Council of Emergency Medicine Residency Directors February 2006

The Debate Continues – How Long Should the CORD Board Officers serve? Is a Two-Year Commitment too Much?

Have you been thinking of getting involved in the CORD leadership but aren't really sure of the amount of time it would take or how long the commitment would be for? Does it surprise you that the term durations for the officers and board members are 2 years? Does that time commitment sound appropriate since there is a lot to do and it takes time to do it, or do you think the time obligation is too long and diminishes your interest in even starting to get more involved?

We on the Board feel the same way, actually, with some of us favoring the existing 2-year terms, and others desirous of a shorter term for the officers. In fact, several times over the past few years, discussion about shortening the length of term for the CORD officers has been raised by an officer to the bylaws committee for evaluation and possible bylaws revision. The bylaws committee did not agree with the revision and it has never been presented to the membership for vote. However, as the debate comes up again this year, we thought that a point-counterpoint article might be helpful to frame the discussion and raise awareness of the difficult issues to the membership, so that the membership could help advise the Board and bylaws committee. To give some historical perspective to the discussion, all of the Past Presidents of CORD were surveyed. They were asked to comment on the historical backdrop that was the basis for the length of terms set initially when the organization's bylaws were formed, and their opinions on those policies in the context of the current environment. Interestingly, their views and explanations are as diverse as the current Board and the membership is on this topic.

As background for the debate, the CORD Board of Directors originally consisted of three at-large members serving staggered three-year terms of office, and four officers serving two-year terms--the Secretary/Treasurer, President-Elect, President and Immediate Past President. Of course we don't elect President and Immediate Past President, they automatically follow the election of President-Elect. Therefore, Election to President-Elect is actually a six-year time commitment. Given the typical manner of things, one usually begins their service on their Board by being elected to a member-at-large position (3 years), then to Sec/Treas (2 years), and then the President-Elect (2 years). Therefore, the whole process was actually an eleven-year commitment. Two years ago, the Bylaws committee carefully evaluated the issue of term duration for the Board positions and officers, and ultimately recommended a change to decrease the Board of Directors' member-at-large term from the original three-year term to a two-year term, a fourth member-at-large position be added to the Board, and the original two-year length of term for the Board officers remained the same. These recommendations were approved by the membership in 2004. In 2005 the membership approved the Bylaws committee's modification in the criteria for nomination for the office of President-Elect to now require that s/he be a current or former Program Director.

For comparison, current emergency medicine organizations have varying lengths of terms for their officers: ACEP and SAEM officers serve one-year terms at each position while AAEM officers, like CORD, have two-year terms. ACEP, SAEM, and AAEM all have full-time Executive Director staff members, which CORD does not. As you may know, CORD contracts with SAEM for the extremely able services of the SAEM staff on a part-time basis.

Historically, the past Presidents of CORD report that the charter bylaws set the officers' length of term for two years because at the time it seemed like a reasonable amount of time to commit to the leadership of CORD. It was thought that rapid turn over of leadership would be too disruptive, and the 6-8 year commitment for officers would allow the leadership to accomplish more over time. Also, at the time, the organization was much smaller and it was felt there was a relatively small applicant pool from which the leadership would draw. Thus the two-year terms would allow for the development of experience and a corporate memory.

The Bylaws committee has chosen not to recommend change in the term duration for officers for several reasons:

• CORD is a relatively small organization, thus the pool of potential leaders is relatively small. Therefore we want to maximize the output of the individuals who are driven to serve.
  
• There has not been a shortage of interested parties to run for offices, so the market hasn't borne a problem.
  
• Without a staff executive director, there is theoretically not as detailed a corporate memory of events, thus relying heavily on the officers themselves to have personal knowledge of the history of the organization. Longer terms make this easier.
  
• Our organization is ever-growing, with increasingly productive committees and task forces. With as much productivity as we are seeing, it may take more than one year for a President's vision for the organization to be implemented. Additionally, because of the cyclic nature of the work of being a program director, there are large blocks of time (Dec – mid-February) when most PDs are not able do much for CORD beyond reading email. With the terms the way they currently are, there is built-in time for decompression, and there isn't such a rush to get things done by the deadline of “end of term.”

Rationale for re-opening the discussion by the Bylaws committee include:

• The activities of CORD as an organization have expanded exponentially since its inception. CORD now holds a three-day, four-track educational meeting, has three other organizational meetings, organizes the CPC competition and provides on-line testing monthly for 75% of the residency programs. The members of CORD continue to develop useful tools including the SLOR, the SDOT, Sharepoint, and the model curriculum. Each of these projects and many others came from the enthusiasm and vast time commitment donated by dedicated individuals. Coordination of the many activities falls to the Board members and requires much more time than when the organization was initially founded. This is the most persuasive argument for decreasing the length of term for the officers and mentioned by a few Past Presidents.
  
• Another more practical reason to decrease the length of term for officers is the shorter longevity of a program director – 5 years on average. More recently there have been several officers who were no longer program directors at the end of their service to CORD. (It is now generally 8 years of service if one takes the traditional route from Secretary/Treasurer through Past President, not including 2-4 years on the Board as a member–at-large.)
  
• With a larger membership, the longer terms of office serve to limit the opportunities to involve more people in these leadership positions. The current extended length of commitment may limit some of the membership from stepping forward to accept these leadership positions.
  
• The long time-commitment on the Board after the term of Presidency is concluded may result in the true leadership of our specialty not being eligible or physically able to take on leadership roles in other organizations. Shortening the term duration would alleviate that barrier.

So on which side of the debate do you fall?

Shortening the two-year officer terms to one year each is the right thing to do for CORD to avoid limiting access of talented individuals who could lead the organization and limits on these leaders' abilities to take leadership positions in other organizations. OR The current two-year term durations are fine – the productivity of our organization means there are plenty of tasks for the officers to do, and the longer term means there is a bit more time to breathe while you are doing it.

Pam Dyne, MD
Olive View-UCLA Medical Center
CORD President
Mary Jo Wagner, MD
Synergy Medical Education Alliance
CORD Secretary/Treasurer

Call for Nominations -- May 2006 elections for Board of Directors:
At the meeting in May, CORD will convene its annual elections for the following positions: Board member-at-large (two 2-year terms) CORD members with a strong interest in the organization are encouraged to submit their name for consideration by the Nominating Committee. Please send a letter indicating your interest and a brief statement indicating why you are interested in the position(s) to the CORD office at cord@cordem.org by March 15.

2006 The Academic Assembly -- Bigger and Better than Ever.

The final preparations are being made for the Academic Assembly to be held in Las Vegas, Nevada March 3-5. Please remember to register early so your name will be included in the list of attendees.

There will be some changes in several processes in order to streamline registration and supplying handouts. We are making these changes as a result of your suggestions, both compliments and complaints, from last year's Assembly.

Registration:
If you have registered early you do not have to sign in on site. We will have your name badge and any other material you need placed on tables so you can just pick them up. That will avoid standing in line unless you wish to register on site or there is a question regarding your registration.

Handouts:
This year's Assembly will have multiple tracks. We want you to have the necessary handouts but the logistics of having enough handouts and not too many is simply too complicated. You can obtain handouts one of three ways:

1. Online- the handouts for all the talks will be online and you can download the ones you want.
   
2. CD- all registrants will be given a CD with all the handouts received from speakers. We are working with our speakers to try and ensure that they meet all deadlines so we can make the CDs. Some discussion sessions do not lend themselves to handouts so of course you won't receive material those sessions.
   
3. Onsite-We will have onsite print capabilities if you forgot to make a handout that you need but are asking that not all of you rely on onsite printing for all of your handouts. We don't want you standing in the print line now that you don't have to stand in the registration line!!!
   Each of the tract leaders has been asked to write a few words about their tracts so you will have an idea of some of the highlights of this year's Assembly.

Poster Session
Dr. Jamie Jones is heading the poster session. Posters will be available for viewing on the afternoon of Saturday, March 4. This is a great opportunity for attendees to see what innovations other programs have developed and found useful in the education of residents and medical students.

Navigating the Academic Waters
Dr. Felix Ankel is coordinating this session. The navigating track is academic basic life support (ABLS) for new faculty.  There will be 17 speakers from 10 residencies from across the country with four panel sessions. There will be ample opportunity to connect with fellow educators. Come to Las Vegas to get your ABLS education.

Best Practices Conference
Dr. Susan Promes is leading this track. The Best Practices Conference will cover a broad range of topics this year. There will be two breakout sessions - one on assessment and the other on setting realistic outcomes for EM residencies Representatives from the EM RRC will be making a presentations and colleagues will share some of their "Best Practices" during the Soundbites session.

New Program Director's Workshop
Dr. Sarah Stahmer has led the efforts for this track. This year's New Program Director's Workshop is designed to give the participant an overview of the entire residency process, with over 13 seasoned program directors sharing their ideas and experiences. The program will take you from building a new program from scratch, designing an orientation program and interview season to surviving an RRC site visit. New program directors, assistants and associates as well as program coordinators will find information designed to help them start a program as well as ideas to help them build on or make changes in their current program.

EMARC Track
Marie Wegeman has been working with her committee to ensure that the EMARC Track is better than ever. The Emergency Medicine Association of Residency Coordinators (EMARC) invites all Emergency Medicine Residency Coordinators to attend this conference that is planned by coordinators for the purpose of providing information, networking, and sharing ideas with other coordinators, EM faculty, and the national organizations associated with Academic Emergency Medicine.

The EMARC Track will provide participants with methods and techniques for successful coordination and residency program management. The role of the residency coordinator will be defined in almost every aspect of the management of the residency program. Participants will develop and enhance their level of confidence and competence in important residency functions.

New Program Coordinator's Workshop Included in the EMARC Track, is a New Program Coordinator's Workshop that is specifically designed for new coordinators who have been in this position for less than two years. This workshop provides the fundamental knowledge and basic information for the daily operations and management of a successful residency program.

Plenary Sessions
We have invited three speakers for this year's Academic Assembly. Generation X will be discussed by Breda Bova, Ph.D. She has performed research and spoken on this topic nationally.

Leadership will be discussed by Dr. James Adams, a colleague in emergency medicine and chair of the Department of Emergency Medicine at Northwestern University. Mentoring will be discussed by Dr. Stephanie Abbuhl, an emergency physician and Medical Director of the Department of Emergency Medicine, University of Pennsylvania.

ORR Report

Gelareh Zargaraff, MD and Kenneth Yu, MD, MBA represented Emergency Medicine and the Council of Emergency Medicine Residency Directors (CORD) at the 14th Annual Meeting of the Organization of Resident Representatives (ORR) of the Association of American Medical Colleges (AAMC) on November 4 - 6, 2005 in Washington DC. The ORR's annual meeting was held in conjunction with the 116th Annual Meeting of the AAMC entitled “Beyond Boundaries”.

The ORR serves as the voice of resident physicians within the AAMC and is comprised of over 40 resident and fellow physicians appointed by their respective member organizations from the AAMC's Council of Academic Societies (CAS). The mission of the ORR is to improve health care quality by resident physician education and professional development, which it seeks to accomplish by supporting the goals and initiatives of the AAMC.

On the first day of the meeting, the ORR initially met at the welcome luncheon where the agenda of the meeting was discussed. This was followed by a plenary session moderated by Dr. Deborah Powell, Dean of the University of Minnesota, on the cost of creating doctors and the growing national expense of medical education. Following this was an educational session led by cardiothoracic surgeon, Dr. Micheal Argenziano of New York Presbyterian Hospital, discussing the introduction and influence of Micro-robotics in medicine.

On the morning of Nov 5th, the ORR had a breakfast meeting with Dr. Jordan Cohen, President of the AAMC. During this meeting, Dr. Cohen briefed the ORR on current issues being addressed by the AAMC and most importantly, the release of the “Compact Between Resident Physicians and Their Teachers”. The Compact was created by faculty of the AAMC and residents of the ORR to reinforce the fundamental principles of graduate medical education and the major commitments of both residents and faculty to the educational process and to patient care. Dr. Cohen urged institutions to “adopt and adapt” the Compact and commit to its mission. More information about the Compact can be obtained at www.aamc.org/residentcompact.

Following breakfast was an educational session led by Dr. David Korn, Deputy Editor of JAMA, on the importance of protecting integrity of clinical research and medical literature. Dr. Korn discussed the gradual loss of credibility of published research and the evolving relationship between the pharmaceutical industry and academic medicine. This was followed by a session held by Dr. Pamela Derstine, Senior Project Associate of the ACGME, on the accreditation and assessment process of residency programs. At lunch, Dr. Bennett deBoisblanc of Louisiana State University gave a moving account of his experience at Charity Hospital in New Orleans during Hurricane Katrina. The afternoon agenda included a plenary session headed by Barbara McNamara, Director of Medical Education at the Ochsner Clinic Foundation, on effectively integrating residents into research activities, and an educational session by Dr. Frederick Chen of the University of Washington on bridging the widening gap between residency training and the evolving practice environment.

On the final day, the ORR held its national elections for the coming year. Dr. Rachel Allen, an Internal Medicine resident at the Mayo Clinic was elected President-Elect of the ORR. Dr. Ferhan Asghar, an orthopedic surgery spine fellow from Vanderbilt University, moved from President-Elect to President of the ORR. A six member executive advisory board was also elected. The ORR Professional Development Conference is planned for March 16 - 18, 2006 in Miami, Florida.

Dr. Zargaraff is a third year Emergency Medicine resident at the University of California, Los Angeles – Olive View Emergency Medicine Residency program. She is serving her second year on the ORR and she can be reached by email at zargaraf@ucla.edu. Dr. Yu is a second year Emergency Medicine resident at the combined Columbia/Cornell program at the New York-Presbyterian Hospital in New York City. He is serving his first year on the ORR and he can be reached by email at kty9001@nyp.org.

Gelareh Zargaraff, MD
zargaraf@ucla.edu
UCLA – Olive View Medical Center
Kenneth Yu, MD, MBA
Kty9001@nyp.org
New York-Presbyterian Hospital

A PD's 20-year Perspective

Sal Vicario was the Program Director at the University of Louisville for over twenty years, until he stepped down last year. We asked him to give CORD his perspective of where we have been, going, favorite memories, etc. Thank you Dr. Vicario, for your leadership, mentorship, and guidance over the years.

I became PD at the University of Louisville in 1984. At that time there were only 20-30 programs and very few assistant or associate PDs. Many Chairs assumed both roles.

My favorite memories include some resident pranks. One of my senior residents became very frustrated trying to suture a large scalp laceration of one of the inner city intoxicated homeless citizens and wrote “DNR” if found call Sal” across the bandages. As luck would have it this gentleman ended up at one of the shelters where a nun who was also a nurse discovered the bandage and reported it to the newspaper. The front page photo was very embarrassing for the program and the soon to graduate resident as well as myself. Fortunately, I was able to provide the appropriate spin by mentioning my volunteer efforts at a downtown church which included feeding the homeless on weekends and assigning community service time to the resident as a condition of graduation from the program.

Another incident that comes to mind goes back to the early SAEM (formerly STEM) days. Barry Wolcott had given Ken Mattox a recommendation for a great Texas Steakhouse in the San Antonio area. After a 40 minute cab ride we arrived at the local watering hole/steakhouse. The steak was great as was the Texas two-step. Certainly, Barry knew of a more sophisticated proximate steak place but enjoyed pulling one over on the Trauma Surgeon.

My resume includes a “silver tongue” debate re: the four vs. three year residency. I don't think we won the debate but at least I didn't have to take on Peter Rosen. Of course, we continue to debate the advantages of each and have more than 20 programs who train residents over a four year span. Given all the issues with duty hours and training requirements, one might argue that 3/12 years allow for adequate clinical experience, academic preparation and time for extracurricular and personal responsibilities.

One of the biggest changes occurred when ABEM became a legitimate entity. This gave validity to emergency medicine and allowed the specialty to flourish in academic as well as community circles. In the past few years the quality of research and journal publications has also improved. The academic meetings have became very large and there are interest groups and committees that allow anyone who is interested to become involved.

It has become increasingly difficult to keep pace with all the advances and nuances in emergency medicine. This continues to challenge our time and energies as a PD tries to fulfill the full gamut of the specialty. I have been very fortunate to be surrounded by a balanced and knowledgeable faculty who provide education and expertise in their own areas of interest as well as general emergency medicine. It has allowed residents to learn from an eclectic mix of minds and experiences.

Another big change was the ERAS. This innovation was initially met with some trepidation. Initial fear was that programs would now be inundated with applications. Although it has no doubt increased the applicant pool, it has truly made the review of applications etc. much simpler. I also like the SLOR (although not everyone agrees) as it does give the PD better clues as to potential and motivation as well as suitability for the program. There is ample space to include enough personal information and editorials in the comment section

I have been asked several times, “How have you done this for so long? My “secret” is that I was to hand over the directorship to my associate PD almost 10 years ago. He got an offer to be the PD at a new program and I was back to looking for a new assistant. I have been fortunate to have only two but very supportive chairs during my tenure. The first chair was able to develop young faculty as he had been the Chair of Anaesthesiology prior to becoming Emergency Medicine chair. Dan Danzl, former ABEM president and Chair of the RRC has also been supportive and offered wonderful advice and leadership. Without their support and the understanding of my fellow faculty, I would have given up the directorship much sooner. I have also taken energy from my residents who provide new spirit and faces to an older program. Surrounding yourself with happy, well-motivated residents has been a key to a successful training environment. If you can support them, they seem to support your efforts as well.

CORD has made remarkable strides in the past few years to enhance cooperation and communication amongst the various PDs. The effort to open the box and improve education, research and comraderie is in the true spirit of medicine and education. Although we struggle to implement all the requirements, including the competencies, minimizing errors while working with limited resources, we are able to share our collective insights and move forward. CORD continues to provide a forum which can formulate ideas and facilitate the training of young physicians into competent, confident emergency medicine specialists. I am sure it can continue to benefit its membership. I would like to see more multi-center research regarding education and am hopeful that there will be increased resources available to that end.

Announcements

David Tanen, MD, has assumed the duties of the Emergency Medicine residency program in the Department of Emergency Medicine at the Naval Medical Center in San Diego. Previously the position was held by Paul Pearigen, MD, who was appointed as Executive Assistant to the Surgeon of the Navy in August.

Mara Aloi, MD, has been named director of the emergency medicine residency program at Allegheny General Hospital. Dr. Aloi previously served as the associate program director and the student clerkship director and director of emergency ultrasound.

Stephen Hayden, MD, University of San Diego, California has been named Editor-in-Chief of the Journal of Emergency Medicine. Dr. Hayden will take over as editor at the AAEM Meeting on February 16.

Brian Clyne, MD, has been named director of the emergency medicine residency program at the Brown Medical School/Rhode Island Hospital. Dr. Clyne is an assistant professor of emergency medicine at Brown Medical School.

Dennis Hanlon, MD, has stepped down as director of the emergency medicine residency program at Allegheny General Hospital in order to accept the position of vice chair of the department of emergency medicine.

Trevor Mills, MD, MPH, assumed the position of director of the Louisiana State University emergency medicine residency program on July 1. Dr. Mills is an associate clinical professor of medicine, Section of Emergency Medicine and an associate professor of the LSU School of Public Health.

Leigh Patterson, MD, has accepted the position of associate program director of the emergency medicine residency at East Carolina University. Dr. Patterson is an assistant professor of emergency medicine at the Brody School of Medicine at East Carolina University.

Thomas K. Swoboda, MD, has been named director of the emergency medicine residency program at Louisiana State University in Shreveport. Dr. Swoboda previously served two years as associate program director for two years. Simon Mahler, MD, has recently joined the faculty at LSU Shreveport and has been named assistant program director.

CORD is proud to announce that the Oral Case Library organized by Doug Char is nearly complete. There are over 50 cases available. They are available within the SharePoint website. This is a great resource!

Lawrence Kass, MD, has been promoted to Vice Chair for Education for the Department of Emergency Medicine of Penn State Hershey Medical Center.

RRC-EM Update and Information for EM program directors

The following is an update on the fall 2005 activities of the RRC-EM, with an emphasis on the information most relevant to EM program directors. Most of this material was covered in the RRC-EM presentation to CORD made by Larry Sulton at the CORD meeting held at the ACEP Scientific Assembly in Washington, D.C. in September 2005. Please also see the RRC-EM update in the previous CORD newsletter for additional information.

1. Accreditation activity: There are currently 134 RRC-EM accredited EM residency programs, and 35 accredited EM subspecialty fellowship programs. At the fall 2005 RRC-EM meeting, 52 EM programs were reviewed, along with 6 Medical Toxicology programs, 2 Pediatric EM programs, and one Undersea and Hyperbaric Medicine program. One new EM program was approved – the University of Florida at Gainesville. David Seaberg, M.D., is the Department Chair and Keith Ferguson, M.D. is the new program director. The spring 2006 RRC-EM meeting will be held this coming week in Tucson, AZ on February 17-19, with several prospective EM programs on the agenda for review, and we will update CORD shortly as these reviews transpire.

2. The RRC-EM periodically reviews and revises the subspecialty area program requirements, and it is currently proceeding with review and revision of both Medical Toxicology and Pediatric EM. Over the past year, the committee has reviewed and undertaken draft revisions to the Medical Toxicology program requirements that are relatively minor. We have approved these changes as a Committee, and they have currently been distributed to organizational stakeholders within Emergency Medicine and to stakeholders in other specialties that sponsor Medical Toxicology (Pediatrics, Internal Medicine, Preventive Medicine) for review and comment. The Pediatric EM program requirements have been extensively reviewed and revised, with agreement on changes approved by the committee. Currently, there is discussion between the RRC-EM and the RRC-Peds on these changes in order to come to consensus and support from both RRC's. Following joint approval by both RRC's (hopefully this spring), these revisions will be sent to stakeholders in both specialties for review and comment.

3. The ACGME Monitoring Committee, which oversees all of the RRC's, formally reviewed the activities of the RRC-EM, and granted 5 years continued accreditation (i.e. delegated authority from the ACGME to continue accreditation activities for EM programs). The RRC-EM was commended for its ability to work well with EM program directors and EM organizations within the specialty, for integration of the ACGME competencies with the Model of Clinical Practice of Emergency Medicine, the RRC-EM 8 year accreditation pilot project, and the use of program guidelines to communicate RRC-EM expectations to program directors. At our next review in 5 years, we will be expected to address 3 issues: Update on experience with the 8 year pilot project, work on creating a systematic approach to collecting procedural and resuscitation data from programs, and address the fact that 50% of the curriculum occurs in specialties other than EM, “outside of the control of EM program directors”. We have seen this as desirable flexibility for programs, to allow you to choose the best experiences locally for your training program, and we hope to be able to educate the Monitoring Committee on this point.

4. Some of the EM Program Guidelines underwent minor revisions:
   • Conference attendance: Two things here. First, language has changed slightly on the conference attendance policy. “The program should require that residents, on average, participate in at least 70% of planned educational experiences”. This revision addresses the recent discussion on the CORD listserve, and makes it clear that the standard is a 70% average across all residents, no 70% for each resident. Also, there are an increasing number of instances of EM programs not meeting conference attendance requirements who require their residents to cover conferences in the ED. The committee feels that this is within EM department control, and therefore is legitimately a citation to programs.

   • Resident survey information: With the advent of the resident survey, the RRC-EM is challenged as to what to do with this information. We were advised by the ACGME that across RRC's, if 15% of residents indicate a problem on a specific survey question, this may be grounds for a citation and a request to the program to look into this area. For those citations with institutional implications (i.e. duty hours on off service rotations, need for additional ancillary support, contract issues), RRC's are now expressly asking the institutional DIO to assist the program in addressing the citation. For EM duty hours violations, we know that the vast majority of these are on off service rotations and not in the ED. This new procedure allows DIO's to effectively address these problems and help EM program directors.

   • Scholarship guidelines: Guidelines changed under individual core faculty productivity: “A minimum of 80% of designated core faculty members must demonstrate at least one piece of scholarship per year as noted within the program requirements (previously 100% of core faculty had to meet this requirement). This allows the committee to not cite programs for inadequate scholarly activity in programs with good research output just because of 1 or 2 faculty that do not meet the requirement.

   • Core competencies: With the PIF now requiring completion of the core competency addendum, the RRC-EM is challenged as to what the criteria should be for citations. The ACGME has now expressed expectations that programs are providing education on the General Competencies to program faculty and residents, and that some implementation of data collection relative to the competencies (checklist of live performance, 360 degree evaluation, etc) related to the competencies must be in place. This had not existed previously, but becomes the threshold for a citation in this area.

5. With the issue of handling resident survey data noted (#3B above), the RRC-EM has formally asked CORD to review the Resident Survey, and to make suggestions for improving the questions. CORD president Pam Dyne has convened a Task Force to do this, consisting of the CORD Board and selected members whose programs were reviewed in the past year. This task force has corresponded electronically and provided much raw feedback on potential changes. We should be able to produce a report to the RRC this next week on feedback from CORD to be used in modifying and improving the survey. One of the lessons of this review and feedback process is that resident response to many of these questions could be improved if the program spends a little time at the outset with the residents (particularly the EM1's) to make sure they understand that the program has semiannual review, has a process for confidential feedback by residents to faculty, presentations on patient safety and fatigue/wellness, etc. (i.e. things that exist but that they have not yet seen as first year residents, so that they may answer affirmatively on the survey).

   The survey does contain a few EM specific questions, including:

   How many faculty attend/participate in weekly conferences?
   Does your program provide you with an opportunity to:
        - perform an appropriate number of procedures to be competent?
        - direct an appropriate number of major resuscitations to be competent?
         - become a competent EM physician?

6. ACGME RRC-EM 8 year pilot project: So far, 34 programs have been invited to participate in the pilot, and all have agreed to do so. Please see the description of the pilot project in the previous RRC-EM report in the last CORD newsletter. At the end of the fall 2005 RRC-EM meeting, these 34 programs complete the number of participating programs that can be used for the pilot project. We anticipate that when the pilot is evaluated by the ACGME monitoring committee in 12-18 months, the committee will be able to expand enrollment to more programs.

7. The committee recently reviewed the composition of the appeals panel, list of specialist site visitors, list of programs with upcoming site visits, and program director changes. Frank Counselman rotates off of the committee in February 2006, but no other changes are anticipated soon. Congratulations to Frank for 6 years of excellent service to the committee and for his many contributions to the ongoing projects and initiatives of the RRC-EM !!!

Louis Binder, MD
Lsbinder688@pol.net
MetroHealth Medical Center

Emergency Medicine organizations agree to a sustained presence at the Student National Medical Association Meeting

Three years ago the Under-Represented Minority Task Force completed a series of Focus Groups exploring the views of under-represented minority medical students, predominately African American, regarding Emergency Medicine as a potential career choice. One prominent finding was the student's had little exposure to our specialty early in their careers, and therefore simply didn't consider it as a viable option. In response to this finding, the SAEM Board agreed to sponsor a booth at the 40th Annual Student National Medical Association Meeting in St. Louis, March, 2005. This organization's focus is the support of current and future under-represented minority medical students and it is linked to the National Medical Association. Leon Haley and I were the representatives for SAEM at this meeting. We found an interested group of students, several of whom were rather surprised to see us in attendance. They noted that although specific programs had participated previously, Emergency Medicine was not formally represented in the past. It was notable that other specialties such as Psychiatry and Orthopedics were making a concerted effort to increase their exposure to this group of students and actively recruit them into their specialties.

In subsequent discussions, it was agreed that Emergency Medicine needed to establish a presence in this environment and that presence could be shared amongst many of the organizations representing the specialty. Therefore, earlier this year, a request went out to several organizations to determine if they would be willing to serve as representatives to the SNMA Meeting on a rotational basis over the next several years. The response was uniformly positive, and the AACEM, AAEM, AAEM/RSA, ACEP, CORD and EMRA organizations have all agreed to sponsor a booth and send representatives during their assigned rotational year. The potential involvement of other groups is currently being explored, but the current commitment allows for, at a minimum, an additional six-year presence of Emergency Medicine at the SNMA Meeting beyond our initial foray in 2005. The next organization to participate is EMRA. They will be the sponsors of Emergency Medicine at the 41st SNMA Meeting in Atlanta in April, 2006. One agreement is all of the other organizations may supply promotional materials to be distributed at the booth sponsored by the specific group.

At the closure of this rotational presence, the participating groups will assess the potential impact of our involvement, and determine whether the rotation will continue in the future. This is a very effective means of distributing resources to allow Emergency Medicine's effective presence at an important meeting. As a Society, we continue to look toward ways to improve our recruitment of under-represented minority medical students as we believe they can have an important impact and influence in the communities we serve. This organizational effort is just one more collaborative means by which SAEM is serving its membership and the community of Emergency Medicine at large.

Glenn C. Hamilton, MD
Wright State University
SAEM President

Emergency Medicine Program Coordinators Salary Survey

Located on the CORD Sharepoint website, is a new Salary Survey for Emergency Medicine Program Coordinators.  At our last national EMARC meeting in New Orleans, the coordinators requested a survey tool to be developed regarding the various duties and responsibilities of an Emergency Medicine Residency Coordinator.  We feel this survey is an important and informative reference for all, as well as a catalyst for increased awareness regarding our role as coordinators.  Each program has one ID & Password to log on, complete the survey and view the results.

Second Circuit Court Dismisses All Claims Against ABEM and Other Defendants in Daniel v. ABEM Case

The Second Circuit Court of Appeals on October 7, 2005, upheld the previous judgment of the Western District Court of New York and dismissed all claims against ABEM and other defendants in the Daniel v. ABEM case.  The Court ruled that the plaintiffs lack standing to bring antitrust claims against ABEM and other defendants, including CORD, and that the District Court lacked venue over any such claims against ABEM.

Background

On June 20, 2003, U.S. District Judge Richard Arcara issued a decision that adopted the January 3, 2003, recommendation of U.S. Magistrate Judge Leslie Foschio, and granted the defendants' motion to dismiss the case. The court entered a final judgment in favor of ABEM.

Judge Arcara found that the plaintiffs lack standing to bring antitrust claims for two reasons: (1) because “a plaintiff-doctor's inability to charge higher fees because he or she has been denied board certification does not constitute a cognizable form of injury under the antitrust laws;” and (2) because these physicians are not proper plaintiffs or efficient enforcers of the antitrust laws insofar as their “objective is to advance their own economic interests” and to “keep prices higher.” In addition, the court denied plaintiffs' request to amend their complaint in a manner designed to avoid dismissal, on the grounds that an amendment would be futile. Judge Arcara wrote that “this case is already 13 years old. The amendment proposed by the plaintiffs would be inconsistent with the now developed record.

“Throughout the case, plaintiffs have claimed that they are entitled to the same super competitive prices earned by board-certified physicians. They now want to change their entire theory of the case to avoid dismissal. Even now, however, they are unable to offer an expert report that would support their theory, despite having had years to secure such a report.” Accordingly, Judge Arcara ordered that the case be closed.

On July 21, 2003, plaintiffs filed a notice of appeal with the Second Circuit Court of Appeals.

On August 1, 2003, ABEM filed a notice of cross appeal, stating its intention to appeal the court's denial of several dispositive motions that would have resulted in earlier dismissals of the case on grounds other than lack of antitrust standing, including a motion to dismiss for lack of venue.

Plaintiffs' appeal brief was submitted in May 2004, and ABEM's brief was submitted in June 2004. Oral arguments for the appeal were heard on October 25, 2004, in the Second Circuit Court in Manhattan. The case was dismissed on October 7, 2005.

More information on Daniel v. ABEM is available at www.abem.org under the heading of “News, Notices, Exam Dates & Fees,” “Announcements,” “Litigation Update

CORD Resident Academic Achievement Award Submission Deadline: March 15, 2006

This award is intended to recognize an emergency medicine resident who has demonstrated great potential as a future academic faculty member. Qualities that will be evaluated include academic productivity, commitment to teaching, and service to the program. Each emergency medicine program director may nominate one of their senior residents for this award. Program directors must submit the nominee's curriculum vita and provide specific information regarding peer-reviewed publications and the resident's role in the publications, presentations at state or national scientific meetings, evaluations of teaching ability by faculty, junior residents or medical students, and other objective evidence of outstanding contributions to the educational program. A copy of a publication considered to be the resident's best work should also be included. Nominations must be sent electronically to the CORD office at cord@cordem.org and received no later than March 15, 2006.

To highlight the importance with which CORD regards the development of excellent emergency medicine faculty, the recipient will personally be presented with the award during the May CORD meeting in San Francisco.

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This award is intended to recognize contributions of a junior faculty member to the education of emergency medicine residents. Qualities that will be evaluated include commitment to teaching, contributions to the residency program, and involvement in state or national activities that promote resident education. Each program director or department chair may nominate one faculty member for this award. The award will be limited to emergency medicine faculty with five or fewer years participation as an emergency medicine faculty member in emergency medicine residency programs. Please submit a curriculum vita and provide specific information regarding evaluations of teaching ability by residents and students, objective evidence of outstanding contributions to the educational program and descriptions of activities in support of resident education at the state and national level. Nominations must be sent electronically to the CORD office at cord@cordem.org and received no later than March 15, 2006.

To highlight the importance with which CORD regards the development of excellent emergency medicine faculty, the recipient will personally be presented with the award during the May CORD meeting in San Francisco.

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