training pro-gram. Responsibilities will include teaching and supervisingpediatric and emergency medicine residents. Salaries, sched-ules and fringe benefits are very competitive. Iowa City is a beau-tiful outdoor and family oriented community located along thebanks of the Iowa River just 200 miles west of Chicago. The areaoffers a superb school system and a great lifestyle. Interestedapplicants should send a CV to Eric Dickson, M.D., Head,Department of Emergency Medicine – 1193 RCP, University ofIowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA,52242-1009. Applicable background checks will be conducted.The University of Iowa is an Equal Opportunity and AffirmativeAction Employer. Women and minorities are strongly encouragedto apply.

26

SAEM Medical Student SymposiumMay 21, 2005

The Medical Student Symposium is intended to help medical students understand the residency and career options that exist inemergency medicine, evaluate residency programs, explore research opportunities, and select the right residency. At the com-pletion of the session, participants will: 1) know the characteristics of good emergency physicians and the "right" reasons to seeka career in this specialty, 2) have a better understanding of the application process with regard to letters of recommendation, per-sonal statement, planning the 4th year, etc., 3) consider factors important in determining the appropriate residency, including geo-graphic locations, patient demographics, length of training, etc., 4) understand the composition of an emergency medicine rota-tion and what to expect while they are rotating in the ED, 5) discuss the skills needed to get the most out of your educationalexperience in the ED rotation, 6) Identify the standard sources of information in the field of emergency medicine, 7) have anappreciation of various career paths available in Emergency Medicine, including academics, private practice, and fellowship train-ing, and 8) discover current areas of research in Emergency Medicine. To register for the Symposium, use the online AnnualMeeting registration form at www.saem.org. The cost is $75.

9:00-9:15 Welcome and Introduction, Kevin Rodgers, MD, Indiana University9:15-10:00 How to Select the Right Residency for You, Cherri Hobgood, MD, University of North Carolina

An overview of EM residency programs will be discussed. Important factors to consider in the selection processincluding length of training, geographical location, patient demographics, and academic vs. clinical setting willbe reviewed. The speaker will also discuss the difference between allopathic and osteopathic programs.

10:00-10:30 Getting Good Advice, Wendy Coates, MD, Harbor – UCLA Medical CenterOne of the keys to any successful career is getting and following good advice. How do you choose the rightadvisor(s) and use their wisdom to help your succeed? What do you do when your medical school doesn't havean EM Residency Program? What resources are available to you about the various programs?

10:45-11:45 Navigating the Residency Application Process, Peter DeBlieux, MD, Charity Hospital - Louisiana StateUniversityThis presentation will provide students with tips on how to prepare their ERAS application, how and when tosuccessfully interview and how to follow-up with top programs.

11:45-12:15 The Dean's Letter, Brian Zink, MD, University of MichiganThe speaker, an emergency physician and Dean, will review with the students the components of the Dean'sletter. The importance of your input into the contents of the Dean's letter will be discussed.

12:30-2:00 Lunch with Program Directors2:00-2:45 Getting the Most out of Your EM Clerkship, Gus Garmel, MD, Stanford University

This session will provide the student with valuable tips for getting the most from your Emergency DepartmentClerkship. Specific topics to be discussed will include: 1) appropriate educational goals for an emergencymedicine rotation; 2) how to best prepare for your rotation in order to make the most of your ED experience; 3)recommended textbooks and references; and 4) important considerations when deciding when and where to doyour emergency medicine rotation.

2:45-3:30 Career Paths and Prospects in Emergency Medicine, Carey Chisholm, MD, Indiana UniversityThis session will expose students to a variety of career paths including private practice, academics, and dualtraining (EM-IM / EM-PEDS) as well as fellowship training.

3:45-4:45 Breakout GroupsBalancing Act - Susan Promes, MD, Duke University and Elizabeth Datner, MD, University of Pennsylvania This session will discuss how to optimize your career and personal life.

Financial Planning - David Overton, MD, Michigan State UniversityThis session will review practical tips on financial issues. The speaker will address such issues as how to puttogether a budget and what to so with medical student loan debt.

Optimizing Your Fourth Year - Doug Ander, MD, Emory University This session will provide students with recommendations for making the most of their senior year includinginformation about EM and other electives, research experience, and when to take their Board exams.

Medical Schools without EM Residencies – Kevin Rodgers, MD, Indiana UniversityThis Q&A session will help guide medical students from medical schools without EM residencies through thecomplicated maze that leads to a residency and career in EM. It will specifically address how this processdiffers from those students with a EM residency at their medical school.

5:00-6:30 Residency Fair and ReceptionAll osteopathic EM residency programs are invited to exhibit and should contact elizabeth@saem.org toregister. Last year residency 69 programs participated in the Residency Fair.

27

Chief Resident ForumMay 24, 2005

Chief residency is a demanding and highly responsible position, however little formal and structure preparation is available priorto becoming a chief resident. New chief residents typically have not had the benefit of training in essential administrative,academic, and leadership skills. This one-day course will include a variety of sessions covering administrative and academictopics relevant to new chief residents. Talks and small group discussions will be led by experienced program directors and pastchief residents. All sessions will include ample time for questions. In addition, a lunch session and coffee breaks will provideopportunities for chiefs from different programs to meet and exchange ideas. The small group discussion sessions will also allowfor interaction with workshop faculty and former chief residents.

At the completion of this course, participants will be able to understand basic characteristics of good leadership, managementtechniques, administration and problem solving concepts; have learned successful scheduling and back-up techniques; becomeaware of common pitfalls faced by chief residents; learned effective communication techniques; had the opportunity to discusspotential ethical dilemmas that may arise during the chief resident year; and learned time management techniques.

All chief residents registered to attend the Annual Meeting are invited to register for the special Chief Resident Forum. Enrollmentis limited and the fee is $100, in addition to the basic Annual Meeting registration fee. Use the online Annual Meeting registrationform to register for the Annual Meeting and the Chief Resident Forum.

7:30-8:00 am Registration and Continental Breakfast

8:00-8:45 am So You’re Chief Resident. What Does that Mean?, Stephen Playe, MD, Baystate Medical CenterThis session will explain the various roles and requirements of chief residents.

8:45-9:45 am Leadership and the Management Role, Robert Hockberger, MD, Harbor-UCLA Medical CenterThis session will describe the scope of authority and responsibility in your role and explain leadershiptheories focusing particularly on action-centered leadership.

9:45-10:00 am Break

10:00-11:00 am Effective Communication, Marc Borenstein, MD, Newark Beth Israel Medical Center Communication is a key element to the success of any leader. At the end of this discussion, participantswill understand how to build effective communication networks, identify the key communication skillsrequired to manage staff, explain formal and informal communication networks, facilitative questioning,active listening, and describe the principles of giving and receiving feedback.

11:00-12:00 noon Developing a Schedule, Kevin Rodgers, MD, University of Indiana (moderator)The emergency department schedule is a central element of any chief resident’s responsibility. Thisdiscussion will outline the RRC requirements for scheduling in EM, suggest tips for managing thecomplexities of an ED work schedule and explain mechanisms for dealing with sudden changes.

12:00-1:30 pm Lunch - Question and answer session

1:30-2:15 pm Professional Growth, Sandra Schneider, MD, University of Rochester This session will illustrate strategies for successful career development, describe various routes toadvancement and describe the challenges and barriers to promotion.

2:15-3:00 pm Ethics and Professionalism, James Adams, MD, Northwestern UniversityAs chief resident, you may confront a new series of ethical dilemmas. This session will highlight ethicaland confidential issues that involve other residents and describe how to set professional examples forothers.

3:00-3:45 pm Time Management, Susan Promes, MD, Duke UniversityAt the end of this session, participants will understand what you can realistically achieve with your time,recognize the importance of prioritizing To-Do lists and describe time management principles that can helpyou in your role as chief resident.

3:45-5:00 pm Lessons Learned - Panel discussion of former chief residents

Board of DirectorsCarey Chisholm, MDPresident

Glenn Hamilton, MDPresident-Elect

Katherine Heilpern, MDSecretary-Treasurer

Donald Yealy, MDPast President

Leon Haley, Jr, MD, MHSAJames Hoekstra, MDJeffrey Kline, MDMaria Raven, MDRobert Schafermeyer, MDSusan Stern, MDEllen Weber, MD

EditorDavid Cone, MDDavid.Cone@yale.edu

Executive Director/Managing EditorMary Ann Schroppmschropp@saem.org

Advertising CoordinatorElizabeth Webbelizabeth@saem.org

“to improve patient care byadvancing research andeducation in emergencymedicine”

The SAEM newsletter is published bimonthly by the Society for AcademicEmergency Medicine. The opinions expressed in this publication are those of the

authors and do not necessarily reflect those of SAEM.

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

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U.S. PostageP A I D

Lansing, MIPermit No. 485

SAEM

Newsletter of the Society for Academic Emergency Medicine