PRESIDENT’S MESSAGEAs you read this, most of you

will have recently taken some timeoff for a summer vacation. Thosewith children will be gearing up foranother school year. We’ve saidour goodbyes to a group of gradu-ates, and welcomed their succes-sors. New faculty have been ori-ented. Overall, there seem to befewer deadlines looming over usduring the summer months. Sum-mer marks the renewal of the aca-demic calendar, and a chance forreflection and future goal setting.

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

Each year the quality and style of the BOD has changed,reflective of the individuals’ expertise, experiences, andinterests. I have been impressed that the BOD has alwaysattempted to serve the mission statement of the organizationas its top priority. The style is a microcosm of governancepracticed on grander scales. This involves four distinct com-ponents: stewardship, leadership, the “crisis” of opportunityand the crisis of disaster management.

Most of the BOD activity appropriately is stewardship. Isay “appropriately” because SAEM has become an estab-lished entity with a clear mission and purpose. In a stew-ardship capacity, the BOD decisions will reflect a tendencyto the status quo. Although cognizant that the organizationmust continue to evolve in order to meet the demands of anever-changing world, decisions tend to be conservative,debate is often brief, and a strong indication of favorablereturn on investment or risk-benefit ratio mandated. Con-sensus is easily obtained, and votes are often unanimous.Decisions are widely accepted by the membership, withfewer than 20% thinking the course to be in error. Stabilityreigns. An overall sense of comfort predominates.

The danger of the stewardship role is the potential forcomplacency, low goal setting, underachievement, and lostopportunity.

I have also observed the BOD in the “leadership” role.This includes visionary thinking, risk, and greater potentialfor failure. Debate is often lengthy, consensus may be slowin developing, and votes can be split nearly evenly for and

Carey Chisholm, MD

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SAEM

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

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”

AEM goes to on-line submissions!The Editorial Board of AEM is pleased to announce that on-

line submission is now available for Academic EmergencyMedicine via the Elsevier Editorial System (EES). The easiestway to access the system is from the front page of the SAEMweb site at www.saem.org or directly at http://ees.elsevier.com/acaeme/default.asp.

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

EES is an Internet-based tool that can be accessed from any-where in the world and works on multiple platforms. Available24/7, the on-line submission system uploads files directly fromyour personal computer, and allows you to track the progress ofyour paper through the peer-review process. On-line submissionand peer-review speeds up the whole publication process.

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

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

SAEM Research Fund Katherine Heilpern, MDEmory UniversitySAEM Secretary/Treasurer

The purpose of the SAEM Research Fund is to provide train-ing grants and other funding opportunities for SAEM members,emergency medicine residents and medical students.

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

CPC Finals CompetitionThe six semi-finalist presenters and discussants will compete

in the CPC Finals Competition during the ACEP ScientificAssembly in San Francisco on October 18 at 1:00-5:30 pm.Registration is not required. All are welcome. The CPC is spon-sored by ACEP, CORD, EMRA and SAEM.

2

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

The SAEM Board of Directors will review all nominations and submit a slate of nominees to ABEM by December 1, 2004.Successful candidates are expected to be members of SAEM with considerable experience in SAEM and academic EM,as well as experience in ABEM. The SAEM Board does not nominate current members of the SAEM Board for consider-ation. In addition, ABEM has established the following criteria for nominated physicians:

● Be a graduate of an ACGME-accredited EM residency program.● Be an ABEM diplomate for a minimum of ten years.● Have demonstrated extensive active involvement in organized EM. Ideally, this includes long-term experience as an

ABEM item writer, oral examiner, or ABEM-appointed representative.● Be actively involved in the clinical practice of EM.

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

Call for Papers2005 AEM Consensus Conference

"Research Ethics: Informed Consent and Research without Consent"Deadline: March 1, 2005

Clinical research hinges on the ability of investigators to identify, recruit and enroll human subjects into clinical tri-als. The process of informed consent for research participation is designed to protect potential research subjects byeducating them about the trial and their rights as participants, allowing them to ask questions regarding the studyand their role, and assisting them in making an informed decision about research participation.

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

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

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

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

3

Call For NominationsYoung Investigator Award

Deadline: December 17, 2004

In May 2005, SAEM will recognize a few young investigators who have demonstrated promise and distinction in theiremergency medicine research careers. The purpose of the award is to recognize and encourage emergency physicians/sci-entists of junior academic rank who have a demonstrated commitment to research as evidenced by academic achievementand qualifications. The criteria for the award includes:1. Specialty training and certification in emergency medicine or pediatric emergency medicine.2. Evidence of significant research collaboration with a senior clinical investigator/scientist. This may be in the setting of a

collaborative research effort or a formal mentor-trainee relationship. 3. Academic accomplishments which may include:

a. postgraduate training/education: research fellowship, master’s program, doctoral program, etc.b. publications: abstracts, papers, review articles, chapters, case reports, etc.c. research grant awardsd. presentations at national research meetingse. research awards/recognition

The candidate must have training and board certification in emergency medicine or pediatric emergency medicine. Criteriataken into consideration in determining the award recipient include prior research grant awards, publications, presentation, andother awards. Research grant awards are most highly weighted, especially if from federal or major foundation sources.Research publications will be weighted based on their quality and number. Publication in high impact or moderate impact jour-nals will be weighted higher than publications in low impact journals. Research presentations at national meetings and non-monetary awards will be given relatively less weight in the overall evaluation.

The deadline for the submission of nominations is December 17, 2004, and nominations should be submitted electronicallyto saem@saem.org. Nominations should include the candidate’s CV and a cover letter summarizing why the candidate meritsconsideration for this award. Candidates can nominate themselves or any SAEM member can nominate a deserving young in-vestigator. Candidates may not be senior faculty (associate or full professor) and must not have graduated from their residen-cy program prior to June 30, 1998.

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

Call for Abstract ReviewersDeadline: October 1, 2004

The Program Committee is currently accepting applications to serve as expert reviewers of scientific abstracts submittedfor consideration of presentation at the 2005 Annual Meeting, which will be held May 22-25 in New York. The minimumrequirement for new abstract reviewers is at least 2 first author peer-reviewed original research manuscripts in the topicarea for which you are applying. Residents are invited to apply but must meet the same criteria. If you have been anabstract reviewer in the past 5 years, you do not need to reapply.

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

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

● abdominal/gastrointestinal/genitourinary

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

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

● pediatrics● psychiatry/social issues● research design/methodology/

statistics● respiratory/ENT● shock/critical care● toxicology/environmental injury● trauma● wounds/burns/orthopedics

Emergency Medicine Sessions to be Held During AAMC Annual MeetingThe Association of Academic Chairs

of Emergency Medicine (AACEM) andSAEM are planning a number of ses-sions to be held on Saturday, November6 during the Association of AmericanMedical Colleges (AAMC) Annual Meet-ing in Boston at the Marriott CopleyPlace.

New EMTALA Regulations and TheirEffect on Medical Specialties‚ Capabili-ties at Community Hospitals: A Threatto Tertiary Care Centers, 8:30-10:00am, Nantucket Room. This session willbe moderated by Dave Sklar, MD, Chair,Department of Emergency Medicine,University of New Mexico. Speakerswill include: Robert Bitterman, MD, JD,Director of Risk Management, Depart-ment of Emergency Medicine, Carolinas

Medical Center; Ms. Sandra Sands,Senior Counsel at the Office of theInspector General, Office of the Counselto the U.S. Department of Health andHuman Services, Timothy C. Flynn,Department of Surgery, University ofFlorida, and Charlotte Yeh, MD. Thissession is sponsored by AACEM andSAEM.

From Observation to Acute CareMedicine, 10:30-12:00 noon, Nantucket.This session will be moderated by GabeKelen, MD, Chair, Department of Emer-gency Medicine, Johns Hopkins Univer-sity. Speakers will linclude: Louis Graff,MD, Professor, Department of Emer-gency Medicine, University of Connecti-cut; James Hoekstra, Chair, Depart-ment of Emergency Medicine, Wake

Forest University; and Sandra Schnei-der, MD, Chair, Department of Emer-gency Medicine. This session is spon-sored by AACEM.

The above educational sessions areopen to all members of AACEM andSAEM at no charge, however, pre-regis-tration is requested. Please register bysending an e-mail to: saem@saem.org

AACEM will convene a BusinessMeeting at 12:00-1:30 pm in the Ver-mont Room. All members of AACEMand their guests are welcome, however,pre-registration is required. Please reg-ister be sending an e-mail to:saem@saem.org Lastly, the AACEMExecutive Committee will meet at 1:30-3:00 pm in the MIT Room.

4

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

Louis Binder, MDMetroHealth Medical CenterEmily Senecal, MDStanford UniversityJonathan Fisher, MDAlbert EinsteinCherri Hobgood, MDUniversity of North Carolina Chapel HillSAEM Undergraduate Education Committee

The Association of American Medical Colleges (AAMC)serves as the umbrella organization for member medicalschools, teaching hospitals, and specialty societies in medi-cine. Each of these three groups has a convening councilwithin the association, tied to the leadership and governingstructure of the AAMC. The association concerns itself withboth the functions of its constituents, and with issues of impor-tance to academic medicine, such as reimbursement issues,research infrastructure, faculty practice, fiscal practice andbudgeting, clinical operations in academic environments, pub-lic affairs, student affairs, and most importantly, medical edu-cation. The largest section within the AAMC meeting is spon-sored by the Group on Educational Affairs (GEA), whichattracts deans and faculty interested in education to a varietyof presentations and informative sessions. Over the four daysof the GEA meeting, a variety of educational formats areemployed: topical sessions on issues of interest; interestgroup sessions that attract faculty with common interests (seeFigure); mini-workshops (small group sessions focused on anarea of personal development for medical educators, such asgiving feedback or writing multiple choice questions); educa-tional research presentations and poster sessions featuringoriginal research in medical education; and Innovation in Med-ical Education poster sessions (similar to what is presented atthe SAEM Annual Meeting, only much larger and morediverse, touching every aspect of medical education).

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

with an interest in undergraduate medical education will find atremendous variety of topics, formats, useful information ses-sions, and skill development sessions that will match theirinterests and aid their growth in medical education. Addition-ally, the opportunity for meeting, networking, and collaboratingwith like-minded individuals across other schools, both in theU.S. and internationally, are extensive. Dr. Louis Binder hasbeen attending the AAMC meeting regularly for the past 20years, and views it as his best opportunity for “CME” and per-sonal development in medical education. He always finds sev-eral sessions that are useful, and that provide information andskill development that he can subsequently use when hereturns home.

The 2004 AAMC GME Meeting will be held in Boston fromNovember 7-10, 2004. Preliminary program information canbe found at the AAMC website at www.aamc.org/meetings/annual/2004 (the AAMC meeting program) andwww.aamc.org/members/gea/start.htm (the GME meeting pro-gram). Particular sessions this year that may be of interest toEM educators fall in three sections of the GME meeting: GEASmall Group Discussions, GEA/GSA mini-workshops, andResearch in Medical Education (RIME) paper/poster presen-tations and discussion groups. Each of these sections has alink on the GEA website that allows one to find descriptions ofsessions that will be held this year. The attached figure listshighlights of sessions that will be offered, providing a sense ofthe breadth and relevance of the sessions.

(continued on next page)

5

FIGURE

Selected GME Small Group Discussion Sessions at the 2004 AAMC Annual Meeting

Managing the Resident in DifficultyFaculty Development in International Medical EducationLearning Communities in Medical Education360 Degree EvaluationDean’s Letters (Medical Student Performance Evaluations)Academic Faculty CompetenciesDeveloping Professionalism in Students and Residents (several sessions)Conceptual Models for Professionalism in Medical EducationEducational Evaluation, Educational Research, and the IRBThe Scholarship of Teaching/EducationEducational TechnologyAssessing the Competencies – Current Best PracticesEarly Detection/Prevention of Student ProblemsBuilding Clinical Simulation CentersBest Practices in Student Academic Review and PromotionComponents of Education Program Evaluation (two different sessions)Preparing Medical Students for USMLE Step 2 Clinical Skills ExamRemediating Student Clinical Practice Exam PerformanceUsing Standardized Patients to Help Identify Clinical Skills Deficiencies in Students

Selected GME/GEA Mini-Workshop Sessions at the 2004 AAMC Annual Meeting

Video Tools to Teach Communication Skills to StudentsGuide for Interactions Between Residents and the Pharmaceutical IndustryTeam Based Learning (two different sessions)Curriculum for Students’ Transition to the WardsPersonal Survival Skills for Academic FacultyFaculty Development Workshops in Systems Based Practice and Practice Based Learning and Improvement (two different sessions)Reviewing Educational Research ManuscriptsAnalyzing Qualitative DataDesigning Mentorship Programs (two different sessions)Dealing with the Problematic Medical Teacher in your Clerkship

Selected RIME Paper/Poster Sessions and Discussion Groups

Professional Deficiencies as M1’s Predict Poor Clinical PerformanceEvaluation of Professionalism as Observable Behaviors (many others that cover professionalism)Common Peer Assessment Tools of Physicians Across SpecialtiesEthnicity and Clinical Skills EvaluationDeveloping Web Based Cases for Medical Student TeachingIntegrating Basic and Clinical Sciences in the M4 YearVirtual Reality and Brain AnatomyDirect Observation in Clerkship RatingsResearch in Medical Career Decision MakingResident Fatigue and Incidence of Medical ErrorsErrors in SurgeryHigh Fidelity Human Patient Simulation in Junior ClerkshipsHuman Patient Simulation to Teach Basic SciencesEye Simulators to Measure Students’ Clinical Skills in OphthalmologyEffectiveness of M4’s and Teaching AssistantsDeveloping Resident AutonomyReliability/Validity in Resident InterviewingPortfolios and ACGME CompetenciesTeaching Practice Based Learning and Improvement

Beyond the GME meeting, the AAMC meeting itself hasother sessions devoted to other aspects of academic medicinethat may be of individual interest. There are also other high-lighted and plenary sessions for all AAMC attendees that focuson issues of broad importance to academic medicine. Thisyear, these include the AAMC President’s Address by Dr. Jor-dan Cohen; a Keynote Address by Ellen Goodman, a PulitzerPrize winning columnist; a presentation by Julie Gerberding,Director of the CDC; a political spotlight session by RobertReich (Secretary of Labor, Clinton Administration) and AlanSimpson (former Senator from Wyoming) which will be heldone week following the November elections, dissecting theoutcomes; a presentation by James Anderson, CEO of Cincin-nati Children’s Hospital, on Partnerships in International Med-

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

We urge you to consider attending the AAMC GME meet-ing. A high level of participation by EM educators raises theprofile of our educational efforts nationally in medical educa-tion, and allows for greater faculty development, interdepart-mental collaboration, and sophistication of our educationalefforts. We would be happy to answer anyone’s questionsabout the meeting, or particular sessions, at our respective e-mail addresses or telephone contacts (through the SAEMdirectory or through the SAEM office at saem@saem.org).

Attractions for Emergency Medicine… (Continued)

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The NIH Roadmap Ilene Wilets, PhDMount Sinai School of MedicineSAEM NIH Roadmap Task Force

There is an impressive new initiativeunderway at the National Institutes ofHealth (NIH) which can potentially opendoors for the emergency medicineinvestigator. In May 2002, Elias A. Zer-houni, MD, the Director of the NIH, con-vened a number of meetings to chart a“roadmap” for medical research in the21st century. The purpose was to identi-fy the major scientific challenges in bio-medical research and to address theroadblocks to progress. It was deter-mined that no one Institute at the NIHcould accomplish this task alone, andthat the agency must address this prob-lem as a whole.

The roadmap represents the culmi-nation of opinion from more than 300nationally recognized leaders in acade-mia, industry, government, and the pub-lic. It is a broad initiative whose primarygoal is to accelerate the pace and effi-ciency of clinical research so that moreand better therapies reach patientsnationwide.

There are several themes compris-ing the roadmap, some of which will beof greater interest to the emergencymedicine practitioner than others. Thefirst theme, “New Pathways to Discov-ery”, focuses on molecular and cellularbiology, including bioinformatics andnanomedicine. Given the relativelysmall percentage of EM investigatorswho are involved in laboratory work, thisagenda will likely have limited signifi-cance for us.

However, another roadmap theme,entitled “Research Teams of theFuture," should prove more important toemergency medicine. It focuses on theneed for interdisciplinary researchteams of physicians from a broad arrayof specialties, across numerous institu-tions. No longer will all research for aclinical trial stem from a lone principalinvestigator from a single academiccenter. The NIH is encouraging betterintegrated networks of academic cen-ters to work together on clinicalresearch. This initiative also promotesthe development of new partnershipsamong organized patient communities,and community-based physicians who

care for sufficiently large groups of well-characterized patients. Involving com-munity practitioners in clinical researchis a smart way to access eligiblepatients for inclusion in clinical trials. Asmany investigators are well aware, sev-eral important studies are languishingdue to limited subject recruitment.

The third roadmap agenda, “Re-engineering the Clinical ResearchEnterprise," is expected to have themost profound effect on emergencymedicine research. A major goal of thiseffort is to greatly reduce the time ittakes to conduct patient-centered clini-cal evaluation of new and promisingtherapies. The NIH recognizes that theclinical research process has stalled,largely due to the increasingly complexfederal regulation of drug, devices, andbiologics.

In addition, the duplication ofresearch efforts among investigatorshas contributed to the slowing of theclinical research process. Given thevast number of therapies, diagnostics,and treatments that must be evaluatedthrough clinical trials, many clinicalresearch networks operate simultane-ously and independently of each other.Consequently, researchers sometimesduplicate already existing data becausethey were unaware of their existence, orbecause they could not access thesedata. To counter the problem of duplica-tion and overlap in clinical trials, theNational Electronic Clinical Trials andResearch Network (NECTAR) wasestablished. NECTAR is a blueprint fora national informatics network usingstandardized data, software tools, andnetwork infrastructure. This system willdovetail with current medical informaticsinitiatives in the Department of Healthand Human Services and other existingand newly created networks. The stan-dardization of data collection and report-ing will facilitate data sharing and sam-ple sharing among studies. This reduc-tion in study redundancy will yield moretime and funds to address additionalresearch questions.

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

The scientific workforce is consideredone of our nation’s greatest resources.To pave the way for scientific progress,the NIH is committing vast resources forthe training of clinical investigatorsacross disciplines. This initiative couldprovide tremendous opportunity for theearly or mid-career emergency physi-cian interested in skills developmentand career enhancement. Throughtraining programs and grant funding,individuals will be selected and men-tored to conduct clinical studies in inter-disciplinary, team-oriented environ-ments. The emphasis will be on newstrategies and curricula with trainingopportunities that span a wide variety ofdisease areas and a broad range of clin-ical disciplines. The Clinical WorkforceTraining program will complement otherNIH training programs that supportscholars who wish to become clinicalinvestigators.

The roadmap presents a greatopportunity for emergency medicine tobe vocal in discussions about biomed-ical research on a federal level. TheSAEM Roadmap Task Force will work toensure that our discipline is well posi-tioned to positively influence NIHresearch activities. The first item on theTask Force agenda is to connect withleading officials at each of the NIHagencies. We believe it is imperative toarticulate the mission of SAEM and itsmembership to all influential parties atthe NIH.

The Task Force is comprised ofemergency medicine professionals fromnumerous institutions across the coun-try, including: Roger J. Lewis, MD, PhD(Harbor-UCLA Medical Center); CliftonW. Callaway, MD, PhD (University ofPittsburgh School of Medicine); RobertW. Neumar, MD, PhD (University ofPennsylvania); Craig D. Newgard, MD(Oregon Health & Sciences University);Ilene Wilets, PhD (Mount Sinai MedicalCenter); Robert O. Wright, MD, MPH(Children’s Hospital, Boston). For addi-tional information on SAEM RoadmapTask Force activities, please contact Dr.Roger Lewis: roger@emedharbor.edu.

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SAEM Consulting Service Report and InformationGlenn C. Hamilton, MDWright State UniversityChair, SAEM Consulting Service

The SAEM Consulting Service completed six consultationsduring the 2003-2004 academic year, many at academic med-ical centers applying for new residency programs. With theirpermission, here is feedback from two of the sites:

“I would rate your consultant’s visit as an A+. He man-aged…to identify the key issues and broad themes wewould need to address with the RRC site visitor, and heastutely picked upon the spirit and the soul of the pro-gram.” Mark S, Smith, MD, Professor and Chairman,Washington Hospital Center and Georgetown Universi-ty School of Medicine.

“We found the consultant to be very prepared with goodinsight and reasonable recommendations. It was partic-ularly helpful when he provided a ‘disinterested party’view when discussing funding and departmental statuswith our Chair of Surgery.” Deana Young, Assistant Pro-fessor, University of Nevada School of Medicine

The SAEM Consulting Service is well prepared to offer its con-siderable capabilities to interested parties in our specialty.Although a variety of services are available, our primaryexpertise is in the following:

1. Establishment of an EM residency: This consult is inadvance of application to the ACGME and RRC-EM forconsideration of a new EM residency. The consultation willassess the suitability and potential of the site for residencytraining and assist in the development of the program infor-mation forms required by the ACGME.

2. “Mock” survey prior to RRC-EM site survey: this serviceserves as a preparatory guide for new programs or as a“dress rehearsal” for re-accrediting residencies preparingfor their official site survey by the RRC-EM. This is a use-

ful process for making sure the issues of potential concernby the RRC-EM are addressed, and convincing institution-al administration of the benefits of EM and its continuedsupport.

3. Program Information Form (PIF) Review: This new serviceis a detailed review of the PIF for new or re-accrediting pro-grams in advance of submission to the RRC-EM.

4. Research Consultation: This relatively new aspect of theservice helps programs develop a research program suit-able to their environment.

5. Faculty Development: EM remains one of the few special-ties that requires faculty development as part of its pro-gram requirements. Programs that are initiating or havingdifficulty in this area may request a faculty developmentconsultation to assist in planning effective program for theirfaculty.

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

The SAEM Consulting Service has played a significant role insustaining the quality of many EM residencies and assistingnumerous program directors in developing and creating solu-tions to their problems. We look forward to assisting interestedinstitutions in addressing their resident program or academicdevelopment needs. Please contact me directly atglenn.hamilton@wright.edu (937-395-8839) or through SAEMsaem@saem.org for further information and assistance.

Board of Directors UpdateThe SAEM Board of Directors meets

monthly, usually by conference call.This report includes the Board highlightsfrom the June 8 and July 13 conferencecalls.

The Board nominated Robert Bitter-man, MD, JD, for consideration as amember of the EMTALA Advisory Com-mittee. The Board elected Ellen Weber,MD, to serve on the Nominating Com-mittee, as required by SAEM Constitu-tion and Bylaws.

The Board approved the proposal ofthe Undergraduate Committee to fundan emergency medicine submission tothe Innovation in Medical EducationExhibit during the Annual Meeting of theAssociation of American Medical Col-leges. The Board approved an applica-tion for a satellite conference to be heldprior to the 2005 SAEM Annual Meeting.

The Board approved a request fromthe American College of EmergencyPhysicians to provide a letter ofendorsement for a proposal that theAgency for Health Research and Quali-ty (AHRQ) undertake an evidencebased practice review of the literature oftriage systems.

The Board approved a six monthsfinancial report that indicated$1,578,012 in revenue and $790,830 inexpenses. The Board noted that nearlyall revenues for the calendar year hadbeen received, but that approximatelyhalf of the expenses for the year had notyet been received. The Board approvedthe recommendation that a $250,000contribution to the SAEM ResearchFund be made.

The Board agreed to undertake areview of the Society's position state-

ments and policies. Working groups ofthe Board will report to the entire Boardat the September Board conferencecall.

The Board approved the document,"Standardized Reporting Guidelines forStudies Evaluating Risk Stratification ofEmergency Department Patients withPotential Acute Coronary Syndromes."The Board approved an editorial writtenby Dr. Chisholm and Dr. Yealy that wassubmitted to the journal, CHEST, forconsideration.

The Board will meet during theACEP Scientific Assembly on Sunday,October 17, 12:00-5:00 pm in the SierraB Room of the San Francisco MarriottHotel. SAEM members are invited toattend.

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Ethics Corner: Drugs on Line: Ethics on the ‘Net'Jason A. Hughes, MDUniversity of IowaSAEM Ethics Committee

No doubt, if you have been surfingon the Internet lately, you have wit-nessed the mushrooming of pharma-ceuticals available to the general publicon-line. This incredible increase in theuse of such pharmaceuticals that arebeing prescribed by non-customarymeans should be an ethical concern fornumerous reasons. This article willaddress a few of the ethical issues thatcould become key points as this slightlyskewed drama on the internet contin-ues.

As if predicting the dangerous possi-bilities of internet pharmaceutical sells,a 1999 article in JAMA addressed theissue. At the time, three state boardshad taken action against physicians pre-scribing over the internet without truepatient-physician contact.1 In a laterissue of JAMA, actual guidelines formedical and health information siteswere published.2

The question remains as to whetherany of this information could affect thefield of emergency medicine. It certainlyseems to have potential, as manypatients might not regard their onlineprescriptions as authentic prescriptions.As a result, patients also might notdeclare these medications to an emer-gency physician due to embarrassmentor due to potential legal ramifications.Untoward and possibly life threateningside effects could result from this vacu-um of knowledge. Finally, as there arefew controls on most of these pharma-ceuticals, patients may even be receiv-ing tainted or placebo medications.3

Physicians in general have licensesin the states where they practice. Theypay for these licenses, and further feesare required for their continuation. Train-ing is imperative for attaining and main-taining the licenses. Many on-line com-panies touting the sale of “controlledsubstances” through the internet arehaving physicians in other states orcountries writing the prescriptions.3 Inan on-line warning to consumers, theFood and Drug Administration suggest-ed numerous risks involved in these on-line proceedings. One such risk is thatmedications could be tainted. Anotherrisk includes the potential side effects ofthe medications and the lack of physi-cian supervision to assist the patientwith these side effects.4 Even moreimportantly, at times there appears to be

no physician intervention in the pre-scribing of medications fraught with sideeffects, drug interactions, and othersuch concerns. There is a true lack ofcontrol and the ethical issues are mostnumerous.

This author has performed two inter-esting exercises in order to find outmore information concerning the pre-scribing of medications on line. Havingbeen the victim of far too many “pop-up”advertisements on one particular day,this author finally took the initiative to e-mail one of these on-line drug compa-nies. The questions that started the dia-logue included: (1) Can someone sendmedications on-line without knowing thenature of the patients’ medical problemsand other medications that he/she istaking? (2) Who has the responsibilityfor any patient malfeiscence, and underwhat jurisdiction would a poor outcomebe initiated? (3) Finally, if medicationscan be prescribed in this manner andwithout apparent physical or mentalexamination, why do physicians whoprescribe in a more conventional man-ner require a DEA license, a state med-ical license, in some cases a state con-trolled substances license, and years oftraining and practice?

The answers to the e-mail weresomewhat shocking, and our ethicalconcerns for our patients now requireheightened “e-wareness”. The gentle-man who answered the questionsreplied that his company does not “pre-scribe” medications, but the company isone of many that “direct” patients tocompanies that do send out such med-ications as Viagra, anti-hypertensives,antidepressants, and other medicationsthat could be potentially dangerous.Thus, it appears that there are internettiers that direct patients to other web-sites and medication markets in order tocloud over the actual entity that is send-ing the medications out to the patients.

A second above-mentioned trial bythis author was even more intriguing.Receiving numerous “spam” e-mailsabout how one could buy Prozac on-linewithout “doctor interference”, an orderwas placed for this medication. An e-mail was then shot back in a shortamount of time purporting to ask med-ical questions in order to assist “thepatient” in making sure this was the cor-rect choice of medications. Obviously,

anyone could fill in the questionnaireany way he or she wanted to; this wouldbe without the direct patient-physiciancontact and the nuances of non-verbalcommunication. In five days, 30 pills ofProzac were shipped; it would seemimportant to mention that these pillsappeared to be Prozac, but in reality,how is someone to know that they arenothing more than placebo or tainted insome other way?

In conclusion, the internet and theanonymity afforded by it could potential-ly be harmful to the very patients thatrequest prescriptions. It should be notedthat there are credible pharmacies onthe “web”; they are recognized on theNational Association Boards of Pharma-cy Website and many state boards alsolist them.5 In one exercise noted above,“prescribing tiers” seem to allow thoseinvolved in this type of practice a truelack of responsibility. The other exercisewas merely a test to see if receivingmedications on-line was as easy asmentioned in these advertisements.

As educators of medical studentsand residents, our obligation to the pub-lic and our ethical considerations for ourpatients have met even a greater chal-lenge.

Awareness of medication “prescrib-ing” without responsibility and without apatient-physician alliance will be impor-tant issues to address in our residencyprograms. Also, continued requeststhrough the DEA and other governinginstitutions should be made to eitherstop the practice altogether, or to at aminimum to impose the same regulato-ry standards to internet prescribing thatapply to all other forms of prescribing.

As for the Prozac received on-line?After reviewing the fact that there wasno physician listed on the label of the“prescription” nor a responsible groupfor the medication, the householdplumbing received a large dose of pur-ported antidepressants. The plumbingdid not seem to work any better after anoverdose of 30 Prozac pills.

It may be time to work on better reg-ulation for the benefit of those who needthe help of a responsible medicalprovider to provide the important com-munication, concern, and follow-upappointments that an on-line prescrip-tion cannot generate. Our duty is to first

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Ethics Corner (Continued)

“to do no harm”; sometimes thisrequires a proactive approach to con-cerns such as prescribing on the inter-net.

References1. Marwick, C. Several groups

attempting regulation of internet rx.JAMA. 1999; 281:975-976.

2. Winker M, Flanagin A, Chi-Lum B, etal. Guidelines, for medical andhealth Information sites on the inter-net. JAMA. 2000; 283:1600-1606

3. Federal Food and Drug Administra-tion (FDA). Buying prescriptionsonline. Retrieved July 14,2004 fromwww.fda.gov/oc/buyonline/default.htm

4. National Association Boards ofPharmacy. VIPPS (Verified InternetPharamcy Providers). RetrievedJuly 12, 2004 from http://nabp.net/vipps/consumer/listall.asp

The SAEM Ethics Committee has a con-sultation service (see below) for thosewho have had difficult issues along thisline. This article is designed to generatea dialogue between our residents andresident educators. If you have anyquestions or concerns, please contacthughestex@sbcglobal.net and the com-mittee as a whole will become involvedin a timely manner.

SAEM Ethics Consultation Service Emergency physicians are faced

with countless ethical dilemmas. Wemake choices based not only on ourknowledge but also on our personalbeliefs and value systems.Occasionally, an ethical issue arisesthat is outside our world view or consid-eration, or a situation confronts us thatmakes us uncomfortable. We may lackthe knowledge to make a reasonablechoice, we may be faced with some-thing totally out of our experience, or wefeel at a loss because we cannot deter-mine the possible options. We may wit-ness an ethically questionable act, mayobserve unprofessional and possiblyharmful actions, may disagree about thecorrectness of another’s decision, ormay feel we ourselves are being sub-jected to exploitation, abuse, or otherunethical behavior. Such situations arefrightening; it is difficult to distinguishreality from perception, to know who can

be approached for advice, or whereresources can be found to assist indeveloping an appropriate response.

Some institutions have committeesor other authoritative bodies designed toexamine grievances, allegations of sci-entific misconduct or specific ethicaldilemmas in clinical practice. The adviceof these groups, however, may havelimited applicability to emergency medi-cine; they may not include emergencyphysicians, or have the expertise torelate to the unique aspects of the ethicsof emergency medicine. In addition,these groups are charged with develop-ing a response to a particular crisis thathas arisen locally. They are goal direct-ed and not necessarily able to provide athoughtful method to educate beyondthe concrete response to the problem athand.

For these reasons, SAEM has devel-oped an Ethics Consultation Service to

assist SAEM members with questionsconcerning ethical issues or decisionsthey must make during the course oftheir clinical, academic or administrativeresponsibilities.

Opinions from the EthicsConsultation Service will be offered toSAEM members in a timely manner;requests from nonmembers will be con-sidered on a case by case basis. Theopinions rendered are not meant to bepart of an ‘appeal process.’ All commu-nications will be anonymous and confi-dential. However, because many ethicalissues confronting emergency physi-cians are universal in their scope, andothers may learn from the issue pre-sented, we hope to develop a series ofarticles for publication, assuming thatconfidentiality can be maintained. Allrequests, inquiries, or correspondenceshould be directed to saem@saem.org.

American Geriatric Society ReportLowell W. Gerson, PhDNortheastern Ohio UniversitiesSAEM Representative to AGS Council on Surgical and Related Medical Specialties

We all appreciate the complexity oftreating older patients who present toEDs. Other specialists face the sameissues in treating older patients. More-over, there are not enough geriatricianstoday, and the situation is likely to getworse. The John A. Hartford Founda-tion, recognizing the need for improvingspecialists’ skills in treating olderpatients, funds The American GeriatricsSociety (AGS) Council on Surgical andRelated Medical Specialties. Emer-gency Medicine is one of the ten spe-cialties that participate in the project.SAEM has a seat on the Council, whichholds a business meeting and scientificprogram as part of the AGS Annual Sci-entific Meeting. This year, the scientificprogram had three main sessions: pre-sentations from the Research AgendaSetting Process, a panel on preopera-tive management of the surgical patient,and posters presented by the JahnigenScholars.

The Jahnigen Scholars programoffers two-year career developmentawards ($75,000 per year for salary andfringe benefits, plus $25,000 per year tosupport costs of doing research) to sup-port junior faculty in the ten specialtiesof the Council. The award is intended toallow individuals to initiate and sustain acareer in research and education in thegeriatrics aspects of their discipline.

Five of the thirty Jahnigen awards havebeen SAEM members. This is an out-standing opportunity for members whohave leadership potential and wish todevelop careers in geriatric emergencymedicine. You can find more informationabout this program at http://www.amer icanger ia t r i cs .o rg /har t fo rd /scholars_award.shtml.

The PDA version of Geriatrics atyour Fingertips was announced duringone of the intermissions. It is designedto provide immediate access to specificinformation needed in caring for olderpatients and is available athttp://www.americangeriatrics.org.

The scientific program had a capaci-ty audience of well over 200 people.Scott Wilber, MD, an SAEM memberand Jahnigen Scholar, presented theemergency medicine/trauma careresearch agenda. The full researchagenda has been posted on line athttp://www.frycomm.com/ags/rasp/.

The day ended with a reception andunmoderated poster session that includ-ed work from the Jahnigen scholars.The session provided opportunity forthe future leaders from all the special-ties to present their work and to formrelationships that are leading to interdis-ciplinary research projects. Contact meat lgerson@neoucom.edu for moreinformation.

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Researcher Profile: Clifton Callaway, MD, PhDAndrew Chang, MDAlbert EinsteinSAEM Research Committee

As part of the Research Committee’scontinuing series of profiles of success-ful EM researchers, Dr. Andrew Changinterviewed Dr. Clifton Callaway, assis-tant professor at the University of Pitts-burgh. After obtaining his MD-PhD at theUniversity of California, San Diego, Dr.Callaway completed the Affiliated Resi-dency in Emergency Medicine at theUniversity of Pittsburgh. In 1998 hereceived a Young Investigator Awardfrom SAEM, and in 2001 he was namedan Outstanding Reviewer for AcademicEmergency Medicine. He has pub-lished over 35 original contributions,and currently has two R01 grants fromthe National Institute of NeurologicalDisorders and Stroke (NINDS).What aspects in your career havehelped you the most in your successas a researcher? I think that my formal scientific traininghas helped me the most. In my case, Iobtained a PhD as part of an MD-PhDprogram. Without that background, itwould have been essential to get a PhDequivalent through a fellowship or longsabbatical. While my training was inbasic science, those pursuing careers inclinical research may prefer to enroll inclinical research training programs,including clinical research fellowships, aMasters of Public Health program, or aRobert Wood Johnson fellowship. How-ever, formal training need not be adegree program or a named fellowship.My basic science PhD gave me very lit-tle edge into clinical research, althoughI had very good statistical training.Therefore, I obtained my clinicalresearch experience by serving on myIRB for three years. That duty allowedme to see lots of clinical research pro-posals and to network with clinicalresearchers. This gave me a muchmore mature perspective on humanresearch.In your opinion, what obstacles doyoung investigators face today instarting their research career? Howdid you overcome these obstaclesyourself? I think young investigators often lacktime to obtain proper formal training. Afellowship or formally structured mentor-ship is essential. Peculiar to our spe-cialty is that many departments still do

not have a research culture. Therefore,a new investigator has to negotiate forhis or her needs including protectedtime and space. What can a young investigator do todecrease his or her clinical time inorder to have more protected timetowards research (other than obvi-ously obtaining scarce grantmoney)?I would not be so pessimistic aboutgrant money. Our specialty sometimesfalls into the trap of being provincial andonly looking to EMF or SAEM for fund-ing. For research training, NIH has avariety of career development awards(K-series). These are within reach if youfocus your research. Comparing thenumber of applications funded to thenumber of applications received, SAEMand EMF may actually be more compet-itive than the NIH! I think that the key togrant money is to keep applying.Obtaining some release time in advanceof grant funding probably requires somechairman charity and is an up-frontinvestment in your research career. Thereturn on the investment is both aca-demic (you will be productive later) andfiscal (you will be more likely to bring inextramural funds). Keep in mind that funding cycles arelong. If you submit a grant now, you geta review back in 6-8 months. If it is notfunded on the first try (which is mostlikely), you will resubmit in about 9-12months from the original submissionand perhaps have funding of the revisedapplication in 18 months from the origi-nal submission. Therefore, reasonableexpectations for a chairman would bethat young faculty seeking their firstgrant will need support for release timefor at least 18-24 months.Regarding mentors:What is the best way to find a men-tor? Many people benefit from mentors.However, I am not as militant an advo-cate for this model of career develop-ment. Instead, I propose the “Transac-tional Model.” In this model, you andyour collaborators find each other mutu-ally beneficial. For example, the waythat I found my primary collaboratorswas to identify an investigator with thetools and techniques that I wanted to

learn. I then offered what I had inexchange. In my case, I had very littlemolecular biology experience six yearsago, but I was pretty facile with animalmodels. I then collaborated with a sen-ior professor who taught me moleculartechniques in exchange for which I haveextended his work from cell culture intoanimals. It really is more of a collegialprocess than mentorship. How important is it to have a mentorthat is NIH-funded? In biomedical science, the NIH has thedeepest pockets for research. NIHfunding is also a form of peer-reviewand its absence in a senior investigatoris similar to a short publication record.Therefore, serious investigators will ulti-mately need NIH funding to sustain theirwork. Although there are some excep-tions, lack of NIH-funding in a long timeinvestigator should raise a red flagabout his or her focus, quality of investi-gation, or persistence. How important is it for a mentor to bein the same hospital?Contact with your mentor is critical.Most of my collaborators to date havebeen faculty in the Arts and Sciencecampus. They are located on the samecampus, but at a different institution.Effective collaboration between cities ismore difficult and really means that youare independent and want to have aprofessional friend with whom to bouncearound ideas. For a young investigator, what is thevalue of conducting individual proj-ects as opposed to joining larger net-works (such as MARC or NEAR) ordrug-company sponsored trials?Large networks and industry-sponsoredtrials may let you see day-to-day opera-tions, but they are unlikely to involveyou in planning and design. Therefore,providing service for these trials may notmove you forward to becoming an inde-pendent investigator. One advantage,however, is that these large-scale stud-ies do offer funding that can be lever-aged into time (or even resources) fordoing your own study. Although I think itis critical to develop your own ideas andprojects (small at first, then bigger),these studies can go on concurrentlywhile participating in a big trial (espe-

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cially if that helps pay the bills).In your opinion, what are the mostimportant elements in a grant appli-cation?A grant application proposes that some-one spend money to answer a scientificquestion. You must convince the review-er (1) the question is worth answeringand (2) you are the best person toanswer the question. In order to sellpoint #1, you need to really focus yourquestion into specific hypotheses. Inorder to sell point #2, a track recordhelps immensely as would uniqueresources that you can access (forexample, specific patient populations orunusual clinical material). In theabsence of your own record, enlistingthe help of other people who are wellqualified is essential.My best experience about grant writing

came from submitting grants and gettingrejected. In my first two years as facul-ty, I wrote about 10 applications beforeone was funded. Each time, I learnedwhich things were well received andwhich things were not. I also had somefriends who shared their copies of suc-cessful applications (an invaluableexample).Preparing a grant de novo is a processthat deserves your full-time attention. Ibudget about 150 hours of preparationtime (actually at the keyboard) for a newgrant. It may be as little as 80 hours fora grant revision.How would you advise a younginvestigator in balancing his/hercareer goals with familial and socialcommitments? Your family will outlast your academicposition and must come first. The con-

verse of that fact is that your research ispart of your professional identity. There-fore, your family and social contactsneed to understand that research is justas serious and demanding as providingpatient care. Needless misunderstand-ings and hard feelings may occur if yoursignificant other doesn’t appreciate thisfact. What are your plans/goals for thenear future? What obstacles do youforesee as an established investiga-tor? The fact that you are asking me that isfunny, because I do not perceive myselfas established! Our work is funded forright now, but I am currently looking athow to keep things running smoothly inthe 2006 fiscal year. I don’t know if thatprocess ever changes.

Clifton Callaway (Continued)

The Aftermath of My SAEM Scholarly Sabbatical GrantDaniel Davis, MDUniversity of California, San Diego

The SAEM Scholarly SabbaticalGrant is intended to provide clinicalrelease time for a young investigator toexplore research career opportunitiesand establish some momentum with theultimate goal of sustainable grant sup-port and a successful research career.As the 2001-2002 recipient, I have beenasked to provide an update on my activ-ities to demonstrate the potential forsuch a period of mentored researchexperience, whether funded by a grantlike the SAEM Scholarly SabbaticalGrant, or by a department as part of thedevelopmental plan for young facultymembers.

My grant application was basedupon an ongoing project in the Universi-ty of California, San Diego (UCSD) Neu-roanesthesia Laboratory exploring therelative neuroprotective efficacy of ananti-excitotoxic agent and an anti-apop-totic agent in a rodent model ofischemia. My basic science researchmentor, Dr. Piyush Patel from the UCSDDepartment of Anesthesiology, was per-forming this work under NIH grant sup-port and was in his first renewal period.While I was involved in the data collec-tion and analysis for this project, Dr.Patel quickly placed me in charge ofanother project using a cDNA microar-

ray to identify potential neuroprotectivegenes involved in ischemic precondi-tioning. There was no extramural fund-ing designated for this work. However,we were recently informed that our pre-liminary results were intriguing enoughto win us an R01 to continue this projectfor a minimum of 4-5 additional years.

The other avenue I chose to exploreas part of my scholarly sabbatical was inthe area of clinical research. Dr. DavidHoyt from the UCSD Division of Traumawas willing to serve as my mentor onthe San Diego Paramedic RSI Trial,which was a prospective study toexplore the efficacy of paramedic-per-formed rapid sequence intubation inpatients with severe traumatic braininjury. While my involvement in the ini-tial phases of this trial was mainly as aparamedic educator, Dr. Hoyt was will-ing to give me responsibility for most ofthe analyses related to the project. Todate, almost a dozen different publica-tions have resulted from this work.More importantly, the working relation-ship we established made it possible forus to produce a competitive applicationfor the Resuscitation Consortiumformed through support generated frommultiple institutes with the NIH as wellas the Department of Defense and

American Heart Association. With Dr.Hoyt as Principal Investigator andmyself as co-Principal Investigator, wewere recently notified that our applica-tion was successful and that we wouldbe participating in this first-ever clinicaltrials network to study resuscitation fromtrauma and cardiac arrest.

While I would like to take most of thecredit, I recognize that it is the quality ofmentorship I received from both Dr.Patel and Dr. Hoyt that were directlyresponsible for this early success. Ifirmly believe that the success of a sab-batical period is as dependent on thementors and the path that they lay outfor the young investigator as on thegrant recipients themselves. In this eraof scarce resources available forresearch endeavors, it is certainlyimportant to select an individual withboth enthusiasm and aptitude for a suc-cessful research career; however, it isan even greater tragedy to squanderthis talent through uninvolved, disinter-ested mentorship.

I would like to humbly thank SAEMfor the opportunity of a lifetime, and mymentors for igniting my passion andguiding me in the right direction.

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ACADEMIC RESIDENTNews and Information for Residents Interested in Academic Emergency Medicine

Edited by the SAEM GME Committee

A Medical Liability Primer for ResidentsSharhabeel Jwayyed, MDJohn Robinson, MDSumma Health SystemAkron, OhioFor the GME Committee

Medical malpractice lawsuits are a fact of life for medicalproviders. Hospitals, physicians, nurses, emergency med-ical technicians, and others who provide patient care can benamed as defendants in medical liability lawsuits. The risk ofresidents being sued is unknown but because residents maybecome targets of a lawsuit, they must have a basic under-standing of medical liability and learn strategies to mitigatethe risk. This article describes the elements of a medical lia-bility claim and describes some basic strategies to employ inthe emergency department to avoid lawsuits. There are fourcomponents that must be present to prove a claim of mal-practice: duty to provide care, breach of the standard of care,proximate cause, and injury/damage.

Emergency physicians assume a duty to care for everypatient presenting to the emergency department because ofthe medical screening exam mandated by EMTALA. Thefirst component is thus always present in emergency depart-ment malpractice claims. The second component mandatesthat the care provided to the patient meets the “standard ofcare”. When a provider with similar training and expertisewould provide like or similar care in like or similar circum-stances, the “standard of care” has been met. Medical“experts” from both sides often testify as to what constitutes“standard of care” and whether it was met. While some cir-cumstances may appear to be very straightforward, definingthe standard of care is often the most debated element of amedical liability claim. After arguing to establish the “stan-dard of care”, the plaintiff’s attorney must argue that the stan-dard of care was not met. The third component requires that“proximate cause” be established. The breach of the stan-dard of care must be the “proximate cause” for the injury suf-fered. In other words, the plaintiff’s attorney must argue thatthe patient’s injury would not have occurred but for the action(or inaction) of the physician being sued. Finally, the patientmust have suffered some sort of injury. Injury can take manyforms including death, dismemberment, pain, suffering, men-tal anguish, loss of consortium, and loss of income.

To prove or win a malpractice suit, the plaintiff must provethat all four elements are present. A medical error by itselfdoes not constitute malpractice. If a duty to care, and breachof the standard of care are present, but not an injury, a claimof malpractice cannot be supported. If proximate cause islacking, malpractice is similarly not supported. The burdenof proof rests with the plaintiff. Many physicians are unawarethat the burden of proof (weight of the evidence) is differentin malpractice trials than criminal trials. In criminal trials, the

burden of proof must show guilt beyond any reasonabledoubt. In malpractice trials, the plaintiff only has to show thata preponderance of the evidence proves their claim of med-ical liability.

Plaintiffs attempt to recover economic damages and non-economic damages. Actuarial experts are retained to calcu-late to economic damages that may result from lost wages,lost benefits, and medical expenses. Non-economic dam-ages are sought for “pain and suffering”. Many claims ofmedical liability are never taken to trial but are settled by bothparties. Both parties agree to a resolution of the case thatusually involves a payment to the suing plaintiff. The deci-sion to settle a case is complex but involves all parties weigh-ing the risk of winning or losing a jury trial. The local liabilityclimate, the nature of the allegation, and the type of patientall may influence a defendant’s decision to offer a settlementor a plaintiff’s decision to accept a settlement. If a physicianloses a medical liability lawsuit, his or her name is oftenentered into the National Practitioner Databank.Settlements, even when no determination of liability is made,may also be entered into the National Practitioner Databank.

Many consider emergency medicine a specialty at high riskfor medical liability. According to data from Pro AssuranceGroup, a multi-state malpractice insurance company, riskyareas within emergency medicine include acute myocardialinfarction, meningitis, undefined chest pain, fractures of thevertebral column, and appendicitis. Most suits againstemergency physicians base their liability claim on an error indiagnosis, improper performance (of history, physical exam,or a procedure), or failure/delay in consultation or admission.Of the three, error in diagnosis is the most common allegedmistake cited in malpractice suits against emergency physi-cians. Factors that contribute to diagnostic error are found inTable 1. Avoiding common pitfalls can also reduce diagnos-tic error and improve patient care (Table 2). Documentationof the ED encounter is the most important element relied onto defend a malpractice claim. Unfortunately, sufficient doc-umentation is lacking in many malpractice cases. Importantaspects that should be documented for each patientencounter are found in Table 3. The last paragraph of thepatient’s ED record is often the most important. The differ-ential diagnoses considered and the diagnostic, therapeutic,or disposition strategies employed are outlined in a state-ment of the “medical decision making”. The patient’s instruc-tions and understanding of the disposition plan are describedhere.

Residents in training can learn to manage the risk inherent inthe practice of emergency medicine and learn to accuratelydocument the ED encounter to adequately convey the careprovided. It is important for EM residents to understand thebasic elements of a malpractice lawsuit and the high-risk

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areas encountered daily. Residents must enhance diag-nostic accuracy, avoid diagnostic and therapeutic pitfalls,and improve documentation. Doing so will improve patientcare and assist in the navigating of a perilous aspect of ourprofession.

Table 1- Factors That Contribute to Diagnostic Error Incomplete patient history recordedFailure or delay in ordering appropriate studies, timely

consultation, or admissionCondition not considered (can’t possibly be MI, meningitis,

etc)Misinterpretation of studies, particularly equivocal resultsPhysician not aware of resultsFailure to communicate results to the patient

Table 2- Strategies to Avoid PitfallsConsider conditions with high mortality and morbidityThe atypical presentation of common illness is more likely

than a “zebra”Patients at extremes of age may present atypicallyAlcoholics or drug abusers may be at high riskIf a disease is considered likely and initial studies are

equivocal, consider more tests or admissionRepeat visits mandate an expanded differential diagnosisConsider consultation, admission, or ED observation if the

patient is symptomatic and diagnosis not established,particularly when serious illness or injury is contemplat-ed

Table 3- DocumentationDocument the chief complaintDocument personal/family historyDocument risk factors for diseaseDocument the differential diagnoses consideredDocument why the diagnostic approach was selectedDocument the patient response to treatmentDocument consultations with other physiciansDocument why admission/discharge is appropriateDocument the times of sentinel events during the

encounterDocument patient understanding/acceptance of treat-

ment/disposition plan

Spadafora Scholarship WinnersAnnounced

Leslie R. Dye, MDWright State University

Michael P. Spadafora, MD, was an academic emergencyphysician and medical toxicologist. A member of SAEM andthe American College of Medical Toxicology (ACMT), formany years he was committed to teaching and the develop-ment of medical students emergency medicine residents,and medical toxicology fellows. After his sudden death inOctober 1999, a scholarship was established in his namethrough the SAEM Research Fund to encourage emergencymedicine residents to pursue fellowship training in medicaltoxicology. The ACMT graciously matched the award andtwo recipients are chosen each year to receive $1,250 eachto attend the annual North American Association of ClinicalToxicology (NAACT) meeting.

This year there were nine outstanding candidates for thescholarships. The applications were scored based on inter-est in medical toxicology, letters of recommendation, cur-riculum vitae, and essays written by each applicant. Allapplications were reviewed and scored by a group ofreviewers representing SAEM and ACMT. The winners are:

Shaun Carstairs, MD, Naval Medical Center, San Diego

Brad Weir, MD, Indiana University

Dr. Carstairs and Dr. Weir will attend the NAACT meeting,which will be held in Seattle in September, and as a condi-tion of their award, will submit a summary of the ACMT sci-entific symposium and the ACMT practice symposium.These summaries will be published in a future issue of theSAEM Newsletter and IJMT.

Call for AdvisorsThe inaugural year for the SAEM

Virtual Advisor Program was a tremen-dous success. Almost 300 medicalstudents were served. Most of themattended schools without an affiliatedEM residency program. Their “virtual”advisors served as their only link to thespecialty of Emergency Medicine.Some students hoped to learn moreabout a specific geographic region,while others were anxious to contact

an advisor whose special interestmatched their own.

As the program increases in popu-larity, more advisors are needed. Newstudents are applying daily, and over100 remain unmatched! Please con-sider mentoring a future colleague bybecoming a virtual advisor today. Wehave a special need for osteopathicemergency physicians to serve asadvisors. It is a brief time commitment

– most communication takes place viae-mail at your convenience.Informative resources and articles thataddress topics of interest to your virtu-al advisees are available on the SAEMmedical student website. You cancomplete the short application on-lineat http://www.saem.org/advisor/index.htm. Please encourage your col-leagues to join you today as a virtualadvisor.

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

Northwestern University’s FeinbergSchool of Medicine has announced thatthe Division of Emergency Medicinewas granted full departmental statuseffective July 1. James G. Adams, MD,has been named the Chair of theDepartment of Emergency Medicine,having served as Chief of the Divisionsince 2000. The ED at NorthwesternMemorial Hospital cares for 72,000patients annually with 24 full-time emer-gency physicians and is a level 1 trau-ma center. The residency programtrains 10 emergency physicians in eachof the four years of the program, and the170 senior medical students at the Fein-berg School of Medicine have a manda-tory fourth year clerkship that is led bythe EM faculty.

Timothy E. Albertson, MD, PhD, MPH,has been named interim chair and chairof the sear committee that is seeking apermanent chair of the newly estab-lished Department of EmergencyMedicine at the University of California,Davis.

Steven L. Bernstein, MD, AssistantProfessor of Emergency Medicine atAlbert Einstein College of Medicine, hasbeen awarded a five-year $1.5 milliondollar grant by the New York StateDepartment of Health to develop a com-prehensive training program in theBronx. The project is called the BronxEinstein Alliance for Tobacco-FreeHealth (Bronx BREATHES) and Dr.Bernstein will be the principal investiga-tor.

Judith C. Brillman, MD, has been pro-moted to Professor of EmergencyMedicine at University of New Mexico.

Daniel Davis, MD, University of Califor-nia, San Diego, has received an RO1grant entitled “Microarray Analysis ofNeuronal Ischemic Preconditioning.”

William D. Fales, MD, has been namedAssociate Professor of EmergencyMedicine at Michigan State University.Dr. Fales is the Director of Pre-hospitalCare at Michigan State University’sKalamazoo campus.

Marianne Gausche-Hill, MD, has beenappointed to the Institute of Medicine’sCommittee on the Future of EmergencyCare in the U.S. System, as well as tothe Subcommittee on Pediatric Emer-gency Care. Dr. Gausche-Hill is theDirector of Pediatric EmergencyMedicine Fellowships at Harbor-UCLAand Professor of Clinical Medicine atUCLA.

On September 1, Jeffrey Hackman,MD, will assume the role of AssociateProgram Director of the EmergencyMedicine Residency Program at theUniversity of Missouri-Kansas City/Tru-man Medical Center. Dr. Hackman is anAssistant Professor in the Departmentof Emergency Medicine at the Universi-ty of Missouri, Kansas City.

Jon Mark Hirshon, MD, MPH, Associ-ate Professor at the University of Mary-land, has been named as one of thevice-chairmen of the InstitutionalReview Board and the Associate Direc-tor of the Charles McC. Mathias, JrNational Study Center for Trauma andEmergency Medical Systems (NSC).The NSC, established by Congression-al resolution in 1986, is an academicresearch organization dedicated tostudying the causes, dynamics, treat-ment, and outcomes of traumatic injuryand sudden illness.

Joseph LaChica, MD, has joined thefaculty at the University of Illinois wherehis area of concentration will be theapplication of technological advance-ments in Emergency Medicine educa-tion.

Richard L. Lammers, MD, has beenpromoted to Professor of EmergencyMedicine at Michigan State University.Dr. Lammers serves as Director ofEmergency Medicine Research atMichigan State University’s Kalamazoocampus.

Janet Lin, MD, MPH, has joined thefaculty at the University of Illinois as theDirector of the International MedicineFellowship.

O. John Ma, MD, Vice Chair of Emer-gency Medicine at Truman MedicalCenter, has been promoted to ProfessorEmergency Medicine at the Universityof Missouri-Kansas City School ofMedicine.

James J. Menegazzi, PhD, is the prin-cipal investigator of a $310,000 grantfunded by the National Heart, Lung, andBlood Institute. The grant is entitled,“Derivation of Innovative Treatments forCardiac Death.” The project will com-bine cardiac arrest databases at theUniversity of Pittsburgh, Harbor-UCLA,and William Beaumont Hospital andthen use advanced statistical modelingto derive and internally validate clinicaldecision rules for determining whichpatients should receive immediatedefibrillation, and which should be firsttreated with CPR and/or other thera-pies.

Roland C. Merchant, MD, MPH, Assis-tant Professor at Brown Medical School,has received a five-year K23 CareerDevelopment Award of $681,480 fromthe National Institute of Allergy andInfectious Diseases to support myresearch on rapid HIV testing in theemergency department.

Carl H. Schultz, MD, has received thisyear's Emergency Medical ServicesAchievement Award from the CaliforniaChapter of the American College ofEmergency Physicians, in recognition ofhis contributions to the field of disastermedicine, especially in the areas ofearthquake and terrorism preparednessand response.

Edward Sloan, MD, has been promot-ed to Professor of Emergency Medicineat the University of Illinois.

Susan Stone, MD, MPH, has receiveda joint faculty appointment in theDepartment of Anesthesiology and PainMedicine at the University of SouthernCalifornia Keck School of Medicine.She is developing projects to improvethe management of pain and palliativecare.

(continued on next page)

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Christine Sullivan, MD, has been named the director ofthe Emergency Medicine Residency Program at theUniversity of Missouri-Kansas City/Truman Medical Cen-ter. Dr. Sullivan is an Assistant Professor in the Depart-ment of Emergency Medicine at the University of Mis-souri, Kansas City.

John Younger, MD, Assistant Professor at the Universityof Michigan, has been awarded a five-year RO1 grantfrom the National Institute of General Medical Sciencesfor the project, “C5a in Defense Against Murine Gram-negative Pneumonia,” which will examine the role of thecomplement protein C5a in directing early inflammatoryand immune events during pneumonia and explorewhether C5a or C5a-like designer peptides might be usedas an adjunct to antibiotics early in the course of lunginfection. Dr. Younger also recently receive a three-yearCareer Investigator Award from the American Lung Asso-ciation of Michigan to study strategies by which Gram-negative bacteria interfere with complement activation ontheir surfaces.

Academic Announcements (Continued)

President’s Message (Continued)

against an idea (we have 11 members for a reason!). Pro-found changes such as combining our precursor organiza-tions, UAEM and STEM, the decision to establish our ownjournal, include a resident as a full voting member of our BOD,and the development of the Research fund are now a thing ofour past, whose history is unknown to many of our currentmembership. These examples of leadership activities wereassociated with initial controversy. By definition, one stepsbeyond the status quo in the “leadership” capacity. The risk oflosing something is present, which runs counter to our humannature to gravitate towards comfort zones. The potential of abad outcome is very real, and as physicians, adds additionalanxiety due to our predisposition to firstly do no harm. In timesof “leadership”, one-third to one-half (or more) of one’s con-stituency will resist or actively oppose the decisions.

The “crisis” of opportunity arises when unexpected eventspresent a narrow window of time for decision-making. Theseopportunities appear to fall within the mission of the organiza-tion, and are largely external in nature. Decision-making isproactive in nature. Discussion is curtailed by an imposeddeadline, and not all stakeholders can be full participants. Vot-ing is at times a 2/3 – 1/3 split for or against, but usually tendstowards unanimity. I have been pleased that many BOD activ-ities fall in this area.

The final component is crisis disaster management. Theseresult from completely unforeseen or improbable events andare reactive in nature. Decisions must be made rapidly, with-out as much data as one would like, and without time to pon-der long-term consequences. They are usually unanimous,and often have little debate. An undercurrent theme of “ifyou’re not with us, you must be against us” may stifle dissen-sion. Once the decision is reached, a united front is displayed,and action follows. Over 90% of the constituency will supportthe governing body, since all have been torn from the statusquo, which no longer exists. They will seek their comfortthrough the stability afforded in the governing body. Thinkback to the days immediately following the 9-11 attacks, JFK’sassassination or how America reacted after Pearl Harbor.

Astute governing organizations will attempt to salvage a com-ponent of “win-win” through the loss associated with the crisisof disaster. Through the “leadership” role, novel ideas can bebrought forward with fewer barriers. Decisions made in thetime of crisis (opportunity or disaster) invariably have unin-tended and unforeseen ramifications.

It is rare to find an individual who functions well in all 4 ofthese governance domains. One can look across their depart-ments, medical schools or elected politicians for testimony.Some excel as stewards yet perform poorly when presentedwith a crisis of disaster. Others shine in disaster, yet maysquander resources in their stewardship role. Using a BOD asthe vehicle of governance increases the likelihood that the 4domain strengths are collectively represented across thebreadth of the BOD.

This year’s BOD has many challenges ahead. Most of ouractivity will be in a stewardship mode. There are also manyleadership issues that will create more controversy…informa-tion technology platforms, SAEM’s interaction with the AAMC,and the Development Committee’s debate about an expandedinteraction with industry to name a few. In October the BODwill have a full day meeting to develop our 5 year strategicplanning in five areas: advocacy, education, research, opera-tions and membership services. Each BOD member will workon two areas. SAEM’s past presidents have been invited toparticipate in this process, and we are pleased to note thattheir expertise will be represented in every area. The BOD isalso currently reviewing all of our policy and position state-ments for potential revisions or areas requiring future develop-ment. Finally, in an effort to better serve the membership inmeeting our mission, we will conduct SAEM’s first membershipsurvey later in the academic year.

In parting, we all are “leaders” in some fashion within ourwork settings, with or without title, whether we wish to con-sciously acknowledge that role or not. Do not underestimateyour impact on those with whom you work and interact. Learnyour domain strengths and share those within your departmentand organizations.

Newsletter SubmissionsWelcomed

SAEM invites submissions to the Newsletter per-taining to academic emergency medicine in the fol-lowing areas: 1) clinical practice; 2) education of EMresidents, off-service residents, medical students,and fellows; 3) faculty development; 4) politics andeconomics as they pertain to the academic environ-ment; 5) general announcements and notices; and 6)other pertinent topics. Materials should be submittedby e-mail to saem@saem.org. Be sure to includethe names and affiliations of authors and a means ofcontact. All submissions are subject to review andediting. Queries can be sent to the SAEM office ordirectly to the Editor at david.cone@yale.edu.

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FACULTY POSITIONSNEBRASKA: The University of Nebraska Medical Center, Section of EmergencyMedicine is recruiting 1-2 additional faculty members committed to developingan academic career. Adequate protected time is provided and start-up fundingis available. Preference is given to individuals with fellowship training orresearch experience. With an accredited residency which began in July 2004,this is a great opportunity to help shape the future of emergency medicine in thisregion. Candidates who have toxicology training will also have the opportuni-ty to work with the Nebraska Regional Poison Center. Respond in confidence to:Robert Muelleman, M.D., Professor, Chief of Emergency Medicine, University ofNebraska Medical Center, 981150 Nebraska Medical Center, Omaha, NE68198-1150. (402-559-6705) The University of Nebraska is an affirmativeaction/equal opportunity employer. Minorities and women are encouraged toapply.

NORTH CAROLINA: University of North Carolina at Chapel Hill - EMSFellowship: A two-year fellowship in Emergency Medical Services. Facilitiesinclude a Level I Trauma Center, state-of-the-art Emergency Department with65,000 annual visits, active aeromedical program with two BK-117 helicoptersand four ground transport units, novel county-based EMS service, andEmergency Medicine residency. The fellow will obtain a Master’s degree whilebeing exposed to county and state systems management and research. TheUniversity of North Carolina is an Equal Opportunity Employer and welcomescandidates from diverse backgrounds. The applicant must have a MD/DO med-icine (or have similar experience). Send written inquiries to: Jane Brice, MD,MPH, University of North Carolina-Chapel Hill, Department of EmergencyMedicine, CB#7594, Chapel Hill, NC 27599-7594 to receive additional infor-mation.

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.

OREGON: The Oregon Health & Science University, Department of EmergencyMedicine is conducting an ongoing recruitment campaign for talented facultymembers. Entry-level clinical faculty members at the instructor and assistantprofessor level. Preference given to those with fellowship training (especially inpediatric emergency medicine) or equivalent experience. Knowledge of emer-gency medicine as a faculty discipline is expected. Please submit a letter ofinterest, CV, and the names and phone numbers of three references to: JerrisHedges, MD, MS, Professor & Chair, OHSU Department of EmergencyMedicine, 3181 SW Sam Jackson Park Road, CDW -EM, Portland, OR 97239-3098.

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.

PENNSYLVANIA: SUMMER OF 2005 – SEEKING TWO additional EMResidency-trained physicians to join 36 BC physicians and 10 PAs evaluating100,000 patients at the three sites of 750-bed Lehigh Valley Hospital. Ultrasoundcertification a plus. Collegial group salaried by hospital, with good mix of expe-rience and great opportunity for advancement. Electronic medical records anddocumentation and PACs system. Academic, tertiary hospital with Level I trau-ma, 9-bed Burn Center, 11 freestanding, fully-accredited residency programs,including one in Emergency Medicine. Eligibility for faculty appointment atPenn State/Hershey. LVH located in the beautiful Lehigh Valley, with 700,000people, excellent suburban public schools, safe neighborhoods, moderate costof living, 60 miles north of Philadelphia and 80 miles west of NYC. Email CV tocarol.voorhees@lvh.com. Phone (610) 402-7008.

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.

John H. Stroger, Jr. Hospitalof Cook County

Chairman - Department of Emergency Medicine

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

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

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

During the past 15 years, the Department of Emergency Medicine hasbecome a center of emergency medicine excellence. There is a well-estab-lished, nationally recognized residency program with 54 EM residents and26 full-time faculty who hold appointments at Rush University. There arenumerous opportunities for clinical research. The Research Division is sup-ported by PhD and Master’s level scientists and is actively engaged in sev-eral NIH and other nationally funded investigations.

The successful candidate will have proven leadership ability, adminis-trative experience in the delivery of emergency healthcare in large systems,demonstrated academic accomplishment, and a commitment to the depart-ment’s mission and provide the highest quality emergency care regardlessof the ability to pay.

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

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

Medical College ofGeorgia

Faculty Position

The Department of Emergency Medicine has one openingfor full-time Emergency Medicine attending. Must beboard certified or board eligible in emergency medicine.Experience in emergency ultrasound is highly desirable.Be part of an emergency ultrasound section with an ultra-sound fellowship and highly productive ultrasoundresearch team. Opportunities also available in DisasterMedicine, Tactical Medicine, Wilderness and InternationalMedicine. Established emergency medicine residencyprogram with nine residents per year. Spacious ED facili-ties. New ten bed ED Observation Unit. New contiguouschildren's hospital and beautiful pediatric ED. Over75,000 visits per year. Level 1 trauma center for pediatricand adult patients. Augusta is an excellent family envi-ronment and offers a variety of social, cultural and recre-ational activities. Compensation and benefits are excel-lent and highly competitive. Contact Richard Schwartz,MD, Chair and Associate Professor, Department ofEmergency Medicine, 1120 15th Street, AF 2036,Augusta, GA 30912; 706-721-3548,rschwart@mail.mcg.edu . EOE

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AcademicEmergencyPhysician

Exciting position for anexperienced, residency trained,board certified/ preparedemergency physician to join the

faculty of the Department of Emergency Medicine, afull academic department of the Mount Sinai School ofMedicine in New York City.

The Mount Sinai School of Medicine is a leader inmedical education and research. The hospital is a 900bed tertiary center with an annual ED census of over70,000. The EM residency is fully accredited.Academic rank commensurate with qualifications.

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

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

Department of Emergency Medicine

EM Teaching Attending Position

We are seeking a dynamic, experienced clinician BC EMto join our diverse, energetic faculty. Fully accreditedEM residency training thirty emergency physicians.82,000 patients per year, one-third children. We are ded-icated to teaching, research, and clinical excellence andseek to deliver the highest quality emergency medicalcare in an way that patients leave with an experienece ofbeing cared for and valued as human beings. Very com-petitive salary and benefits. Please submit resume andletter of interest via mail, fax, or e-mail:

Marc Borenstein, MD, FACEP Chair and Residency Program DIrector

Department of Emergency Medicine Newark Beth Israel Medical Center

201 Lyons Avenue Newark, New Jersey 07112

973-926-7562 office 973-282-0562 fax

mborenstein@sbhcs.com

Take Pride. Take Ownership. Deliver Excellence. Patients 1st.

The Mount Sinai HospitalDepartment of Emergency Medicine

Associate Director

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

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

The position includes a competitive salary, an academic MSSM appoint-ment, administrative space, and support.

If interested in becoming part of a dynamic team and prepared to bring inno-vative management to a progressive department, please send your letter ofinterest and curriculum vitae to:

Carol Leah Barsky, MD, Director and Vice Chair, Department ofEmergency Medicine, 1 Gustave Levy Place, Box 1149, NY, NY 10029, Tel:(212) 241-7403, Fax: (212) 427-2180, Email: carol.barsky@mssm.edu

We are an equal opportunity employer.

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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 ✩✩

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DEPARTMENT OF EMERGENCY MEDICINETOXICOLOGY FELLOWSHIP

The University of Cincinnati seeks candidates for a two-yearfellowship in medical toxicology consisting of inpatient andoutpatient clinical consultation, environmental and occupa-tional toxicology, regional poison center experience, labora-tory and clinical research and experience in hyperbaric med-icine. Three medical toxicologists serve as faculty. Clinicalexperience is derived from an adult emergency room whichis the regional level I trauma center with more than 90,000visits annually and the second busiest pediatric emergencydepartment in the country (83,000 annual visits). NIOSHand EPA have headquarters in Cincinnati and a NIOSHmedical toxicologist is involved in training the fellow. The fel-low takes call for the poison center, conducts inpatient andoutpatient toxicologic consultations, and learns to use hyper-baric medicine for carbon monoxide poisoning and otherindications for which it is used. The option exists to obtainadditional training in occupational medicine leading to Boardeligibility. Candidates should have completed residencytraining in emergency medicine, pediatrics, internal medi-cine, or occupational medicine, and must be eligible forBoard Certification in one of these specialties. Submit letterof interest and CV to Curtis P. Snook, MD, Director,Toxicology Fellowship, University of Cincinnati, Departmentof Emergency Medicine, PO Box 670769, Cincinnati OH45267-0769; phone (513) 558-5281; emailsnookcp@ucmail.uc.edu.

Yale University School of MedicineSection of Emergency Medicine

Associate Section ChiefAssociate Professor Level

Section of Emergency MedicineYale University School of Medicine

The Section of Emergency Medicine at Yale University School of Medicine is seek-ing an experienced clinician with academic interests and administrative skills forthe position of Associate Section Chief in the Section of Emergency Medicine.Duties will include oversight and further development of clinical operations in con-junction with the Medical Director of the Emergency Department, as well as devel-opment of a quality improvement program and participation in faculty developmentactivities.Candidates must be board certified in Emergency Medicine, obtain licensure inConnecticut, have a minimum of 7 years of experience with significant adminis-trative responsibility within a Section or Department of Emergency Medicine in anacademic setting. The successful candidate will also have significant teachingexperience, as well as demonstrated leadership skills and a strong commitment tomedical education and clinical excellence. Rank and salary will be commensuratewith education, training and experience.Yale New Haven Hospital which is the primary practice site is a level I trauma cen-ter with over 90,000 ED visits per year and an accredited Emergency Medicine res-idency program with 40 residents (PGY 1-4). Ultrasound and EMS fellowships arealso offered. In addition, faculty will be staffing a new satellite facility expected toopen in the summer of 2004.For more information, contact Dr. Gail D’Onofrio at (203) 785-4363 orgail.donofrio@yale.edu. To apply, please forward your CV and cover letter via faxat (203) 785-4580, email jamie.petrone@yale.edu, or mail at Yale UniversitySchool of Medicine, Department of Surgery, Section of Emergency Medicine, 464Congress Ave, P.O. Box 208062, New Haven, CT 06519-1315.

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

The Department of Emergency Medicine of the Christiana Care Health System has a full-

time clinical teaching position available at the assistant or associate professor level.

Candidate must be residency trained and certified in Emergency Medicine and have a

strong interest in bedside teaching and working at a busy Level One Trauma Center that

also has a high medical acuity. There is also potential for protected academic as well as

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

experience.

The Department of Emergency Medicine sees over 130,000 patients annually at a level

one suburban regional trauma center serving Delaware, and parts of New Jersey,

Pennsylvania, and Maryland and at an urban inner-city hospital in Wilmington. Private

fee-for-service group offers a highly competitive compensation package. New members

of the group participate in all benefit programs within the first year of employment and

become voting stockholders of the group after only one year with no buy-in required.

There are 51 emergency medicine residents in categorical and EM/IM programs.

Fellowships are offered in ultrasound, ED administration, and EMS. The emergency

medicine research section employs three full-time research nurses.

If you desire to learn more about our opportunity to become a co-owner of a medical

group in a dynamic and stimulating practice environment, please send your Curriculum

Vitae to:

Charles L. Reese, MD

Chairman, Department of Emergency Medicine

Christiana Care Health System

4755 Ogletown-Stanton Road

P. O. Box 6001

Newark, DE. 19718

The Department of Emergency Medicine of the Christiana Care Health System has afull-time clinical teaching position available at the assistant or associate professorlevel. Candidate must be residency trained and certified in Emergency Medicineand have a strong interest in bedside teaching and working at a busy Level OneTrauma Center that also has a high medical acuity. There is also potential for pro-tected academic as well as research time. Level of protected time will be based onqualifications and prior experience.

The Department of Emergency Medicine sees over 130,000 patients annually at alevel one suburban regional trauma center serving Delaware, and parts of NewJersey, Pennsylvania, and Maryland and at an urban inner-city hospital inWilmington. Private fee-for-service group offers a highly competitive compensationpackage. New members of the group participate in all benefit programs within thefirst year of employment and become voting stockholders of the group after onlyone year with no buy-in required.

There are 51 emergency medicine residents in categorical and EM/IM programs.Fellowships are offered in ultrasound, ED administration, and EMS. The emer-gency medicine research section employs three full-time research nurses.

If you desire to learn more about our opportunity to become a co-owner of a med-ical group in a dynamic and stimulating practice environment, please send yourCurriculum Vitae to:

Charles L. Reese, MDChairman, Department of Emergency MedicineChristiana Care Health System4755 Ogletown-Stanton RoadP. O. Box 6001Newark, DE. 19718

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21

The Institute for International EmergencyMedicine and Health at Brigham andWomen’s Hospital and the Division of

Emergency Medicine at Harvard MedicalSchool are now accepting applications

for their International Medicine Fellowship.

Fellowship involves:• Two-year track combining clinical emergency medicine,

international fieldwork and research project.• Academic classes lead to a Masters Degree at the

Harvard School of Public Health.• Academic appointment at Harvard Medical School.• Clinical emergency medicine at affiliated teaching

hospitals.• Participation in training of medical students and

residents.• Competitive salary, benefits, CME, international travel

funds, and training course expenses. • Opportunity to tailor experience to meet specific

interest in disaster response, emergency medicalsystems development, health education, human rights,health emergencies, international public health, andrefugee relief.

Requires:• Residency Training in Emergency Medicine.• Completion of application process, interview, and

selection.

Inquiries should be sent to the fellowship director: Mark A. Davis, MD,Institute for International Emergency Medicine and Health, Departmentof Emergency Medicine, Brigham and Women’s Hospital, Neville House,75 Francis St., Boston, Massachusetts 02115, or by email tomadavis@partners.org. Telephone (617) 732-5813; Fax (617) 713-3060.

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.

The University of ChicagoDepartment of Medicine

Section of Emergency Medicine

The Section of Emergency Medicine seeks full-timeacademic faculty members. Academic rank andsalary commensurate with background and experi-ence. Candidates must be BC/BE in EmergencyMedicine and eligible for medical licensure in theState of Illinois. Excellent teaching skills requiredWe currently have 14 faculty, 42 residents, and anoverall ED volume of 76K. We are involved inregional and international aeromedical transport anddirect one of the country’s busiest EMS systems. Wealso direct a resuscitation research center, a healthservices research group, and an informatics pro-gram.. We offer significant protected time and sup-port for those interested in research. Send a curricu-lum vitae to James Walter, M.D., Chief, Section ofEmergency Medicine, University of Chicago 5841South Maryland, MC 5068, Chicago, IL 60637 or e-mail to jwalter@medicine.bsd.uchicago.edu. TheUniversity of Chicago is an AffirmativeAction/Equal Opportunity Employer.

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7th Annual Mid-AtlanticRegional SAEM Meeting

October 1, 2004Washington Hospital Center

Georgetown University Medical Center/Marriot Conference Center

Washington, DC

The meeting will take place Friday October 1; 8 am to 4pm. Registration and hotel information is available on-lineat www.saem.org. There will be teaching, research and alarge medical student residency application session. Allmedical students from the Mid-Atlantic Region areenouraged to attend.

14th Annual Midwest Regional SAEM Meeting

September 9-10, 2004The Wyndham Milwaukee Center Hotel

Milwaukee, WisconsinThe meeting will take place Thursday, September 9, 6:30-

8:30 pm, and Friday, September 10, 8:00 am-4:00 pm at theWyndham Milwaukee Center Hotel, 139 East Kilbourn Avenue,Milwaukee, WI.

Registration forms are available from Dawn Kawa,dkawa@mcw.edu

Registration Fees: Faculty--$75; Other health care profes-sionals--$40; Fellows/residents/students--No Charge. Latefee after Wednesday, September 1: add $10. For information,call 414-805-6452.

Call for Abstracts9th Annual SAEM New England

Regional Meeting

April 27, 2005Shrewsbury, Massachusetts

The Program Committee is now accepting abstracts forreview for oral and poster presentations. The meeting willtake place April 27, 2005, 8:00 a.m. – 3:30 p.m. at theHoagland-Pincus Conference Center in Shrewsbury, MA.For information, contact: www.umassmed.edu/conferencecenter/. The deadline for abstract submission is Wednesday,January 5, 2005 at 3:00 pm Eastern Standard Time.Only electronic submissions via the SAEM online abstractsubmission form at www.saem.org will be accepted.Acceptance notification will be sent mid-March 2005. Send registration forms to: Linda Quattrucci, ResearchAssistant, Department of Emergency Medicine; RhodeIsland Hospital, Coro West, Suite 106, One Hoppin Street,Providence, RI 02903. Email contact is lquattrucci@lifespan.org.Registration Fees: Faculty = $100; Residents/Nurses =$50; EMTs/Students = $25. Late fee after April 8, 2005 =add $25. Make checks payable to Brown Medical School,Department of Emergency Medicine.

Call for SubmissionsInnovations in Emergency Medicine Education Exhibits

Deadline: February 22, 2005The Program Committee is accepting Innovations in Emergency Medicine Education (IEME) Exhibits for consideration of

presentation at the 2005 SAEM Annual Meeting, May 22-25, 2005 in New York City. Submitters are invited to complete anapplication describing an innovative new educational methodology that they have designed, or an innovative educationalapplication of an existing product. The exhibit should not be used to display a commercial product that is already availableand being used in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teach-ing setting. Commercial support of innovations is permitted but must be disclosed. IEME exhibits will be published in a sum-mer 2005 issue of Academic Emergency Medicine, as well as in the Annual Meeting on-site program. However, if submit-ters have conducted a research project on or using the innovation, the project may be written up as a scientific abstract andsubmitted for scientific review in the appropriate subject category by the January 6 deadline.

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

The SAEM Newsletter is mailed every othermonth to approximately 6000 SAEM members.Advertising is limited to fellowship and academ-ic faculty positions. The deadline for theNovember/December issue is October 5,2004. 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, alongwith contact person for future correspondence,telephone and fax numbers, billing address, adsize and Newsletter issues in which the ad is toappear to: Carrie Barber at carrie@saem.org

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

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

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

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

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

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

ErratumIn the July/August issue of the SAEM Newsletter two of the 2004 Annual Meeting Presentation awards were inadvertentlytransposed. The correct awards are:Basic Science Fellow PresentationJing Chen, MD, Thomas Jefferson UniversityLuna Benvenisti-Zarom, Raymond F. Regan: Increasing Expression of Endogenous Heme Oxygenase-1 Protects Astrocytesfrom Heme-mediated Oxidative Injury

Clinical Science Resident PresentationBasmah Safdar, MD, Yale New Haven HospitalLinda C. Degutis, Keala Yamamoto, Harry C. Moscovitz, Swarupa R. Vedere, Gail D’Onofrio: Comparison of Efficacy andAdverse Events of Intravenous Ketorolac and Parenteral Morphine Alone and in Combination in the Treatment of Acute RenalColic

Call for Abstracts2005 Annual Meeting

May 22-25, 2005New York, New York

Deadline: January 5, 2005

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

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

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

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

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 CoordinatorCarrie BarberCarrie@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.

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Newsletter of the Society for Academic Emergency Medicine