Advocating forEmergency Physician

AdvocacyOver the past year I have had the

opportunity to visit every region ofour country, witnessing emergencycare in our academic medical cen-ters, and speaking with emergencyphysicians, residents, medical stu-dents, and patients from Californiato Rhode Island. So, you might for-give me for humming a few bars of

“This Land is Your Land” while I stroll down the all too similarhallways of nameless airports. I was surprised to learn thatthis song, written by the legendary folk singer, WoodyGuthrie, is not as celebratory as one would gather upon firsthearing it. It was a protest song, written as a parody to IrvingBerlin’s “God Bless America”. Joe Klein, in his authoritativebiography, notes that Woody Guthrie’s original verses of “ThisLand is Your Land” talk about private property restrictions,and implore open access to the land for all Americans. Thesemore socialist verses were omitted by other singers over theyears, and the song is now regarded as a patriotic anthem.1

One thing that Woody Guthrie had going for him was cred-ibility. He knew of what he sang. He grew up in an Oklahomafrontier town with tremendous personal tragedy. He adoredhis older sister, and watched her die from severe burns aftershe impulsively lit her clothes on fire after an argument withtheir mother. Woody’s mother suffered from a wild moodswings, depression and neurological symptoms that wereeventually diagnosed as Huntington’s disease. Her final actbefore being sent to deteriorate and die in a state mentalhospital was to douse her sleeping husband with lamp oiland light him on fire. Following the collapse of his family,Woody learned of hunger, poverty, and hardship. He traveledwith the hobo culture, telling tales and singing folk songs withother destitute men and women in the post-depression era.The songs he composed were unfailing true to the lives ofthe people he met. His songs railed against the hard-heartedness of big business and the inadequacies of govern-ment in helping the poor. They were painfully accurate de-pictions of the problems experienced by the common man.When Woody Guthrie advocated for a cause through hismusic, people listened. His songs helped guide the directionof advocacy for the poor in those times.1

Emergency physicians have that same type of credibilitywhen it comes to health care advocacy that Woody Guthriehad with social causes in the middle of the 20th century.Fortunately, most of us have not had to endure the tragediesand hardships that Woody did. But our work immerses us in

NEWSLETTERNEWSLETTER901 North

Washington Ave.

Lansing, MI

48906-5137

(517) 485-5484

saem@saem.org

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January-February 2001 Volume XIII, Number 1Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE

Brian Zink, MD

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Neuroscience Research FellowshipSAEM is pleased to announce the availability of the

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

The Grant application and criteria are posted on theSAEM web site at www.saem.org by. The deadline for thesubmission of completed applications will be February 15,2001, with announcement of the recipient by March 15. Thefunding will be for the period from July 1, 2001 to June 30,2002. Contact SAEM at saem@saem.org for questions orfurther information.

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

Call for PapersAcademic Emergency Medicine is sponsoring a Consen-

sus Conference to discuss this topic on May 9, 2001 at theSAEM Annual Meeting in Atlanta. Topics to be discussed in-clude the importance of emergency departments as a medi-cal and social safety net, challenges currently faced by U.S.emergency departments, and trends that threaten emer-gency care delivery. Manuscripts relevant to this theme arebeing solicited. The deadline is March 1, 2001, and authorsshould use the AEM Instructions for Authors posted on theAEM and SAEM web sites. Please send manuscriptselectronically to aem@saem.org or by mail to: AcademicEmergency Medicine, Special Issue, 901 North WashingtonAve., Lansing, MI 48906.

Call for “Virtual Advisors”Felix Ankel, MDChair, Undergraduate CommitteeWendy Coates, MDUndergraduate Committee

SAEM will soon be looking for virtual advisors to providecareer advice to medical students attending schools withoutemergency medicine residencies. The SAEM UndergraduateCommittee is developing the Virtual Advisor Web Site wherestudents can browse commonly asked questions/answersand then be assigned to a “virtual” EM advisor from some-where in the U.S. This service should be especially useful forstudents who do not have an EM advisor. We will soon belooking for EM faculty with experience in advising students.For further information contact SAEM at saem@saem.org.

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We’re Making Changes to the Annual MeetingEllen Weber, MDChair, 2001 Annual Meeting ProgramCommitteeUniversity of California, San Francisco

Next time you think about tossingthat annual meeting evaluation form inthe trash, think twice! We do want toknow what you think, and we are mak-ing many of the changes our mem-bers have asked for.

Each year the Program Committeereviews the evaluations of the AnnualMeeting that attendees submit. I read(and have for the last three years)every written comment, exclamationpoints, capital letters and all. Twoyears ago, under the very capableleadership of Sue Stern, the ProgramCommittee organized a Needs As-sessment Task Force (headed by BobNeumar) to find out how the ProgramCommittee had been doing in meetingthe needs of its members. The over-whelming majority of respondents saidthe Annual Meeting met their needsand expectations. But there weresome areas for improvement. Spe-cifically, members requested more“state-of-the-art” sessions and moreopportunities for networking withsenior members of the organization.

This past summer, we receivedover 600 responses to our surveyabout the Annual Meeting banquetand we want to thank you all for yourresponses and the extra time you tookto write comments. Overwhelmingly,members wanted us to hold the ban-quet earlier. Many also felt we should“reconsider” the entertainment. Mostmembers said they were willing to paymore for the banquet to help offset thecosts of a larger banquet, but also feltthat we should charge less to theresidents. And, in addition to theseformal requests for information, wealso pay attention to the more spon-taneous expressions of frustration,such as, the digs made at last year’sbanquet about how hard it is to get adidactic accepted!

Well, we wanted you to know thatwe heard you. Here are some of theinnovations we are working on for the2001 meeting. Your comments andadditional suggestions are welcome. • We’re looking at ways to increase in-

formal opportunities for meeting peo-ple and networking. One thought is ahappy hour at the end of the day,where people can talk to the days’presenters, and meet up with friendsbefore going out on the town. We’dalso like to hold the Keynote Lecturetowards the end of one of our days

and follow it with a reception, so wecan all meet and talk to the speaker(and each other). We’re looking atholding a large buffet lunch one daywhere you can catch up with friends,introduce colleagues to each other,have informal discussions aboutyour research and programs, andmeet the Board members. If possi-ble, we’ll try to put in a few morescheduled breaks between sessionsto give people some time to hobnoband move from room to room. We’reconsidering what we used to call atsummer camp, an “evening activity”a late night fun, yet educational ac-tivity that you can come back to afterdinner, eat popcorn and drink beerand still get to bed at a reasonablehour. Right now we’re thinking abouta session that would help you getthe most of your palmtop for ED clin-ical work and education.

• The banquet will not be held on thelast night of the meeting. We’re hop-ing to hold it on the first night, as anopening banquet. Gone of coursewill be the imago obscura award, be-cause you can’t steal slides youhaven’t seen yet. I know some ofyou will miss it, but judging from thebanquet responses, only some ofyou will miss it. Maybe we can findanother venue for it. We’l l takesuggestions.

• Many of you said the meeting wastoo long and you wanted to gethome right after the last day of themeeting. So we’re looking at com-pacting the formal programming onthe last day. It will still be a very fullday with lots of research and didac-tic sessions. And there will be sev-eral excellent but optional work-shops that afternoon that will stillend in time to get you home thatnight. Sue Fish has agreed to teachan IRB certification course that manyof us need to conduct clinical trialsfor the NIH. A workshop on negotia-tion and resolving conflict in theworkplace offered by faculty from theHarvard School of Public Health isalso under consideration. We under-stand AEM is planning a ConsensusConference and we hope to be ableto t ie this in with some of ourresearch presentations on that day.

• We re-wrote the guidelines for thedidactic submissions, which we hopeclarified what the Society was lookingfor in these proposals. We receivedover 90 excellent proposals. Ofcourse, we can’t accept all of them,unless we make the meeting twoweeks long! For those of you whose

submissions were not accepted thisyear, we want to assure we spent agreat deal of time reviewing anddiscussing all of the proposals.Please continue to offer proposals!

• We are looking into ways to improvethe lunches. Believe me, the entireProgram Committee has tasted therubber chicken and we feel yourpain. Some of this is a hotel issueand may be out of our control. Butwe’re working on it. We may havefewer “luncheon” didactics, and in-stead hold meetings over the lunchhour. In particular, we are looking athaving more interest group, taskforce and committee meetings in theearly mornings, lunch hour and lateafternoons to avoid the conflicts withdidactic and research sessions.

• We know that many of you have ac-complished important tasks in yourinterest groups and want to presentwhat you’ve done to the larger mem-bership. We’d like to help get theword out to others that might like toattend. If interest groups get theiragendas in to their Board Liaison ina timely fashion, and they are ap-proved by the Board, we will high-light the content of these meetings inthe on-site brochure.

Finally, a confession. It was mypleasure and honor to accept theposition of Chairperson of the Pro-gram Committee this year, following inthe (figuratively) large footsteps ofSue Stern. Three years ago, when Ijoined the Program Committee, Ibarely knew a soul in SAEM . . . and Idoubt many people knew me. I hadbeen a member of SAEM since 1990,but as an attending in a relativelysmall program, without its own resi-dency, it was hard to meet people atthis large, very busy Annual Meeting.Three years ago, I filled out the appli-cation to join my first SAEM commit-tee with a specific request to work onthe Annual Meeting. I have to thankScott Syverud, that year’s president,for offering me a spot on the ProgramCommittee. I urge you all to do some-thing similar. It is easy to feel like anoutsider in a large organization with astructured leadership; but its also veryeasy to get involved and feel part ofthings. And even if you don’t join acommittee, just remember this whenyou are about to crumple up that An-nual Meeting evaluation form and tossit in the circular file — we do hear you!

Comments and additional sugges-tions are welcome. Send emails to saem@saem.org or weber@itsa.ucsf.edu

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SAEM Joins CORD and AAEM in FSMB ProposalCarey Chisholm, MDIndiana UniversityJerris Hedges, MDOregon Health Sciences University

In May 2000 representatives of theCouncil of Emergency Medicine Resi-dency Directors (CORD, Sam Keim), theAmerican Academy of EmergencyMedicine (AAEM Antoine Kazzi, JosephWoods and Robert McNamara), theFederation of State Medical Boards(FSMB Ron Joseph) and SAEM (MarcusMartin and Carey Chisholm) met todiscuss the recent FSMB proposalsabout medical licensure and reportingduring the post graduate training period.Over the summer this group, joined byJerris Hedges, developed a proposalthat has been endorsed by all three EMorganization boards and forwarded tothe FSMB for action at their FebruaryBoard of Directors meeting.

The proposal can be found below.The major changes include a strongrecommendation for a “dependent prac-tice” license that residents may obtainprior to completion of their postgraduatetraining. This form of a limited licensewould permit residents to work in theirown specialty in specific supervisedwork conditions independent of theirpostgraduate training program. Super-vision would have to be provided byAmerican Board of Medical Specialties(ABMS) or American Osteopathic Asso-ciation (AOA) certified physicians in thatresident’s specialty. These physicianswould have to be on-site and wouldshare medicolegal responsibility forpatient care rendered by the resident.

The second major proposal is to op-pose the FSMB-recommended man-dated reporting of adverse actionsagainst residents (e.g. probation or re-mediation) by program directors to thestate licensing board. All participating or-ganizations feared the potential adverseimpact this would have on the learningenvironment. Instead, all reports wouldcome through the teaching institution’sGME office, and only serious actions(e.g. termination) would be reported.

Why did SAEM make these recom-mended changes to the FSMB pro-posal? First and most important, for thesafety and welfare of our patient popu-lations. Patients presenting for care atan emergency facility desire and de-serve consistently high quality care. TheSAEM Board of Directors believes thathigh quality emergency care is bestrendered by an emergency medicine(EM) residency-trained and board certi-fied specialist. An EM resident lacks therequisite skill set to consistently deliversuch high quality care in an independentpractice setting. Furthermore, residentsare often inexperienced in the art of

dealing with private medical staffs, andtherefore are less well positioned toserve as patient advocates in the face ofinappropriate treatment or dispositionrecommendations by a consulting physi-cian. By functioning under the direct su-pervision of a ABEM/ABOEM certifiedphysician, the resident is less likely to in-advertently administer substandard care.

Second, we make these recommen-dations for the welfare of our residents.Unsupervised moonlighting activitiesprior to completion of the requisitetraining and acquisition of the full skill setnecessary to practice the specialty ofemergency medicine places not only thepatient at risk, but our residents at riskas well. In addition to the psychologicalstress of working alone before acquiringthe skill set necessary for success, theresident is at risk for malpractice claims.Mandated reporting of such claims to theNational Practitioners Data Base willmagnify the impact of a malpracticeclaim against an independentlypracticing resident, potentially adverselyaffecting their future malpractice feesand medical staff privileges.

Lastly, this is the correct thing to dofor the specialty of Emergency Medi-

cine. If we truly believe that there is aspecific knowledge base and skill setnecessary for the successful practice ofEM, then it is hypocritical to allow thosewho are incompletely trained to workunsupervised in an ED. Some will saythat it is better to have a partiallytrained emergency physician than anon-emergency physician deliveringemergency care. This argument harmsboth our specialty and our patients.This claim appears to be self-servingby those who stand to gain immediatefiscal reward from the current statusquo. Until we as a specialty insist thatfully trained practitioners practice EM,the impetus to train adequate numbersof specialists in emergency medicinewill remain stifled. Our specialty, ourtraining programs, and ultimately, thepublic suffer as a consequence.

No other specialty advocates thattrainees should be considered at thesame level as their residency-trained,board certified colleagues. It is time foremergency medicine to step forwardand advocate for professionalism in ourspecialty. Revising the standards formedical licensure is an important stepin this direction.

Consensus Recommendations to the Federation ofState Medical Boards (FSMB)

I. FSMB recommends “3. All applicants for licensure should have satisfac-torily completed a minimum of three years of postgraduate training in anACGME- or AOA-approved postgraduate training program, includingcompletion of PGY3 level training prior to full and unrestricted licensure.”

With regard to the FSMB recommendation to restrict full licensure to physiciansthat have completed 3 years of post-graduate training, we agree with this recom-mendation, which will raise the medical standards for new licensees. The currentpractice of moonlighting by physicians-in-training subjects patients to care by physi-cians with less than optimal training.

We also acknowledge that a shortage of board-certified emergency physicianspersists at this point, particularly in rural and underserved areas.

We therefore propose the following addition to the FSMB recommendation: “theFSMB should support the establishment of a dependent practice of medicine licenseby state boards that a physician in-training can secure after successfully completingone year of residency training in a US -accredited allopathic or osteopathic program(ACGME or AOA).”

❐ The dependent practice license is to be time-limited. A “physician in-training” isdefined as a resident physician who maintains current, satisfactory enrollment inan ACGME or AOA approved residency-training program.

❐ Such a dependent practice is to be restricted in scope to clinical activities consis-tent with those that the resident is performing in the course of their residency-training program and the scope of practice for that clinical specialty.

❐ On-site supervision of the resident physician that is working under the dependentpractice of medicine license is required.

❐ Such supervision should be 1) continuous, 2) onsite, and 3) provided by fullylicensed physicians who are board-certified/prepared in the resident’s own fieldof training.

❐ A certifying body recognized by the American Board of Medical Specialties or theAmerican Osteopathic Board of Specialties must provide board certification orpreparation of the supervising physician.

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Password Required toReceive AEM OnlineAcademic Emergency Medicine

(AEM), SAEM members must now usea password to access their online sub-scription. All SAEM members areentitled to a receive a free subscriptionof both the print copy and onlineversion of AEM.

To activate your subscription go tothe website: <www.aemj.org>. Click onthe subscriptions button. Click on thelink “activate your member subscrip-tion.” Enter your membership number(which is printed above your name onthe mailing label of this Newsletter) andclick the submit button. You will then beasked to select a user name and pass-word. If you need assistance or do nothave a member number, send an e-mail to saem@saem.org or call 517-485-5484.

Medical Student Excellence inEmergency Medicine Award

The SAEM Medical Student Excellence in Emergency Medicine Award is of-fered annually to each medical school in the United States and Canada. It isawarded to the senior medical student at each school who best exemplifies thequalities of an excellent emergency physician, as manifested by excellent clin-ical, interpersonal, and manual skills, and a dedication to continued professionaldevelopment leading to outstanding performance on emergency medicinerotations. The award, presented at graduation, conveys a one-year membershipin SAEM, which includes subscriptions to the SAEM monthly journal, AcademicEmergency Medicine, the SAEM Newsletter and an award certificate.

Announcements describing the program and applications have been sent tothe Dean’s Office at each medical school. Coordinators of emergencymedicine student rotations then select an appropriate student based on thestudent’s intramural and extramural performance in emergency medicine. Thelist of recipients will be published in a summer issue of the SAEM Newsletter.

Over 110 medical schools currently participate in this award. The goal is tohave all medical schools participate. Please contact the SAEM office if yourschool is not presently participating.

CORD/AACEM Faculty DevelopmentConference: Navigating the Academic Waters

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

Geriatric Emergency Medicine Resident/FellowGrants Available

SAEM with funding from the John A. Hartford Foundation and the AmericanGeriatric Society (AGS), is pleased to announce the availability of grants to sup-port resident/fellow research related to the emergency care of the older person.Investigations may focus on basic science research, clinical research, preven-tive medicine, epidemiology, or educational topics. Awards may be up to $5,000for each project.

Applications for the Geriatric Emergency Medicine Resident/Fellow Grant willbe sent to each residency program or may be obtained from the SAEM office orthe website at <www.saem.org>. The deadline for receipt of a complete appli-cation at the SAEM office is March 5, 2001 with notification of selections byMay 7 and funding awarded by July 1.

NewsletterAdvertising

The SAEM Newsletter is mailed everyother month to the 5,000 members ofSAEM. Advertising is limited to fellow-ship and academic faculty positions. Allads will be posted on the SAEM website at no additional charge.Deadline for receipt: December 1 (Jan/Feb issue), February 1 (March/Aprilissue), May 1 (May/June issue), June 1(July/August issue), August 1 (Sept/Octissue), and October 1 (Nov/Dec issue).Ads received after the deadline can oftenbe inserted on a space available basis.

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

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

To place an advertisement, e-mail, faxor mail the ad, along with contact per-son for future correspondence, tele-phone and fax numbers, billing ad-dress, ad size and Newsletter issues inwhich the ad is to appear to: JenniferMastrovito at <jmastrovito@saem.org>,via fax at 517-485-0801 or mail to 901N. Washington Avenue, Lansing, MI48906. For more information or ques-tions, call 517-485-5484 or <jmastrovito@saem.org>.

No rate increases in 2001!All ads posted on SAEM web site

at no additional charge!

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❐ Such a dependent practice of medicine is equivalent to extending eligibility for a“Physician Extender” status to residents who are in good standing in their trainingprogram.

❐ Such dependent practice licensure will require annual renewal.❐ Physician groups and institutions that contract or employ physicians who are

practicing under a dependent practice license must share the legal liability for thequality of care provided by the residents working for them. They must assumethe responsibility of clearly documenting the supervision mechanism for thedependent practitioner. This mechanism must not vary substantially from thatprovided in the resident’s training program.

II. FSMB recommends “2. All physicians enrolled in postgraduate trainingprograms shall be subject to medical board regulation and oversight througha mechanism that requires the physician to obtain a training permit or limitedlicense expressly designed for such purpose. This mechanism shall alsorequire that program directors report annually to the medical board on allindividuals enrolled in their respective programs.”

We believe this recommendation requiring program directors to annually reportdetails of each resident’s education process is counterproductive. All representedEmergency Medicine organizations are strongly opposed to this requirement. Wepropose modifying this 1998 FSMB position by shifting the responsibility and timingof the reporting of residents and the permit renewals from the program director tothe Graduate Medical Education Office (GME) of their medical institution.

The proposed revision is: “All physicians enrolled in postgraduate trainingprograms shall be subject to medical board regulation and oversight through amechanism that requires the physician to obtain a training permit or limited licenseexpressly designed for such purpose. This mechanism shall also require that thegraduate medical offices of training institutions report annually to the medical boardany serious disciplinary action taken against a resident such as termination.However, remediation programs and probationary actions are best handledinternally within the training institution. Such a process permits deficiencies inperformance to be openly addressed by the program director with the trainee ratherthan overlooked or inadequately addressed for fear of harming the resident’s futurecareer. Mandated reporting of such activities by the program director would createan environment in which residents attempt to hide or cover up educational mistakesor deficiencies, rather than proactively seeking assistance through the residency.

Semi-Final CPC Competition Submissions SoughtSubmissions are now being accepted from Emergency Medicine residency

programs for the 2001 Semi-Final CPC Competition to be held May 5, the daybefore the SAEM Annual Meeting in Atlanta. This event has increased in popu-larity every year and is an excellent opportunity to showcase a residencyprogram. The deadline for submission of cases is February 2, 2001 and thereis an entry fee of $200.

Case submission and presentation guidelines can be obtained from theCORD home page at <www.cordem.org> or the CORD office 517-485-5484.Residents participate as case presenters, and programs are encouraged toselect junior residents who will still be in the program at the time of the finalscompetition in October. Each participating program selects a faculty memberwho will serve as discussant for another program’s case. The discussant willreceive the case approximately 4-5 weeks in advance of the competition. Allcases are blinded as to final diagnosis and outcome. Resident presentersprovide this information after completion of the discussant’s presentation.

The CPC Competition will be limited to 50 cases selected from thesubmissions. A Best Presenter and Best Discussant will be selected from eachregion. The Best Presenter recipients will receive a placque and $250; the BestDiscussants will receive a placque.

Winners of the semi-final competition will be invited to participate in the CPCFinals to be held during the ACEP Scientific Assembly in October in Chicago. Atthe finals competition a Best Presenter and Best Discussant will be selected.Both will receive a statue and $500.

The CPC Competition is sponsored by ACEP, CORD, EMRA, and SAEM. Ifyou have any questions, please contact the CORD office at<cord@cordem.org> 517-485-5484, or via fax at 517-485-0801.

Consensus Recommendations (Continued)

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Academic AnnouncementsFrank Day, MD, a fellow at UCLA has been awarded aPostdoctoral Fellowship Award from the Agency forHealthcare Research and Quality (AHRQ). Dr. Day’sstudy concerns the development and evaluation of theEmergency Department Patient Classification system,being designed to identify similar types of patients asthey present to an ED. David Schriger, MD, will be Dr.Day’s mentor for the fellowship.

Wyatt Decker, MD, was appointed Chair of the newlycreated Department of Emergency Medicine at MayoMedical School in October 2000. Dr. Decker overseesthe newly accredited emergency medicine residencytraining program and supervises the development andimplementation of the department’s operational plans.The Division of Emergency Medicine was redefined intoa new academic and administrative department onJanuary 1, 1999.

Robert A. Schwab, MD, has been named the Chief ofEmergency Medicine at Truman Medical Center Hospi-tal Hill and the Chair of the Department of EmergencyMedicine at the University of Missouri-Kansas City. Dr.Schwab has been with Truman Medical Center for sixyears, most recently serving as Vice-Chair and InterimChief of Emergency Medicine.

Terry VandenHoek, MD, Lance Becker, MD, and col-leagues at the University of Chicago’s Emergency Re-suscitation Research Center, have received a four-year$1,000,000 grant entitled, “Cardiac Oxidants and Apop-tosis: Lessons of Preconditioning” that will investigatethe role of cell suicide (apoptosis) in myocardial ische-mic injury, and how intrinsic adaptive responses of theheart can stop this process. The ultimate goal is to dis-cover new potential therapies that improve survivalfrom cardiac arrest and myocardial infarction.

Robert O. Wright, MD, MPH, Assistant Professor ofPediatrics at the Division of Pediatric Emergency Medi-cine, Section of Emergency Medicine, Brown MedicalSchool, has received a K23 Mentored Clinical ScientistResearch Award from the National Institute of Environ-mental Health Science. Dr. Wright will be the principalinvestigator of the project entitled, “Neurochemical andGenetic Markers of Lead Toxicity.”

Donald M. Yealy, MD, Professor of Emergency Medi-cine, University of Pittsburgh, is the principal investiga-tor and Thomas E. Auble, PhD, Research AssistantProfessor of Medicine, is the co-principal investigator,of a two year, $368,000 grant from the Agency forHealthcare Research and Quality (AHRQ). The pro-ject, “A Risk Stratification Rule for Health Failure” aimsto derive a clinical guideline to help identify patients atlow risk for short term mortality and morbidity.

Kelly D.Young, MD, Harbor-UCLA Medical Center,has received a 5-year Mentored Patient-Oriented Re-search Career Development Award (K23) from the Na-tional Institutes of Health, National Center for ResearchResources. Dr. Young’s project is entitled “Post-Traumatic Stress and Pain in Children UndergoingPainful Medical Procedures.” Dr. Young will studyethnic differences in the stress response and post-traumatic stress syndrome in children who haveundergone painful medical procedures. Dr. Young’smentor will be Roger J. Lewis, MD, PhD.

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Ethics Corner: Questions and Answers Column

“Can Families Give Informed Consent for Ethnic Patients?”H. Gene Hern, Jr., MD, MSHighland General Hospital

This is the second in a series of col-umns, regarding ethical issues, writtenby members of the SAEM EthicsCommittee. Readers are invited tosubmit ethical questions or cases to:saem@saem.org

QuestionA 77 year-old Chinese female is seenin the Emergency Dept for abdominalpain and weight loss. During thecourse of her evaluation, a CT scan isobtained which showed multiple livermasses with metastases. On yourway back to her room to deliver thenews, her daughter stops you in thehall and asks to speak with you. Shehas already guessed the diagnosisand she asks that you not tell hermother. The daughter pleads that, inher culture, it would do her moreharm. She states the family is willingto make any decisions that wererequired. She begs you to not tell hermother. What do you do?

IntroductionThe question of how to allow culturalvariation into the medical interactionwithout creating a checklist of culturalcharacteristics forces us to be verycareful in this situation. We must firstlook at what is required in informedconsent and then allow some variationon our clinical practice. Can the familymake decisions for a patient fromanother culture? The short answer isyes, but with some reservations. Wewill briefly look at the requirements forinformed consent from the last “EthicsCorner” column, and then look at thecomplicating factors of differentcultural values.

Elements of Informed ConsentIn the previous Ethics Corner,Catherine Marco discussed informedconsent as consisting of the followingthree elements: patient capacity,delivery of information, and voluntaryparticipation. While the patient in ourcase may have the mental capacity tomake decisions, she may not want todo so, based on her cultural back-ground. This makes our job all themore difficult as we must ensure thepatient has the ability to make thedecisions if she so desires, but is notforced to if she doesn’t.

Case DiscussionConsidering the complications involvedin openly discussing the diagnosis andtreatment options with patients fromdifferent cultures, any approach will

Choosing not to become engaged andto leave decisions up to the family isthen a decision, not a default setting.

Regardless of the patient’s choice,this model retains the patient’s auton-omy, including the autonomous optionof not wanting to know. Choosing tonot participate is still an exercise ofautonomy. Legal precedent confirmsthis assertion. In the case of Cobbsvs. Grant (Cal 1972), the court ruledthat “a medical doctor need not makedisclosure of risks when the patientrequests that he be not so informed.”

ConclusionPatients from different backgroundspose challenges to our standard ap-proach to ethical problems. When pa-tients don’t share similar values, theapproach we use to deal with ethicalissues may not reflect the way our pa-tients are used to thinking or acting.While this is far from stating that allcultural differences should berespected, clinicians should at leasttry to understand why a patient orfamily acts the way they do. Auton-omy is the classic example of thisconflict. Some patients are used tohaving lots of choices in their medicalcare, others are not. We have to ap-proach clinical practice from the van-tage point of western medicine andwestern values, yet we need to beflexible to sometimes allow non-wes-tern practices to be respected. Whilethis is not a call for universal culturalrelativism (the notion that all values isother cultures are right within that cu-lture) this discussion might at leastprovide a framework for understand-ing and exploring non-western valuesand helping patients from othercultures receive care within ours.

ReferencesBrotzman GL, Butler DJ. Cross-cultural issues in the disclosure ofterminal diagnosis. J Fam Prac 1991;32: 426-427.

Freedman B. Offering truth. Arch IntMed 1993: 153: 572-576.

Hern HE , Koenig BA, Moore LJ,Marshall PA. The difference that cul-ture can make in end-of-life decisionmaking. Cambridge Quarterly Health-care Ethics 1998; 7: 27-40

Jecker et al. Caring for patients incross cultural sett ings. HastingsCenter Report 1995; 25: 6-14.

Moskop JC: Informed consent in theemergency department. Emerg MedClin NA 17: 327-40; 1999.

have to address the value of patient in-volvement in the decision process, yetallow patients to retain their culturalnorms and values if they desire. ManyAsian cultures, including Chinesecultures, maintain that the familyshould make decisions for patients,especially if they are terminally ill. Tospeak the term “cancer” often carrieswith it the significance of “giving uphope” or “abandoning” the ill familymember. The peril lies in the conflictbetween our “western” culture, whichcherishes individual autonomy, andother cultural values, which may not.Our practice is further complicated bythe difficulties in discussing informedconsent in the ED.

One approach which retains bothpatient choice and respect for culturalvalues requires that patients be offeredmultiple opportunities for discussingtheir situation, yet does not mandatetelling the diagnosis or requiring activeparticipation if the patient does not wishit. The limited time available in the EDmay make such an approach difficultbut may allow the patient to retain theircultural values within our western sys-tem. In addition, the admitting teamand the ethics committee should havea role in this process.

This process has the following ele-ments:1. Listening to the patient and family

to try to understand their values.2. Explaining the western notion of

individual choice and autonomy.3. Offering to the patient the option of

autonomy.

It is this last point which requiresthat even the most experienced clini-cian to be careful. The interaction ac-quires different characteristics de-pending on individual circumstances.Patients and physicians communicatethrough a number of different means;verbal information, non-verbal cues,and body language all can affect theinteraction. Offering autonomy differsfrom the standard western notion ofautonomy. Rather than determining apatient’s lucidity and then proceedingto explain the diagnosis, prognosis,and all possible treatment options, theprocess of offering autonomy requiresthat repeated attempts be made toascertain from the patient how muchhe or she wants to know, and how in-volved he or she wants to be in theprocess. This approach outlines a com-promise between the possible harmassociated with patient ignorance andthe possible harm caused by callouslypresented unwanted information.

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Call for PhotographsDeadline: February 15, 2001

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

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

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

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

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

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

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

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

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

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

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

Resident Group Discount Membership ParticipationMarcus Martin, MDUniversity of VirginiaSAEM Secretary/Treasurer

On behalf of the Board of Directors, I would like to thank the residency programs which have elected to participate in theresident group discount membership. These 64 programs bring 1,879 resident members to the Society. This program providesresidents with invaluable exposure to all facets of academic emergency medicine. Each resident member receives subscriptionsto Academic Emergency Medicine and the SAEM Newsletter, plus a greatly discounted registration fee to attend the AnnualMeeting. The participating programs are:

Albany Medical CenterAlbert Einstein Medical Ctr., PhiladelphiaBaystate Medical CenterBoston Medical CenterBrigham & Women’s HospitalCarolinas Medical CenterCharity HospitalChrist Hospital and Medical CenterChristiana Care Health SystemCooper Hospital/Univ. Medical CenterEarl K. Long Medical CenterEast Carolina UniversityEmory UniversityGrand Rapids Merc/MSUHennepin County Medical CenterHenry Ford HospitalHoward UniversityIndiana University/MethodistJohns Hopkins UniversityLoma Linda UniversityLong Island Jewish Medical CenterMetroHealth Medical CenterMichigan State University, Kalamazoo

University of Illinois, ChicagoUniversity of KentuckyUniversity of LouisvilleUniversity of MichiganUniversity of New MexicoUniversity of North Carolina Chapel HillUniversity of PennsylvaniaUniversity of PittsburghUniversity of RochesterUniversity of Texas, HoustonUniversity of VirginiaWake Forest University Baptist

Medical CenterWayne State University/Detroit

Receiving HospitalWayne State University/Grace HospitalWilliam Beaumont HospitalWest Virginia UniversityWright State UniversityYale-New HavenYork Hospital

North Shore University HospitalNorthwestern UniversityOhio State UniversityOregon Health Sciences UniversityPalmetto Richland Memorial HospitalRegions HospitalResurrection Medical CenterSaginaw Cooperative Hospitals, Inc.St. Luke’s-Roosevelt Hospital CenterSt. Vincent Mercy Medical CenterStanford/KaiserState University of New York, BuffaloState University of New York,

Stony BrookState University of New York, SyracuseTemple UniversityTexas Tech UniversityThomas Jefferson UniversityUniversity of ArizonaUniversity of ArkansasUniversity of ChicagoUniversity of CincinnatiUniversity of Connecticut

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the lives of common people. Becausewe provide care to the disenfranchised,the uninsured, and the patients whoothers shun, and because we are therein our emergency departments, capableand prepared every day of the year, 24hours a day, we have the credibility andexperiences to be able to speak onbehalf of those patients whose voicesare suppressed or never heard. Whenemergency physicians advocate forchanges in our health care system thatwill improve emergency care, increaseaccess to care, and make our patients’environments safer, people listen.

In some ways academic emergencydepartments are the last vestiges of thehuge philanthropic effort of medicalschool teaching hospitals in providingcare to the underserved. Historically, themissions of teaching hospitals includedproviding a great deal of “charity” care. Infact, in the early to mid 1900’s, it wasconsidered inappropriate for a teachinghospital to have a majority of patients whowere not indigent.2 While our history is incaring for and advocating for the poor, wein academic medical centers are nowfocused almost totally on the businessside of medicine — efficiency, throughput,funding, grants, and margin. The largepublic appropriations that funded teachingphysician salaries and hospitals are alsohistory. But, our emergency departmentscontinue to take all comers, and are thelast and only resort for many indigentpatients who need health care.

Emergency medicine is a taxing job.An emergency physician might reason-ably ask — is it not enough that I pro-vide care for the destitute in our soci-ety? Am I also expected to be an ad-vocate for the uninsured, the victims ofviolence and abuse, the homeless, andthose who are otherwise harmed by oursociety and medical care system? Howcan I find the time to be an advocatewhen the expectations are that I willalso be an excellent clinician, teacher,and perhaps researcher?

These are all good questions, and toanswer them we can turn to the giants ofadvocacy in emergency medicine —people like Ed Bernstein, Art Keller-mann, and Steve Hargarten. The firstlesson to be gained from these aca-demic emergency physicians is that ad-vocacy is most effective when it isfocused. Although we may feel an altru-istic sense that we must advocate for allof those who are wronged, it is not ex-pected, or desired, that academic emer-gency physicians will be all-purpose ad-vocates. In the areas of research andteaching, we have found that the best re-sults are achieved with a focused ap-proach. The same is true with advo-cacy. A physician advocate who is ex-pert in an area can use his or her aca-demic credibility to full advantage. This

is why, for example, that Ed Bernstein inthe area of access to care and sub-stance abuse, and Art Kellermann in thearea of violence and hand guns, havehad so many advocacy triumphs.

How does an academic emergencyphysician incorporate advocacy into hisor her personal mission and practice?One way is to view advocacy as a na-tural component of academic endeav-ors. Steve Hargarten, the Professorand Chair of Emergency Medicine atthe University of Wisconsin, is a longtime public health advocate who hasbeen remarkably effective in the field ofinjury prevention. Dr. Hargarten de-scribes 4 potential sites of advocacy forthe physician scientist: bedside, curb-side, tableside, and courtside.3 Anemergency physician advocate whohas a special interest in, for example,asthma, can function at the bedside incaring for patients with acute exacerba-tions of asthma, and also by educatingpatients, families, resident physicians,medical students, and nurses aboutemergency asthma care. Bedside advo-cacy would also include research that isconducted on treatment of acuteasthma. Curbside advocacy for thisphysician would include exploring theenvironmental and socioeconomicfactors that have lead to an increase inasthma in children in that community.Media advocacy may become a part ofthis — the emergency physician mayreport to the media his or her findingsthat a neighborhood next to a factorysmokestack has a high prevalence ofasthma in children. An example oftableside advocacy in this case wouldbe the emergency physician meetingwith representatives of the companythat runs the factory, and promotingefforts to eliminate or reduce smokeemissions from the factory. Courtsideadvocacy might be necessary in thiscase, as governmental organizationsmay regulate factory emissions. Theemergency physician could play a rolein testifying before a state or federalgovernment about the plight of asth-matic children whose symptoms areworsened by factory emissions.

If advocacy is omitted from our aca-demic lives, the circle remains open —we settle for a triple when we couldhave had a home run. In order to be ef-fective advocates, academic emer-gency physicians must learn to deal ef-fectively with two institutions from whichwe inherently shy away — governmentand the media. Like it or not, many ofthe large scale changes that we seekthrough advocacy, will only be possiblethrough new policies, laws, or regula-tions. An advocate must become famil-iar with the local, state, and federal gov-ernment laws and regulations that applyto the advocacy focus area. In conjunc-

tion with this, one must learn the facesand gain access to the ears of thosewho make the laws and rules. A full les-son on governmental advocacy is be-yond the scope of this article, but a cou-ple good places to start are as follows:

1. “The School of Political Advocacy”,held as part of the ACEP Leadershipand Legislative Issues Conference,April 29th — May 2nd, 2001, Wash-ington, D.C.

2. The Advocacy Gurus, at www.advo-cacyguru.com, — an informative sitewith nice coverage of frequentlyasked questions about how to getstarted with political advocacy, and anumber of helpful links, includinghow to email your Congressionalrepresentatives.

The second component of effectiveadvocacy is learning how to use themedia to advance a purpose. Despiteour sometimes negative and cynicalview of how the media functions in oursociety, it is a fact that media coverageof an advocacy issue validates it as anissue. As the veteran news reporter andjournalist, Daniel Schorr, has said: “Ifyou don’t exist in the media, for all prac-tical purposes, you don’t exist.”4 Asmost of us now ponder how we don’texist, some strategies are necessary toimprove media advocacy in emergencymedicine. It is clear from the great pub-lic interest in emergency care topics,that if advocacy issues are properlypresented, they will receive coverage.The techniques that can be used toproperly frame and disseminate an is-sue to the media are expertly coveredin the book: “Media Advocacy andPublic Health — Power for Prevention”,by Wallack, et al.5. This book speaks ofthe power of an “authentic voice” — thetype of voice that academic emergencyphysicians develop through years ofpractice, teaching and research in aca-demic emergency departments.

It was noted that Woody Guthriefavored his mother’s side of the family,and this genetic link proved to be tragicas he developed the symptoms of Hunt-ington’s disease when he was at theprime of his career. During the years ofhis slow neurological deterioration,leading to his death in 1967, he lost theability to write and sing, but his workand his history as an advocate for thecommon man were highly influential inthe careers of new folk singers, such asyoung Robert Zimmerman who playedguitar and sang in the bohemian sec-tion of Minneapolis in the late 1950’sand early 1960’s. Zimmerman becameenthralled with the music and spirit ofWoody Guthrie, and switched from arock to folk music focus, and laterchanged his name to Bob Dylan.

President’s Message (Continued)

(continued on next page)

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EMF Call for Grant ProposalsEMF is accepting applications for its annual grants. Funding is for research donewithin the academic year of July 1, 2001 through June 30, 2002 unless otherwisespecified. To request an application, contact EMF, P.O. Box 619911, Dallas, Texas75261-9977 or call (972) 550-0911 ext. 3340. The following is a description of theawards and application deadlines:

EMF/FERNE Neurological Emergencies GrantA maximum of $50,000. This grant is sponsored by EMF and the Foundation forEducation and Research in Neurological Emergencies (FERNE). The goal is to fundresearch based towards acute disorders of the neurological system, such as theidentification and treament of diseases and injury to the brain, spinal cord andnerves.Deadline: January 15, 2001

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

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

EMF/ENAF Team GrantA maximum of $10,000 to be used for physician and nurse researchers to combinetheir expertise in order to develop, plan and implement clinical research in the spe-cialty of emergency care.Deadline: March 5, 2001

EMF Established Investigator AwardA maximum of $50,000 to established researchers. An established investigator isone who has obtained significant extramural funding and made significant contri-butions to emergency medicine research. Priority will be given to those who havebeen principal investigators on federal and/or foundation grants.Deadline: March 19, 2001

President’s Message (Continued)

Woody Guthrie had a hard life, butwas frequently noted to have an optim-istic outlook. His songs gave poor anddisenfranchised people a voice, andthis advocacy fueled him, and kept himmoving forward, even as he battled al-coholism and Huntington’s disease.1

Maybe we can take a similar approach.Maybe by being emergency physicianadvocates, we can do the same for ourpatients. And instead of being anothertask that weighs us down, advocacymay be the catalyst that keeps ourcareers moving forward.

References:1. Klein J: Woody Guthrie: A Life.

Delta Book, Dell Publishing, RandomHouse, Inc., NY, 1980.

2. Ludmerer KM: Time to Heal —American Medical Education fromthe Turn of the Century to the Era ofManaged Care. Oxford UniversityPress, NY, 1999. Pages 118-122.

3. Hargarten S: Physician ScientistAdvocacy. Grand Rounds Presenta-tion, University of Michigan Depart-ment of Emergency Medicine, 2000.

4. Schorr D. Quote from the Communi-cations Consortium Media Center,1991, p. 7.

5. Wallack L, Dorfman L, Jernigan D,Themba M: Media Advocacy andPublic Health — Power for Preven-tion. Sage Publications, NewburyPark, CA, 1993.

SAEM Ethics Consultation Service Now AvailableEveryday, emergency physicians are

faced with countless ethical dilemmas.In our practice, our teaching, our re-search and our administrative duties,we make choices based not only on ourknowledge but also on our personal be-liefs and value systems. For the mostpart, these decisions are made in typi-cal emergency medicine style — wethink, we decide, we act, and we moveon. We feel confident that we haveacted appropriately, based on a rea-soned assessment of the circum-stances and the strengths of our con-victions. We act in good faith, and hopethat we have acted wisely and justly.

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 that we need to make areasonable choice, we may be faced withsomething totally out of our experience,or we feel at a loss because we cannotdetermine the possible options. We maywitness an ethically questionable act,may observe unprofessional andpossibly harmful actions, may disagreeabout the correctness of another’sdecision, or may feel we ourselves are

being subjected to exploitation, abuse, orother unethical behavior. Such situationsare frightening; it is difficult to distinguishreality from perception, to know who canbe approached for advice, or whereresources can be found to assist indeveloping an appropriate response.

Some institutions have committeesor other authoritative bodies designedto examine grievances, allegations ofscientific misconduct or specific ethicaldilemmas in clinical practice.

The advice of these groups, how-ever, may have limited applicability toemergency medicine; they may not in-clude emergency physicians, or havethe expertise to relate to the unique as-pects of the ethics of emergency medi-cine. In addition, these groups arecharged with developing a response toa particular crisis that has arisen locally.They are goal directed and not neces-sarily able to provide a thoughtfulmethod to educate beyond the concreteresponse to the problem at hand.

For these reasons, the SAEM Boardof Directors charged the Ethics Com-mittee to develop an Ethics Consulta-tion Service. As the title implies, theEthics Consultation Service is now

available to assist SAEM members withtheir questions concerning ethicalissues or decisions they must makeduring the course of their clinical, aca-demic or administrative responsibilities.

Opinions from the Ethics Consulta-tion Service will be offered to SAEMmembers in a timely manner; requestsfrom nonmembers will be consideredon a case by case basis. The opinionsrendered are not meant to be part of an‘appeal process.’ This service is offeredto SAEM members who may need ad-vice or assistance when faced with adifficult ethical decision.

All communications with the EthicsConsultation Service will be anonymousand confidential. However, becausemany ethical issues confronting practic-ing emergency physicians are universalin their scope, and others may learnfrom the issue presented, we hope todevelop a series of articles for publica-tion for the Society, assuming that con-fidentiality can be maintained.

All requests, inquires, or correspon-dence should be directed to the EthicsConsultation Service at SAEM, 901North Washington Avenue, Lansing, MI48906 or saem@saem.org

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

IOWA: Emergency medicine faculty positions are available. We have awonderful opportunity to build emergency medicine excellence in asuperb academic setting. Iowa is a Level 1 Trauma Center with an activeaeromedical program. Emergency medicine faculty are positioned in aclinical track within the Division of Emergency Medicine, Department ofSurgery. Comprehensive back up is readily available. Low volume(24,000/year), with interesting patient mix. There is 30 to 36 hours ofattending coverage daily plus PAs. Residents from IM, FP, OB/GYN andPediatrics rotate in the ED. There are opportunities in curriculumdevelopment, EMS, telemedicine, ALS education, paramedic training,and research. Salaries and schedules are competitive, and fringe benefitsare excellent. Iowa City offers a superb school system and a great lifestyle. Applicants should send curriculum vitae to Alfred Hansen, MD,FACEP, Emergency Medical Services, UIHC, 200 Hawkins Drive, IowaCity, IA 52242. The University of Iowa is an equal opportunity andaffirmative action employer. Women and minorities are stronglyencouraged to apply.

NEW YORK CITY, Director of Clinical Operations: Exciting position forexperienced board certified emergency physician to join the faculty, De-partment of Emergency Medicine, Mount Sinai School of Medicine;manage operations, informatics and fiscal issues during a time of signifi-cant departmental growth. Combined annual ED census over 80,000,EM residency program, 1100-bed tertiary center. Academic rank com-mensurate with qualifications. Please submit confidential letter and CVto Scot Hill, MD, Chair of Search Committee, Department of EmergencyMedicine, Mount Sinai School of Medicine, One Gustave L. Levy Place,New York, NY 10029. Fax: 212-426-1946.

TEMPLE UNIVERSITY SCHOOL OF MEDICINE: We currently have aFaculty Position open for an individual BC/BP in EM, with commitmentto academic career. Rank and salary commensurate with experience.Benefits highly competitive. Protected time for research/academicpursuits. Temple University Hospital is a 500-bed tertiary care teachinghospital with a Level 1 Trauma Center. 48,000 adult emergencydepartment visits annually. New EM residency began 7/1/97. Sendcurriculum vitae to Robert McNamara, MD, FAAEM, Professor andChief, Section of Emergency Medicine, Temple University School ofMedicine, 3401 N. Broad St., 1002 Jones Hall, Philadelphia, PA 19140or via e-mail at rmcnamar@unix.temple.edu. Temple University is anequal opportunity/affirmative action employer and strongly encouragesapplications from women and minorities.

The Division of Emergency Medicine at the UNIVERSITY OF COLO-RADO SCHOOL OF MEDICINE is seeking a residency-trained andboard-certified (or prepared) emergency physician to join our faculty.Fellowship training, research experience, or other post-graduate educa-tion is preferred. All faculty are expected to participate in education, re-search, and clinical activities. Salary is negotiable. Minorities andwomen are encouraged to apply. UCHSC is an equal opportunity em-ployer. Mail CV and cover letter stating interest to: Benjamin Honigman,MD, UCHSC, Campus Box B215, 4200 E. 9th Avenue, Denver, CO80262. You may e-mail inquiries to: Joline.Constance@UCHSC.edu

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

University ofPittsburgh

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

Enrollment in the Graduate School is a part of all fellow-ships with the aim of obtaining a Master’s Degree. In addi-tion, intensive training and interaction with the nationally-known faculty of the Department of Emergency Medicine,with experts in each domain, is an integral part of the fel-lowship experience. Appointment as an Instructor is offered,and fellows assume limited clinical responsibilities in theEmergency Department at the University of Pittsburgh Med-ical Center and affiliated institutions. Each fellowship offersthe experience in basic and/or human research as well asteaching opportunities with medical students, residents andother health care providers. The University of Pittsburgh isan Equal Opportunity Employer, and will welcome candi-dates from diverse backgrounds. Each applicant shouldhave an MD/DO background or equivalent degree and beboard certified or prepared in emergency medicine (or havesimilar experience). Please contact Donald M. Yealy, MD,University of Pittsburgh, Department of Emergency Medi-cine, 230 McKee Place, Suite 500, Pittsburgh, PA 15213 toreceive information.

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

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DDISTRICTISTRICT OFOF CCOLUMBIAOLUMBIA

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

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

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

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

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

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

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

UNIVERSITY OF CONNECTICUT/HARTFORD HOSPITAL: ResearchDirector. Senior faculty position, Spring/Summer 2001. Established in-vestigator to manage and build research endeavors at multihospital EMprogram. 23 faculty, 30 residents, two fellows, 100,000 + patient visits.Strong infrastructure at Medical School and Hospitals, funded projectscurrently underway. Very competitive salary, substantial protected time.Inquires to Robert D. Powers, MD, MPH, Professor & Chief, UCONNEmergency Medicine. Please use email: Rpowers@harthosp.org.

UNIVERSITY OF FLORIDA/JACKSONVILLE is expanding its EmergencyMedicine operations. Full and part-time clinical opportunities availableat Orange Park Medical Center and Shands Jacksonville (formerly Meth-odist Medical Center and University Medical Center). Positions are non-tenure accruing; salary is negotiable. Full-time (1.0 FTE) positions offerfaculty appointments to the University. Part-time positions pay competi-tive hourly rates. If interested, fax current CV to Dr. Robert Luten, Chair-man, Search Committee, (904) 549-5666 or e-mail luten.robert@ufl.edu.Application deadline: 4/30/01, anticipated start date 7/1/01. The Univer-sity of Florida is a stable and reliable health care employer (EEO/AA) inNortheast Florida (Jacksonville).

UNIVERSITY OF MISSOURI-KANSAS CITY/TRUMAN MEDICAL CENTER,Department of Emergency Medicine seeks academic faculty for a full-timeappointment at the assistant or associate professor level. Candidates mustbe board-certified or board-eligible in EM and have demonstrated researchinterests. TMC is the primary teaching hospital for the UMKC School ofMedicine; fully accredited EM residency since 1973. Current research ininfectious disease surveillance, trauma, ED ultrasonography, asthma, EMS,public health, and clinical process improvement. Contact Robert A.Schwab, MD, Truman Medical Center, 2301 Holmes S., Kansas City, MO64108. (816) 556-3250. Schwabra@trumed1.trumanmed.org. An equalopportunity employer.

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

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WEST VIRGINIA UNIVERSITYDepartment of Emergency Medicine

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

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

NORTH SHORE-LONG ISLANDJEWISH HEALTH SYSTEM

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

Director, Emergency Medicine Trauma and CriticalCare Faculty, Ultrasound Medicine

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

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

Department of Emergency MedicineNorth Shore University Hospital

300 Community DriveManhasset, NY 11030

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

UNIVERSITY OF NEW MEXICO: Department of Emergency Medicineinvites applications for a medical toxicologist/emergency physician whowill serve as Assistant Medical Director of the New Mexico PoisonCenter. Academic rank will be based on experience and prior researchproductivity. Clinical responsibilities include patient care in theemergency department and on the toxicology consult service; academicresponsibilities include original research and medical student and houseofficer training in emergency medicine and toxicology. Qualifiedapplicants will be residency trained and board certified in emergencymedicine and in medical toxicology. Send letter of interest, CV, and twoletters of recommendation to David Sklar, MD, Professor & Chair,Department of Emergency Medicine, UNM Health Sciences Center, ACC4-West, Albuquerque, NM 87131. Position open until filled. EEO/AA

Department of Emergency Medicine — UNIVERSITY OF NEW MEXICO,ALBUQUERQUE: Faculty positions, Clinician Educator or Tenure track,are available for board certified/board eligible Emergency Physicians, withstrong clinical skills and demonstrated interest and experience in teachingand in research. Qualified applicants are invited to send a letter of interest,CV, & two letters of recommendation to David Sklar, MD, Chair,Department of Emergency Medicine, UNM Health Sciences Center, ACC4-West, Albuquerque, NM 87131. Positions open until filled. EEO/AA

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

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Academic and Private Practice Emergency MedicinePositions Available

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

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DUKE UNIVERSITYDUKE UNIVERSITY HEALTH SYSTEM

Faculty Position

The Division of Emergency Medicine at DukeUniversity Medical Center is working to develop anEmergency Medicine Residency Program. We arecurrently seeking full-time academic faculty mem-bers. These positions offer a variety of opportuni-ties for clinical practice, teaching, and research.Residency training and BC in EM required. DukeUniversity Medical Center Emergency Departmentis a Level I Trauma Center in Durham, NorthCarolina, with a annual volume of 65,000patient visits. Competitive salary and benefits.Faculty at all academic levels are invited to apply.

Please contact:Kathleen J. Clem, MD, FACEP

Chief, Division of Emergency MedicineDUMC 3096, Durham, NC 27710email: clem0002@mc.duke.edu

Advertising Positions Availableat Annual Meeting

SAEM is again offering an opportunity to advertise inthe on-site program. The Annual Meeting will be heldMay 6-9 in Atlanta and will attract approximately1,800 academic emergency physicians.

A limited amount of space is being set aside for theposition available section and only academic positionsavailable will be accepted. The deadline for receipt ofads at the SAEM office is April 1 .

The following ad requirements and prices are avail-able for the on-site program:

Classified line ads (100 words maximum):$100 (contact SAEM member) or$125 (non-SAEM member)

Quarter page ads: 3-1/2" wide x 4-3/4" deep $300

Half page ads:7-1/2" wide x 4-3/4" deep or3-1/2" wide x 9-3/4" deep $350

Full page ads: 7-1/2" wide x 9-3/4" deep $450

A typesetting fee ($25-$50) will be charged if thequarter, half, or full page ads are not camera-ready.

ACADEMIC EMERGENCY MEDICINE

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

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

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

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

RESIDENCY DIRECTORSt. Luke’s-Roosevelt Hospital Center

New York, New York

We are seeking a leader with a demonstratedrecord of achievement in academic, administrativeand clinical activity. The residency is a fully RRCaccredited program with 30 residents (EM 1,2,3)There are currently 36 Full-time faculty (including sixPediatric Emergency Physicians). Columbia Uni-versity College of Physicians and Surgeons FacultyAppointment commensurate with academic status.The SLRHC ED consists of two sites, three miles apartserving Midtown Manhattan, Upper West Side,Columbia University/Morningside Heights, andCentral Harlem. Level I Trauma Center. 120,000annual visits. Separate Pediatric, Adult, Psychiatricand Fast Track EDs at each site. Clinical ToxicologyService. Associate and Assistant Residency DirectorPositions, EMS Director, Director of Toxicology, aswell as Research Director and Associate ResearchDirector Posit ions in place. Medical studentelective. Hospital-based EMS service. Visit ourwebsite – stlukes-roosevelt-ed.com.

Send CV to:Dan Wiener, MD, Chair

Department of Emergency Medicine,St. Luke’s-Roosevelt Hospital Center

1111 Amsterdam AvenueNew York, New York 10025

Hospital Center is an affirmative action/equal opportunity employer

NEWSLETTERNEWSLETTERNewsletter of The Society For Academic Emergency Medicine

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

EditorDavid Cone, MDDavid.Cone@yale.edu

Executive Director/Managing EditorMary Ann Schroppmschropp@saem.org

Advertising CoordinatorJennifer MastrovitoJennifer@saem.org

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

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

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