2340 S. River Road, Suite 200 • Des Plaines, IL 60018 • 847-813-9823 • saem@saem.org • www.saem.org

SEPTEMBER/OCTOBER 2010 VOLUME XXV NUMBER 5

Caring for potential

organ donors

GIVING BACKin medical education

David Seaberg, MDAdvancing Emergency Medicinefor More Than 25 Years.

ImprovingPATIENT CAREthrough collaborative research

James R. Tarrant, CAEext. 212, jtarrant@saem.org

Barbara A. Mulderbmulder@saem.org

Sandy Rummelext. 213, srummel@saem.org

Michelle Iniguezext. 201, miniguez@saem.org

Christine Baroud ext. 211, cbaroud@saem.org

Holly Gouin, MBAext. 210, hgouin@saem.org

Kirsten Nadler ext. 207, knadler@saem.org

Maryanne Greketis, CMPext. 209, mgreketis@saem.org

David Kretzext. 205, dkretz@saem.org

Don Geschkeext. 204, dgeschke@saem.org

Neal Hardinext. 204, nhardin@saem.org

Janet Bentleyext. 202, jbentley@saem.org

Melissa McMillianext. 207, mmcmillian@saem.org

2295 Active59 Associate

3521 Resident/Fellow198 Medical Students

13 Emeritus9 Honorary

$530 Active $155 Fellow$495 Associate $130 Resident Group$465 Faculty Group $130 Medical Student$435 2nd yr. Graduate $110 Emeritus$315 1st yr. Graduate $100 Academies$155 Resident $ 25 Interest Group

October 1, 2010 for the November/December issue

December 1, 2010 for the January/February 2011 issue

February 1, 2011 for the March/April 2011 issue

April 1, 2011 for the May/June 2011 issue

June 1, 2011 for the July/August 2011 issue

August 1, 2011 for the September/October 2011 issue

The SAEM Newsletter is limited to postings for fellowship and academic positions available and

those along with the completed ad.

We appreciate your proactive commitment to education, as well as personal and professionaladvancement, and strive to work with you in any way we can to enhance your goals.

Contact us today to reserve your Ad in an upcoming SAEM newsletter. The due dates for 2010 are:

All membership categories include one free interest group membership.

International – email membership@saem.org for pricing details

Highlights

SAEM Member Highlight

The 2010 NRMP Match

President’s Message

Wilderness MedicineInterest Group

Academic Resident Section

RFA for Emergency Medicine Research Training Programs

Ethics In Action

CDEM Highlights

4

7

8

10

18

20

21

24

The American Board of Emergency Medicine will elect two new directors at its February 2011 Board of Directors meeting. ABEM is soliciting nominations for these two positions from Emergency Medicine organizations. ABEM has invited and encouraged SAEM to submit nominations.

The ABEM Nominating Committee will review all nominations and prepare a slate of candidates for consideration by the ABEM Board of Directors, who will vote on this slate at its February, 2011 meeting. The newly elected directors will begin an initial four year term in July, 2011 and upon successful completion of that term, will be eligible for election to a second and four year term. New directors attend the summer 2011 ABEMBoard meeting as observers.

Nominated physicians must meet the following criteria:

Be a graduate of an ACGME-accredited Emergency Medicineresidency program.

Be an ABEM diplomat for a minimum of ten years.

Have demonstrated extensive active involvement in organized Emergency Medicine. this experienceas an ABEM item writer, oral examiner, or ABEM appointed representative.

Be actively involved in the clinical practice of Emergency Medicine.

Interested SAEM members should send a letter of interest, a current CV, and a letter of willingness to serve by November 1, 2010 to James Tarrant, SAEM Executive Director, jtarrant@saem.org. The SAEM Board of Directors will select a slate of nominees to forward to ABEM.

HiggHiggNominations SoughtABEM Board of Directors

Deadline: November 1, 2010

Midwest Regional Meeting

November 8, 2010

Dayton, OH

Submit abstracts online at saem.org

4

The good news about this newsletter is that I am not going to mention the words Arizona or Law. Except for that time. Instead, I am going to address a topic that most of you have been clamoring to read about in exquisite for a time.And that topic is my heirloom tomatoes.

Occasionally, I am fortunate enough, I suppose, to overhear someone refer to me an expert

in the disease topic of pulmonary embolism. These words are usually said by a person who happens to be one of my research coordinators, ostensibly to a patient consenting for a clinical study that helps pay the research coordinator’s salary. On other occasions, a resident or medical student, whose grade depends upon my opinion, will ask me how I became a PE expert. In either I must to ignoremy inner 14 sarcastic yammering “yougot ‘em fooled …the only thing that you are expert in is growing tomatoes!” I do not want to a patient or student orresident down. I maintain an expert facial expression and make some expert statements.

But let’s get back to what you really want to know more about. I grow heirlooms from seeds that I either save from last year’s crop using a fermentation process, or I buy them online from my pal, Bob, at www.tomatobob.com. Growing these requires a great of backgroundhypothesis generation, experimentation, documentation, household mess, and family cooperation. And by

what I mean is putting up with my tomatogrowing crap in and around the house from about February to August. (And my but I am working on that). I sew theseeds in pH-adjusted starting in mid February. I

10-12 different varieties with names “HanksBig Giant Red” or “Boxcar Pink Petunias” orGood Beefsteak from Last Year.” The requires of

forceps and some hugeTupperware containers. The seeds sprout in 10-14 days.Then in comes the 40-wattfor three then the 400-watthalogen lights, followed by a visit from the DEA. Eventually, this indoor phase with the four-inchtall plants outdoors around tax day. The outdoor phase is even more requiring steps toaerate, calcinate, phosphorylate, nitrogenate and mulch the

soil and my own super special watering system that involves lots of PVC piping. My wife refers to this as my white trash irrigation system, a term that does not offend me in the least. Also, the invisible fence must be coursing with radio signal to keep Gracie out (for more on see the SAEM

of this year). This one of my keyaims was to test if plastic ground liner would prevent weed growth, trap moisture and improve yield.

All of this work is worth it because heirlooms taste so much better than those genetic monstrosities hybrids atMart. are with weak innate andminimal tolerance of heat or pest stress. Best grown by an expert. Expecting a high mortality rate, I start far too many seedlings for my own use, such that I always have many plants to spare. I like to give these to whomever will agree to grow them. This year, I foisted a dozen or so on my colleague, Alan Jones. Alan was my research fellow at one point, and then protégé and is now an independentan expert in sepsis in his own right, funded by NIH, publishing like crazy, and often now my mentor. But he cannot grow tomatoes as well as I can.

I that expertise requires three Cs:competence and connectivity. If you are an aspiring

then to become an you must chooseto become an expert. You may detest this exercise, but this requires you to say it out Somebody has to hear thesewords outside of your mind: “I want to become an expert in…

approach to invasiveburns, pain management, informed consent or growing pumpkins.” Then it becomes something of a promise toyourself as well as your witness. Much like the aphorism that a great journey begins but with the the pathto expertise starts the day that you can say that you want to be an expert. So say it. The second C is competence, which is about training and experience (to be the subjectof my next and the third C is connectivity with yourpeers (the subject of my message after that). To achieve true

this third requires that you manifestthe and required to shareas a mentor. and then can you for certainyour yammering inner 14 year old. I chose to be an expert in thromboembolism and tomatoes, but I have mentored on other topics.

This year, I got my tomatoes in my carefully tended garden a little late. Alan planted his in some untilled red clay in his back yard. I thought sure his would all die from malnutrition,

or perhaps a and if

Jeffrey A. Kline, MDJ ff A Kli MD

President’s MessageSOCIETY FOR ACADEMIC EMERGENCY MEDICINE

Jeffrey A. Kline, MD

Expertise, Part I

Continued on Page 6

5

Executive Director’s Message

This time of year medical students are dreaming of the next phase of their journey to become physicians, and residents are viewing the at the end of the -- when theycan begin to earn a living and practice medicine.

It may also be a time to ponder the intellectual curiosity that brought you to this point in life. Whether choosing an academic career or focusing on patients in the community setting, I hope none of you lose the intellectual curiosity inherent in your profession. SAEM members discuss scholarly activity as a part of a physicians training. A Baylor Medical School article describes the importance of physicians embracing and quest forknowledge by inserting a little scientist in every physician.

Thinking like a scientist is increasingly important for doctors to be effective in treating patients. Medical discoveries are happening so rapidly, much of what medical students learn today will be obsolete in the coming years. Keeping current throughout their career

require doctors to read and informationabout their

As medicine has become more complex, the need for this new breed of physician—ones that can translate laboratory discoveries to patient care—has never been greater; however, the supply has not kept pace with the demand.

During my medical administrative career, I have known several physicians who talk about how the path they chose was diverted along the way. Early in my career as Director of Medical Education, a community based internist told me how he was planning a career as a nuclear physicist who was advised that being a physician was the same as “being ascientist”.More abiochemistrymajorworkingtowarda PhD, was encouraged to consider becoming a physician to combine medicine with his interest in biochemistry. He is an academic anesthesiologist conducting research in Sickle Cell Anemia.

Life takes many turns. The majority of emergency medicine residents be providing care for patientsin the community hospital setting. A smaller number will select an academic career, training the next generation of emergency physicians while advancing the level of training through education and research. A third group will be hybrids, spanning the bridge between academia and community. These EM physicians are at hospitals that serve as training sites for academic programs.These physicians are challenged daily by the intellectual curiosity of medical students and residents, while providing experience in the art and science of patient care. Residents and faculty can encourage these clinical instructors to reengage with SAEM.

How can we reach more of the residents entering practice, community and clinical faculty to rekindle or retain their curiosity?At the 2010 SAEM Annual Meeting, a California physician approached registration. I asked him where he worked and he named a hospital which was unfamiliar to me. He stated it was a community hospital with no academic Ifthis were true, then why was he attending the SAEM meeting?He described the emphasis that was imparted at his residency training program to retain intellectual curiosity and from the forefront of changes in the whichSAEM provided for him.

As residents consider career choices they need to maintain the commitment to and tomaintain a high level of knowledge and the opportunity to give back to the profession and patients.

and techniques in the arerapidly expanding. According to Carl Lindsay, James Morrison, and E. James Kelley, it is estimated that the

of acquired in isyears. in just

half of what a doctor learns in medical school will be obsolete. With such a vast increase in the knowledge base, it is essential that health professionals, particularly doctors, dentists and nurses, constantly update their

In their and oftendepend on health professionals keeping current on the latest advances.

Patricia A. McPartland Ed. D.Southeastern Massachusetts Area

Health Education Center.

A physician at Cottage Hospital in Grosse Pointe Michigan was respected for his diagnostic skill. He shared his secret. He said it wasn’t that he was smarter than others, but that he attended courses that challenged him and maintained his knowledge with cutting edge information. With the majority of out dated in how

the next generation retain current How doyou perceive SAEM can help residents prepare for their future careers and be a resource throughout your career no matter what career path you forward yourthoughts to membership@saem.org.

James Tarrant, CAESAEM Executive Director

James Tarrant CAE

Intellectual Curiosity: Art and Science of Medicine

6

Academic Announcements

not that, they would just die because they like to die. I expected great things from my tomatoes. What with my expertise and all.

this as a consequence of the of themy tomatoes contracted some version of tomato syndrome.

Their roots cooked under the plastic this hot summer, and my babies succumbed to leaf rust, Tomato Mosiac virus, nematodes, blossom rot, end rot, and general rot. They got it

Figure 1 demonstrates my the pain of a aim gone bad.

On the other when invited my over for dinner in I witnessedhis tomatoes and fat in their beds of red No fancy wateringsystem. No death by dog. Of course, they were delicious as heirlooms always are. See Figure 2.

“His tomatoes are better than mine” I sighed to my wife as we drove home. “But atI grew the for him” I said with a trying to mytomato mentoring role to sooth my pain.

“Those were not your tomatoes…” she said. “Reagan wife) said he got those at

I don’t think Alan wanted me to know that.

Figure 1. Typical example of my disastrous crop of 2010

Figure 2. Typical example of Alan’s tomato crop in 2010

Expertise, Part I – Continued from Page 4

DR. ROSS DONALDSON, received the 2010 Humanitarian Award from the California chapter of ACEP in recognition of the role he has played with the International Medical Corps in developing a civilian emergency medical care system in

training over 350 Iraqi physicians to provide emergencycare in local communities, establishing three EM residency programs in the and authoring 5-Year Strategyfor Emergency Medical Care. Dr. Donaldson is the director of the at Harbor-UCLACenter and an Assistant Clinical Professor of Medicine at the David Geffen of Medicine at UCLA.

NICOLE M. DEIORIO, MD, Associate Professor of Emergency Medicine at Oregon Health and Science

has received the Mentor Award fromthe 2010 graduating class of medical students. This award recognizes the faculty member who has best demonstrated outstanding mentoring and advising skills.

DAVID BAHNER MD, RDMS, has been chosen as Professor of the Year at Ohio State’s College of Medicine. This annual honor is given by the graduating class to one faculty member who they consider a role model and mentor. Started in 1931, many distinguished Ohio State medical

have been awarded this distinction. This is thetime in the history of this award that an Emergency Medicine physician has received this honor. Over his 12 years on the

Department of Emergency Medicine faculty, Bahner has been instrumental in introducing and advancing ultrasound in education. is now embedded intoall four years of the medical student curriculum, and each student receives a core exposure to techniques.The Emergency Department at Ohio State is chaired by Douglas Rund, MD.

SHANA KUSIN, MD, McGaw Medical Center of Northwestern University has been named the recipient of the2010 SAEM Michael P. Spadafora Toxicology Scholarship Award. One recipient is chosen each year to attend the North American Congress of (NACCT)conference. This years conference will be held in Denver,

October 2010.

PETER D. PANAGOS, MD, has been promoted to Associate Professor of Emergency Medicine and Neurology at Washington University in St. Louis. Dr. Panagos is theCo-Director of the Barnes-Jewish/Washington UniversityStroke Network and Barnes-Jewish Stroke Center. He has recently been appointed a Fellow of the American Heart Association/American Stroke Association.

7

David Seaberg, MD –SAEM Member Highlight

Dr. David Seaberg has had a career of service in advancing Emergency Medicine over the last 25 years. A strong believer in Servant Leadership, Dr. Seaberg believes that in order to one must serve.This tenant is demonstrated throughout his rise from research director, to residency director, to chairman and to his current position as Dean at the University of Tennessee

College of Medicine Chattanooga.

Aftergraduating fromWashingtonUniversitywithadegreein Chemistry, Dr. Seaberg received his medical degree from the University of Minnesota of Medicine.Between his second and third years of medical school, he did a research fellowship in Pediatric Cardiology, which laid the foundation to a career in academic medicine. It also started a series of mentorships that would help guide him throughout his career. “I was to haveexcellent mentors throughout my career to help guide my development. As I advanced in my career, I wanted to give back by serving as a mentor to those training behind me. ”Dr. Martin returned home to train in both EmergencyMedicine and Medicine at the University ofMaryland Medical Center—where he also served as Chief Resident.

He completed his Emergency Medicine training at the University of Pittsburgh Residency inEmergency Medicine and was Chief Resident in 1989-90. After spending one year as Research Director and helping establish an Emergency Medicine residency program at MetroHealth Medical Center in Cleveland,

he returned to at the University of Pittsburghand served as Vice Chairman of Research at the Mercy Hospital of Pittsburgh.

In Dr. Seaberg the University of Pittsburgh tobecome the Emergency Medicine Residency Director at the University of program. He wasthe recipient of the ACEP National Faculty Teaching Award in 1999. After helping create an academic Department of Emergency Medicine, Dr. Seaberg became Chairman of the Gainesville campus in 2000. During his tenure, the Department developed a new Emergency Medicine Residency Program on the Gainesville campus and started the construction of a new Emergency Department. While in Florida, Dr. Seaberg helped the state’s

preparedness for domestic security events. He founded and chaired the University for Weapons of MassDestruction Education and Chaired the Medical/Hospital/EMS Committee of the State Workgroup on Domestic Security. He also helped form the Emergency Medicine Learning and Resource Center which is a leading source of emergency physician, nursing and EMS education in the Southeast.

In Dr. Seaberg to become theDean of the University of Tennessee of MedicineChattanooga where he oversees 576 faculty, 168 residents in 9 residency and 5 fellowship programs, and has over 170 medical students rotating through the campus. He helped establish another Emergency Medicine Residency Program at the University of Tennessee and createan academic Department of Emergency Medicine this year. He has worked over the last 2 years to establish the Physician Practicewhich has over 130 physicians.

Dr. Seaberg continues to be actively involved in Emergency Medicine. He has served on the ACEP Board of Directors for the years and serves onthe Episodes of Care Taskforce. He was President of the

Chapter of ACEP and now serves as anBoard of Directors member of the Tennessee Chapter. He has served on the SAEM Program Committee and has had 40 presentations at the SAEM Annual Meeting over the years, including two at this year’s meeting in Phoenix. He was recently named to the Board of Directors of the

County Society and serveson the State of Tennessee Health Planning Committee.

Dr. Seaberg and his wife Carol have been married nearly 19 years and have two sons, Ryan, age 16 and Tyler,age 13.

8

Broaching the Question

Approaching the family of a young healthy patient who has died suddenly of traumatic injuries is one of the more

tasks we face as physicians.approaching members with a request to harvesttheir daughter’s organs, during a time of maximum shock and grief, can feel like an impossibly cruel gesture. In fact, the rates of obtaining family consent are abysmal when discussions of potential brain death and organ donation are included in the same conversation. Separating the

of brain death from the request fororgan donation made by a trained representativefrom a organ procurement [OPO]) hasbeen found to be 3-8 times as to inconsent for donation as requests. The dramaticdifference in rates of consent may be the result of protecting physicians from the perception of aof interest when advocating for a patient’s best interests and the interests of the potential organ recipients. Finally, brain death determination requires testing that isnever performed in the emergency department. Given these considerations, the most prudent course of action in the ED is to make an early referral to an OPO while refraining from broaching the topic of organ donation with the patient’s family.

Issues of Consent and Autonomy

canarisewhenan organdonor registrystatus and the wishes expressed by the individual’s family differ. It is helpful to consider the legal, ethical, and

perspectives in such stateshave adopted the Uniform Gift which

mandates that the donor registry status printed on most state driver’s licenses is considered a legal document, and provides a legal basis that supports using registry status over wishes when in theethical principle of respect for autonomy suggests that we should honor the individual’s own previously expressed wish regarding organ donation rather than valuing their family members’ opinion over their own. However, practical considerations often result in deferring to the family’s desires regarding donation. Taking an individual’s organs for donation over the wishes of their family, even when the individual would have wanted to become an organ donor, can result in extreme misgivings among the family and has the potential to negatively impact the societal impression of the organ donation process.

Care of the Patient vs. Care of the Potential Organ Donor

Once a family has decided to consent to donate the organs of their brain dead relative, several interventions may be used to preserve those organs including a ventilator to ensure oxygenation, vasopressors to maintain hemodynamic stability, bronchoscopy to maximize pulmonary function, and heparin to prevent vascular thrombosis and ischemia. If brain death is diagnosed and organ procurement is in line with the patient’s wishes and the family’s wishes, then it is acceptable to administer the preceding organ-sustaining treatments. Becausebrain death is almost never determined in the emergency department, however, emergency physicians cannot ethically administer interventions with the sole purpose of preserving the patient’s organs for donation. This is especially true if those interventions would hasten the

ETHICS IN ACTION

Caring for Potential Organ Donors in the Emergency DepartmentGlen E. Michael, M.D.a and John E. Jesus, M.D.b

a. University of Virginia Dept. of Emergency Medicine, Charlottesville, VAb. Beth-Israel Deaconess Medical Center, Dept. of Emergency Medicine, Boston, MA

Case:

A 29 year-old woman is brought to the emergency department (ED) by ambulance after being struck on her bicycle by a

being found unresponsive and apneic by paramedics. On arrival to the ED she has a Glasgow Coma Score (GCS) of 3

trauma workup reveals atlanto-occipital dissociation and diffuse axonal injury, but CT scans of her chest, abdomen, and pelvis are unremarkable. As you begin to wonder if the patient’s head trauma and apneic period have left her brain dead, a nurse safeguarding her belongings announces that the patient’s driver’s license indicates that she has joined the organ donor registry.

9

patient’s death or cause the patient harm. As a result, the interventions administered in the ED ought to be those

A recent study demonstrated that patients referred from

more likely to become successful donors than patients referred from inpatient settings. 1 Another ongoing study is currently examining the feasibility of harvesting organs from patients after the declaration of cardiac death, and within minutes of their arrival to the E.D.2. These studies highlight the need for emergency physicians to have a basic understanding of the care of the potential organ donor as well as of the ethical issues surrounding the organ procurement process.

In the case presented above, the patient has sustained injuries that have spared her healthy organs and may have resulted in brain death. Though she represents the ideal organ donor, it is important to uncouple the

of organ donation. Whenever possible patient autonomy should be respected by following patients’ organ registry status, but in practice family wishes often prevail. An OPO representative should be contacted as soon as possible in order to begin the process of evaluating the patient for organ donation and to facilitate the donation

obtained, the patient should be treated without regard to the interests of potential organ recipients and transferred

1 Michael GE, O’Connor RE. The importance of emergency medicine in organ donation: successful donation is more likely when potential donors are referred from the emergency department. Acad Emerg Medicine

2 Stein R. Project to get transplant organs from ER

Mar 2010; A1

10

ACADEMIC RESIDENT SECTION

On of the SAEM GME we are to re-introduce the “Academic Resident” section of the SAEMnewsletter. Quarterly articles will focus on topics of interest and importance to emergency medicine residents, with topics recurring on a 3-year It is our hope that you these to be in yourdevelopment. We encourage your feedback and suggestions regarding additional content areas that would be of value to residents and recent residency graduates. Feel free to email comments and suggestions to techsupport@saem.org

Jonathan Davis Georgetown University | Douglas McGee Einstein | Jacob Ufberg University

Introduction

As a compendium of cognitive, psychomotor, and affectual behaviors, clinical skill is easier demonstrated than described. And, like ballet, it is best learned in front of a mirror. Feedback occurs

actually did well as the consequences of his or her actions.

Since Ende’s seminal article, giving learners feedback has been recognized as a crucial component to clinical medical education.1-4 Moreover, medical education has been, and continues to a apprentice-based system. itis imperative that all physicians who supervise learners are capable of giving feedback effectively.5 However, feedback has been in the 6 and disagreement between teachers and learners exists regarding the type and frequency of feedback that occurs.3,7,8 Furthermore, physicians have reported feeling uncomfortable giving feedback9 and may be to do so.10 This

1. Provides an of feedbackbased on recent literature; 2. Discusses the importance of feedback to medical education; 3. Highlights key components of the content and process of effective feedback; 4. Focuses on important behaviors of teachers as well as learners in the feedback process, and 5. Addresses potential problem areas of the feedback process.

What is Feedback?

there has been noof feedback. Believing this to be likely harmful to medical

van de Ridder et performed a meta-analysis to investigate the concept of feedback. Within the body of medical education and social sciences literature, three concepts of feedback dominated: 1. Feedback as information, 2. Feedback as a reaction, and 3. Feedback as a cycle. Therefore, the authors proposed the following

and of feedback thatincorporates each of these elements for further research:

information about the comparison between aobserved performance and a standard, given with the intent

to improve the performance.” 6 This directsthe supervisor to describe objective performance measures to the to give constructive critique comparing his orher performance to this standard, and to provide information to help close this performance gap.

Why Feedback?

Having a working of thequestion remains: Why give feedback? The answer

physicians and trainees are inaccurate atassessment.11 To counter this, regulatory guidelines mandate, and experts in graduate medical education recommend, frequent and objective feedback. The Accreditationfor Graduate Education requires residency trainingprograms to “provide objective assessments of residentphysician competence, use multiple evaluators, document progressive performance, and provide evaluation of performance with feedback.” 3 A recent consensus statement from the Council of Emergency Medicine Residency Directors (CORD) Academic states that frequent feedbackis important, particularly in the education of the current generation of medical students and residents.12

the of a of feedback haslimited rigorous study of feedback, the available evidence suggests that feedback in its various forms improves both cognitive and procedural competency. Early on, Wigton et al. demonstrated that computer program feedback improved clinical diagnostic skills among medical students,13 and Porte et al. showed that verbal feedback created immediate and lasting improvement in the technical skills performance of medical students learning to suture.14 Finally, there is increasing evidence that feedback in the formof simulation medicine is an effective tool that improves learners’ knowledge, clinical decision making, and procedural competency.15-26 Simulation medicine additionally has the advantage of being able to instruct, test, and provide feedback to the learner in both cognitive and procedural realms simultaneously.

Giving Feedback in Medical EducationJohn Houghland MDChief ResidentDenver Health Residency Program in Emergency MedicineDepartment of Emergency MedicineUniversity of of Medicine

Jeff Druck MDAssociate Residency DirectorDenver Health Residency Program in Emergency MedicineDepartment of Emergency MedicineUniversity of of Medicine

11

suggests that certain behaviors and characteristics are

Furthermore, these individuals begin teaching interactions by asking learners for educational goals, and make professional goals clear to the learner by writing down or discussing them.

with learners to establish mutually agreed upon goals and

achieve these goals, as well as other issues, themselves.27

Setting the Stage. When you are ready to give feedback, perhaps the most important step to doing so effectively is setting the stage: ensuring a ready and willing recipient and an appropriate setting. A key element is recognizing there is a large emotional component to receiving feedback.28 The majority of clinical performance evaluations are comprised of subjective feedback, and the literature suggests that learners may at times disregard feedback that is negative

Effective feedback may be further hampered when learners are 28

Therefore, avoid giving feedback that could be misconstrued as a personal attack, and instead guide the learner through a

measures.1 Consider developing the habit of asking the learner for permission to give feedback. This not only may

is viewed as negative or as personal.3,7 Finally, choose an appropriate setting to give feedback. Positive feedback may

constructive criticism in a more private setting.4

During the feedback process, be sure to incorporate these elements into the feedback to maximize learner reception.

1. This

above, involving a series of exchanges regarding the learner’s performance. First, ask the learner what elements of his or her performance went well; then list elements you thought went well. Second, ask the learner what he or she thinks could be improved; add your thoughts for what could be improved. Soliciting the learner’s view in both cases not only increases his or her participation in the feedback, but also gives the teacher

allowing correction of behaviors and misconceptions.4

2. Timely feedback allows the learner to more rapidly correct errors, preventing cementing of misconceptions and incorrect behaviors. Timely feedback also provides immediate positive reinforcement for appropriate behavior and thought processes.4 Finally, as medical education is a highly situated learning environment, a lack of a temporal

connection to feedback likely decreases the signal strength and effectiveness of feedback.

3. Overly general statements do not provide learners a guide on which elements need correction or how to improve.4

have misread this patient’s EKG and missed their ST

4.interaction cannot be changed. A learner’s gender and speech pattern are impossible to change. Still other aspects, such as body habitus, hairstyle, and dress are inappropriate to comment on unless there is a clear violation of a written guideline regarding the latter

knowledge and behavior.4

5.is your opinion. Doing so adds credibility and weight to the information. At the same time, it gives the learner the opportunity to critically evaluate the feedback, and if he or she, to engage the teacher in further discussion.

6. As mentioned previously, learners may be less receptive to feedback that is negative

augment learner acceptance by preceding any

Anecdotally, many teachers in the authors’ collective

where negative elements are sandwiched between positive elements, additionally allowing the feedback to conclude on a positive note.34

Several problems are inherent to the process of giving feedback. The personal interaction that occurs with both giving and receiving feedback introduces potential problem areas related to body language, which communicates attitudes and feelings, voice tone, silences and other nuances of interpersonal communication which may result in poor reception of feedback. Second, educators may have received no formal training on giving feedback; thus many key elements of feedback may be lost. Finally, while educators may generally know the elements of appropriate feedback, without priming, they may not focus on enough on objective measures of performance.

Learner resistance to feedback happens. Before attempting to tackle what you assume

situation—look for problematic aspects of the feedback or learner barriers to progress, such as underlying personal issues. Consider whether the feedback was provided in a clear manner and understood by the learner, or if your expectations for improvement were unrealistic. Alternatively, consider whether personal issues or drug or alcohol abuse may be interfering with learner improvement. If these issues can safely be excluded, consider the following solutions to several common behavioral issues.

1. Overwhelmed at times with the pressure to perform or increasing responsibility,

12Continued on Page 15

this learner will not accept responsibility for errors,

providing misinformation, or emphasize that certain data points are unknowable due to the patient not disclosing them. If these behaviors occur consistently, they likely poor coping mechanism that has become a habit. To remediate these learners, constant reproducible and measurable documentation is critical. Only by showing the repeated nature of the error will the learner recognize

9

2. Some learners will turn on the evaluator when receiving negative feedback, blaming

from multiple sources will help remedy this issue. Even better, we recommend archived, written evaluations on a regular basis to prevent confusion and misinterpretation, as learners who blame the evaluator have even brought their disagreements with feedback into the legal arena.

3. Finally, some learners will appear to have no interest in improving in a certain area, rationalizing that performance in this area is irrelevant to their ultimate career goals. Often this is a false

of the tasks at hand to their future goals. For example, for the medical student going into General Surgery, emphasize the similarity of the elements used in the history and physical for medical and surgical patients. For the student going into Internal Medicine, emphasize the importance of learning a good physical exam during their General Surgery rotation for when they will later refer their patients for elective hernia repairs.9

Current teaching methods and evaluative processes emphasize the best practices of the teacher. However, future emphasis may shift away from modifying evaluator behaviors

barriers to effective feedback include the low capacity of

aforementioned overpowering affective reactions of learners

1 Interventions focusing on the teacher

improve feedback. In the future, educational focus needs to be additionally directed at the learner.11,35,36

Reference

2. Ende J. Feedback in clinical medical education. JAMA.

3. Yarris LM, Linden JA, Gene Hern H, et al. Attending and resident satisfaction with feedback in the emergency department. Acad

4. Vickery AW, Lake FR. Teaching on the run tips 10: giving

essential professional skills: a framework for teaching and

6. van de Ridder JMM, Stokking KM, McGaghie WC, ten Cate

7. Sender Liberman A, Liberman M, Steinert Y, McLeod P, Meterissian S. Surgery residents and attending surgeons have

472.

8. Hutul OA, Carpenter RO, Tarpley JL, Lomis KD. Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency.

9. Lake FR, Ryan G. Teaching on the run tips 11: the junior doctor

A faculty development program evaluation: from needs

Teaching across the generation gap: a consensus from the Council of Emergency Medicine Residency Directors 2009

24.

13. Wigton RS, Patil KD, Hoellerich VL. The effect of feedback in

14. Porte MC, Xeroulis G, Reznick RK, Dubrowski A. Verbal

15. Issenberg SB, McGaghie WC, Gordon DL, et al. Effectiveness of a cardiology review course for internal medicine residents using simulation technology and deliberate practice. Teach

16. Ten Eyck RP, Tews M, Ballester JM. Improved medical student

emergency medicine curriculum: a randomized controlled trial.

17. Kneebone R. Simulation in surgical training: educational issues

18. Okuda Y, Bryson EO, DeMaria S, et al. The utility of simulation

20. Fried GM, Feldman LS, Vassiliou MC, et al. Proving the value of simulation in laparoscopic surgery. Ann. Surg.

21. Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon

simulations that lead to effective learning: a BEME systematic

22. Boulet JR. Summative assessment in medicine: the promise

23. Maker VK, Bonne S. Novel hybrid objective structured assessment of technical skills/objective structured clinical examinations in comprehensive perioperative breast care: a

351.

24. Xeroulis G, Dubrowski A, Leslie K. Simulation in laparoscopic surgery: a concurrent validity study for FLS. Surg Endosc.

25. Binstadt E, Donner S, Nelson J, Flottemesch T, Hegarty C.

among emergency medicine residents. Acad Emerg Med.

26. Lammers RL. Learning and retention rates after training in posterior epistaxis management. Acad Emerg Med.

13

The CTSA and Emergency Medicine:Improving Patient Care through Collaborative Research

In 2006, the National Institutes of Health launched The and Science Awards (CTSA) Program.

The goals of the program are to reduce the time it takes for laboratory discoveries to become treatments for patients, to engage communities in clinical research efforts, and to train the next generation of clinical and translational researchers. There are now 55 institutions that have received CTSA funding from the National Center for Research Resources

and emergency medicine researchers at these 55institutions are asking how this impacts them.

In our experience, the greatest impact occurs when emergency medicine researchers offer to support their CTSA, rather than simply asking how the CTSA can help the researcher. Emergency Medicine is a highly interdisciplinary specialty, and the emergency department is a wonderful laboratory for clinical and translational research. Few illnesses or injuries are not seen by emergency physicians and the emergency department is visited by the rich and poor, blacks and whites, and both the acutely ill and not so sick. Clinical research in the emergency department has improved the care of patients with acute coronary syndromes, sepsis, and acute ischemic stroke, and health services research rightly positions the emergency department as a cornerstone and safety net for the entire system of care. By making the clinical research community aware of our access to patients, diseases, and systems, and collaborating with CTSAs in areas such as community engagement and patient we can entrenchemergency medicine within the framework of CTSAs, and ensure that our is sought after (andpaid for). The opportunities for areOne just needs to browse the CTSA website to thenumerous opportunities. http://www.ctsaweb.org/index.cfm?fuseaction=home.showHome

Several groups of emergency medicine researchers have already begun to capitalize on this change in paradigm. Craig Newgard, MD, MPH, an emergency medicine physician from Oregon & Science Universityis leading a major project that incorporates expertise from emergency medicine, pediatrics, trauma surgery and emergency medical services. Initially independent of the CTSA, the multicenter study is now being hailed by the

CTSA as an of community-based translational research. As such, the investigators have garnered funding to support their collaboration, which is cost-effective trauma triage tomore match and resource needswith hospital resource availability. This effort was catalyzed

through an inter-CTSA (WESTRN) 7sites: University of UC UCSF/San Franscisco General Hospital, Stanford, Denver Health, and University of Utah. such maybe somewhat typical for emergency medicine, they are not typical in clinical research, and we should make our CTSA leaders aware of how we routinely bring researchers together to solve complex problems.

As well as bringing teams together to help solve systems issues, emergency medicine is also bringing together more diverse teams. A group of emergency medicine heart failure

is partnering with the Texas CTSAand research design (BERD)

network to adaptive designs to heartfailure clinical trials. The aim of this ‘network of networks’ is to design and thatcan tune using biomarkers and patientcharacteristics to identify patients most likely to respond to therapies. This collaboration between investigators and methodologists serves both partners: it provides the methodologists with complex and exciting problems that require offering theinvestigators ready access to some of the best clinical trial design minds in the world.

As the CTSA consortium nurtures collaboration, emergency medicine researchers should be thinking broadly about synergistic partnerships. How can we from astrategic with the CTSA key functions? Perhapsa partnership between clinical trialists conducting research with exception from informed consent might frombuilding a relationship with a CTSA community engagement core. Collaboration between emergency physicians and novel technologies might bring new problems to the fore that can be tackled by engineers and scientists. In the future we could see EM investigators partnering with biomedical informatics, providing a framework for research using biobanks and data warehouses, which commonly house thousands to millions of patient records. By creating

partnerships and forming new networksof interdisciplinary teams focused on emergency medicine problems, the CTSA consortium has tremendous potential to impact research efforts and drive evidence-informed patient care. All we need to do is seek to support, not to be supported.

Sean MSc • Christopher PhD • Jeff MD

14

The Department of Emergency Medicine at Massachusetts General Hospital is seeking candidates for faculty positions at all academic levels. Special consideration will be given to those with an established track record in clinical or laboratory research and a commitment to excellence in clinical care and teaching. Academic appointment is at Harvard Medical School and is commensurate with scholarly achievements.

Emergency Medicine Residency Program. The ED at MGH is a high volume, high acuity level 1 trauma and burn center for both adult and

ED visit volume is ~91,000.

The successful candidate will join a faculty of 37 academic emergency physicians in a department with active research and teaching programs, as well as fellowship programs in research, global health, medical simulation, ultrasonography, and wilderness medicine. Candidates must have completed an accredited residency program in EM and have at least 4 years of training/experience.

addressed to:

dbrown2@partners.org

15

David Levine, MD, FACEP, Former ED Director at Stroger Hospital, Joins

University HealthSystem Consortium as Associate Vice President, Medical Director

OAK -- The University Consortium (UHC)today announced that David Levine, MD, FACEP, has joined the organization as associate vice president of informatics and medical director of Comparative Data & Informatics department.

Dr. Levine oversee risk-adjustment andphysician engagement activities in comparativedata products and services for the 107-member academiccenter consortium.

Dr. Levine has spent his 15-year career as an emergencydepartment physician at the 464-bed John H. Stroger Jr.of Cook County, Ill.—the last 7 years as medical director of the emergency department. He has also served as a physician leader for information technology upgrades including expansion of computer physician order entry and documentation improvements. In addition, he has been a consultant for emergency departments and physician groups to and He is anassistant professor of emergency medicine at Rush Medical School in Chicago.

“We not be happier to David to the saidSteve UHC senior vice Comparative Data &Informatics. “The he brought to Cook County forso many years and his experience inand compliance in a large, complex academic medical center will be a tremendous to our members.”

Dr. Levine received his medical degree from Northwestern Feinberg of Medicine and his degree

from the University of Michigan. He his emergencymedicine residency at Boston City (now known as Boston

Center). He is a in the American of EmergencyPhysicians.

About UHC

The University formed in is anof 107 academic centers and 238 of their

representing 90% of theacademic centers. UHC offers its members programsand services to improve and patientsafety performance. The mission of UHC is to advancefoster collaboration, and promote change to help members succeed in their respective markets. For more information, visit www.uhc.edu.

PROGRAM COMMITTEE DEADLINES

• Call for DidacticsDeadline Tuesday, September 7, 2010

• Call for Expert Abstract ReviewersDeadline Tuesday, October 05, 2010

• Call for AbstractsDeadline Tuesday, December 7, 2010

• Call for IEMEDeadline Tuesday, January 25, 2011

• Call for PhotosDeadline Tuesday, February 8, 2011

• Call for Medical Student AmbassadorsDeadline Tuesday, February 15, 2011

• Call for ManuscriptsAEM Consensus ConferenceDeadline Saturday, March 26, 2011

All Program Committee set deadlines are at 5PM EST

AW

We have remained focused on our goal to promote the recruitment, retention, advancement and leadership of women in academic emergency medicine throughout their careers. We are in the stages ofthe framework to give you – our AWAEM members- a network for womenphysicians to facilitate mentoring and research collaboration. We have a new team of involved members working on some intriguing projects.

AWAEM Research and Mentoring Committee – Marna Greenberg is the lead. They will be compiling list of researchers and their areas of interest in research related to careers of women in medicine or women’s health issues

Extracting and monitoring data from AAMC and SAEM regarding number and percentage of women by academic rank- Fiona is the

Regional Mentoring Oversight Group- Linda is the Theyare identifying leaders and working group members for each of the 6 SAEM regions New NewYork). The is to AWAEM meeting at SAEMmeeting and coordinate networking opportunities within region.

Development of Process by which we maintain a list of women who are interested in leadership positions - Tracy Sanson is the Theyare creating a list of women who are interested in leadership positions in medical schools which can be supplied to national searches to match suitable candidates with vacant positions.

Medical school liaison- Preeti is the They are creatingpresentations to female students about EM and academic emergency medicine and/or becoming involved with EM interest groups to encourage women to consider an academic career.

Develop a list of med schools which have programs to support women faculty- Keme Carter is the They are identifying the best practices/

for maternity part-time women-in-medicine programs.

Book Club Kathryn Dong is the lead. This group has compiled and maintains resources for women including online resources, articles, monographs, and books which have information of interest to women in academic EM.

Bio form – Alice Mitchell is the lead. This is one of our most exciting initiatives and AWAEM members. This bio-form be used forfunctions. It will help with research mentoring, serves as a database for tracking demographics for practice representation, academic rank, interests, and leadership interests.

Any SAEM member in good standing at any level of training may join. Dues are payable when you join and are currently $100 per year. Residents and Fellows may join free of charge with a current SAEM membership.(Remember to sign up when you renew your SAEM membership.)

Log on to your SAEM Web Account and click on the link to Join an Academy (http://member.saem.org).

16

17

faculty member in the Health Sciences Clinical Series at the Assistant or Associate Professor level. The HS Clinical Series includes substantial patient care, medical student and resident teaching, and

tertiary care hospital with all residencies. The ED is a progressive

County. Collegial relationships with all services. Excellent salary

Orange, CA 92868, or at mark.langdorf@uci.edu, Apply online at https://recruit.ap.uci.edu.

through diversity.

Position: Health Sciences Clinical Professor Series, Open Ranks

ment of Emergency Medicine anticipates openings in the HS

includes substantial patient care, medical student and resident teaching, and optional clinical research. Board preparation or

patients, in urban Orange County. Collegial relationships with all

Application Procedure: Interested candidates should apply through https://recruit.ap.uci.edu/

apply/and upload the following application materials electronically to be considered for the position: Curriculum vitae and Names and addresses of four references.

ployer committed to excellence through diversity.

18

The 2010 NRMP Match in Emergency Medicine

The of the 2010 NRMP Match became on March 2010. Emergency Medicine residency programs offered aof 1575 entry positions (7% of positions in The numbers (taken from the 2010 NRMP

Data Book) information from programs that entered the 2010 Match:

Louis Binder, MD, Professor of Emergency Medicine andVice Chair for Academic University of Nevada of Medicine

2008 2009 2010Total # of NRMP positions 25,066 25,185 25,520

% of positions 5.6% 4.6% 4.5%Number of EM programs listed 141 147 150

(133 8 PG2) (141 6 PG2) (147 3 PG2)Total PG1/PG2 entry positions 1475 1515 1575

(1399 76 PG2) (1472 43 PG2) (1556 PG2)EM positions/total NRMP positions 6.0% 6.0% 6.8%

# EM programs with PG1 vacancies 11/133 (7.5%) 5/141 (3.6%) 5/147 (3.4%)# unmatched EM PG1 positions 29/1399 (2.1%) 13/1472 (1%) 16/1556 (1.0%)

# EM programs with PG2 vacancies 1/8 (12%) 0/6 (0%) 0/3 (0%)# unmatched EM PG2 positions 1/76 (1%) 0/43 (0%) 0/19 (0%)

# EM programs with vacancies 12/141 (9%) 5/147 (3%) 5/150 (3%)# unmatched EM positions 30/1475 (2%) 13/1515 (1%) 16/1575 (1%)

Applicant Pool DataApplicants who ranked only EM programs:

2008 2009 2010US graduates 1125 1167 1175Independent applicants 317 457 439Total applicants 1442 1624 1614

Applicants who ranked at least one EM program:

US graduates 1239 1324 1343Independent applicants 606 684 791Total applicants 1845 2008 2074

US seniors to EMPrograms who went unmatched 36/1071 (3.4%) 64/1167 (5.9%) 68/1175 (5.7%)

Independent 117/371 (32%) 181/457 (40%) 151/439 (34%)only to EM programs who wentunmatched

Percent of matched US seniors (8%)who matched in EM residencies

19

(“Giving Feedback in Medical Education”, Continued)

PG1 EM positions 1399 1472 1556

PG2 EM positions 76 43 19

Total EM positions 1475 1515 1575

physicians, 109 by US international medical graduates, 22 by international medical graduates, 2 by Canadian physicians, and 0 by Fifth Pathway graduates.

From these data, several conclusions can be drawn:

applicant pool are determined.

percentage with recent years.

and Independent Applicants who apply will match into an EM residency.

28. Watling CJ, Lingard L. Toward meaningful evaluation of

the process. Adv Health Sci Educ Theory Pract. 2010. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20143260 [Accessed February 10, 2010].

29. Sargeant J, Mann K, Ferrier S. Exploring family physicians’ reactions to multisource feedback: perceptions of credibility and

30. Sargeant J, Mann K, Sinclair D, Van der Vleuten C,

31. Lave J, Wenger E. Situated Learning: Legitimate Peripheral

1991.

32. Orey MA, Nelson WA. Situated Learning and the Limits of Applying the Results of These Data to the Theories of Cognitive Apprenticeships. In: ; 1994. Available at: http://www.eric.ed.gov/ERICWebPortal/contentdelivery/servlet/

33. Brown J, Collins A, Duguid P. Situated cognition and the culture

34. Kilminster S, Cottrell D, Grant J, Jolly B. AMEE Guide No. 27: Effective educational and clinical supervision. Med Teach.

35. Notzer N, Abramovitz R. Can brief workshops improve clinical

36. Salerno SM, Jackson JL, O’Malley PG. Interactive faculty

834.

20

CDEM members have been busy since the SAEM meeting putting the toucheson important resources. Themodules are available at www.cdemcurriculum.org. They are a set of learning modules based on the national emergency medicine curriculum and provide substantial information on all the core topics in emergency medicine including the “approach to” and disease processes. TheMedical Student Educators Handbook is nearing completion and a hard copy will be available for purchase. Updates to our addition ofmore educator resources, and work on a third year curriculum, pediatric EM curriculum and

examination are underway. The AcademicEmergency Medicine Education Supplement will be coming out soon with articles from CDEM members.

meeting putting the touches

CDEM Highlights

21

SAEM is pleased to offer a variety of grants available for competitive application. The grant below has an upcoming deadline:

SAEM / Emergency ServicesResearch for 1 year) –deadline: November 1, 2010

Through the generous support of thisin emergency services (EMS) provides

an opportunity for a emergency physician to acquireimportant skills and begin to develop expertise as part of an academic career with a focus in EMS.

SAEM/EMPSF Patient Safety Research Grant for 1year) – (has been extended): January1, 2011

Additional SAEM grants include:

SAEM Research Training Grant for 2 years) –Application deadline: August 1, 2011

This grant provides support to emergency physicians for two years of concentrated training in research methods and concepts.

SAEM Research Training Grant for 2years) – August 2011

The Institutional Research Training Grant is intended to identify and fund centers of excellence to train Emergency Medicine research fellows.

For more details as well as detailed application instructions, go to the SAEM website (www.saem.org) and on

“Grants” under the “Grants & Awards” tab.

2010 / 2011 SAEM Grant Information

Wilderness Medicine Interest Group Holds Inaugural Meeting

The SAEM Wilderness Medicine Interest Group held its inaugural meeting in Phoenix in June. Over 25 new members from across the country — ranging from medical students to wilderness medicine fellowship directors — engaged in an energetic discussion over for thissubspecialty of Emergency Medicine.

medicine is by the practice of medicine in resource-limited, austere environments -not exclusively by distance from human population centers. The taught through this training have broad and unique

in disasterand and

environmental/medical policy development.

The goals of the SAEM Wilderness Interest Group are:

To establish a community of providers interested in 1.Wilderness Medicine.

To act as a resource base for our members (from very2.curious students to very experienced staff) tohelp advance their careers and the continued growth of wilderness medicine as a vibrant emergency medical discipline.

To provide a forum to advance our members’ expertise 3.and opportunities in wilderness medical research, teaching, and administration.

To enable our members to develop their expertise and 4.in issues – most on the

myriad intersections between human health and local and global ‘environmental’ issues.

Currently, there are four Wilderness Medicine Fellowship programs: at Stanford Massachusetts

Harvard University of andUCSF-Fresno. Other residencies areworking to establish additional fellowships. Numerous Emergency Medicine residencies are developing expertise in this discipline and have published research on wilderness medicine topics, from high altitude physiology, to wilderness policy planning. Over twenty wilderness medicine interest groups exist at across the U.S..We seek to encourage them all.

Great opportunities exist for SAEM members to explore wilderness medical teaching, research, and clinical care. Research expeditions have pursued their work in wilderness areas from the to the theHimalaya, Mt. Kilimanjaro and other austere environments.

care opportunities are distributed.

We welcome new members of any level of experience to join our group and help develop this exciting discipline of emergency medicine. be in touch with any questions.I’ll look forward to meeting you in Boston in June, 2011.

N. Stuart Harris MD MFA FAAEM Director, MGH Wilderness Medicine Fellowship. Chief, MGH Division of Wilderness Medicine. MGH Department of Emergency Medicine. Assistant Professor of SurgeryHarvard Medical School

By N. Stuart Harris MD, MFA, FAAEM

22

23

24

the single largest, directed investment in emergency medicine research training to date. In developing the vision for and securing the resources to support this program, NHLBI has demonstrated a thorough understanding of, and is addressing, our national

rigorous research training programs worthy of this federal support. Please note that institutions submitting K12 applications to

training program. Please see for details.

Roger J. Lewis, MD, PhD

Charles B. Cairns, MD

25

26

Wiley InterScience, will be shut down at the end of July and replaced with the Wiley Online Library. Please take a look at this material very carefully, as this will be your entry into accessing the new Academic Emergency Medicine home

Questions, etc. Should you experience any

contact Sandra Arjona, sandrak.arjona@gmail.com. We are looking forward to a much more robust platform, with many innovative features.

is seeking applicants for a faculty position in the HS Clinical Series at the associate or full professor level. The applicant must have a PhD in

with postdoctoral training. The individual must also have extensive experience in the initial psychological assessment of disaster victims and also have at least 10 years of experience in the clinical assessment of children’s psychological needs. Demonstration of successful sustained grant funding in the area of disaster psychological assessment is

state, and federal government agencies, including the Department of Defense, the Centers for Disease Control and Prevention, and the American Red Cross is also necessary. Possession of a national

center with 2200 runs/year and a 40,000 ED census. The applicant will participate in the disaster education of emergency medicine residents and will support research in the proposed Disaster Medical Sciences Institute. Salary is commensurate with level of academic productivity.

system located at: https://recruit.ap.uci.edu/apply/. Applicants should

application materials electronically to be considered for the position:

Curriculum vitae; Names and addresses of three references. For additional information regarding this position, you may contact:

Mark Langdorf, MD, MHPE Chair, Department of Emergency Medicine

101 City Drive, Orange, CA 92868.

committed to excellence through diversity.

is seeking applicants for the fellowship in EMS and Disaster Medical

center with 2200 runs/year and a 40,000 ED census. Fellows serve as HS Clinical Instructors. The program combines the disciplines of emergency management/disaster medicine and public health with traditional emphasis on services systems research including mass casualty management and triage. Completion of American Council

program, with an integrated Masters of Public Health, will be jointly administered by Director, Emergency Medical Services and Disaster Medicine. Salary commensurate with level of clinical work.

Send CV, statement of interest and three letters of recommendation to: Carl Schultz, MD.Department of Emergency Medicine, Rte. 128

101 The City Drive South, Orange, CA 92868.

committed to excellence through diversity.

Society for AcademicEmergency Medicine2340 S. River Road, Suite 200Des Plaines, IL 60018Newsletter

Jeffrey A. Kline, MD President

Debra E. Houry, MD, MPH President-Elect

Adam J. Singer, MD Secretary-Treasurer

Jill M. Baren, MD, MBE Past President

Brigitte M. Baumann, MD, MSCE

Deborah B. Diercks, MD, MSc

Cherri D. Hobgood, MD

Robert S. Hockberger, MD

Alan E. Jones, MD

O. John Ma, MD

Jody A. Vogel, MD

Executive Director James R. Tarrant, CAE

Send Articles to: newsletter@saem.org

Send Ads to: mgreketis@saem.org

Board of Directors

The SAEM newsletter is published bimonthly by

the Society for Academic Emergency Medicine. The opinions expressed in this publication are those of the

authors and do not necessarily reflect those of SAEM.

For newsletter archives and e-Newsletters

Click on Publications atwww.saem.org

2011 June 1 - 5

Marriott Copley Place, Boston, MA

2012 May 9 – 13

Sheraton Hotel and Towers, Chicago, IL

2013 May 15 – 19

The Westin Peachtree Plaza, Atlanta, GA

2014 May 14 – 18

Sheraton Hotel, Dallas, TX

2015 May 13 – 17

Sheraton Hotel and Marina, San Diego, CA

At www.saem.org, you will find more information on each regional meeting

in the Meetings > SAEM Regional Meetings section of the site.

FuturE SAEM AnnuAl MEEtingS

MiDwESt rEgionAl MEEting

20th Annual Midwest Regional SAEM Meeting November 8, 2010 • Wright State University Boonshoft School of Medicine Dayton, Ohio

Abstracts may be submitted from May 1 to October 1

For additional information contact Nancy Andrews at nancy.andrews@wright.edu

grEAt PlAinS rEgionAl MEEting

Friday, September 17, 2010 (Reception: September 16, 2010)

Michael F. Sorrell Center for Health Science Education University of Nebraska Medical Center • Omaha, Nebraska

For More Information:

Robert Williams rlwilliams@unmc.edu (402) 559-6705

Brenda Ram, CMP bram@unmc.edu (402) 559-9250

NONPROFIT ORG. US POSTAGE

PAID MILWAUKEE, WI PERMIT NO. 3563