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CORD Meets in Boston
During the Council of Emergency Medicine Residency Directors (CORD) meeting in Boston on May 21, the results of the annual elections were as follows:
Pam Dyne, MD, from UCLA/Olive View, was appointed to the Board of Directors to complete an unexpired term. Carey Chisholm, MD, completed his term on the Board of Directors and was presented with a placque in appreciation of his service to CORD.
The CORD Faculty Teaching Award was presented to Felix Ankel, MD, from the University of Minnesota. The CORD Resident Academic Achievement Award was presented to Daniel Davis, MD, from the University of California, San Diego.
The next CORD meeting will be held during the ACEP Scientific Assembly in Las Vegas on October 13.
President's Message
Starting off a term as the new president of an organization I can, again, empathize with the new residents. Most of them, like me, are excited, nervous, and really want to do well. They require guidance and mentoring and fortunately for me, our organization is full of quality mentors. Although you may not hear it from your new housestaff, I would like to thank all those who have given advice and will continue to serve as role models. We are truly fortunate to have such a fine collegial subculture in CORD.
I have asked the Board to help the organization focus its efforts on activities related to three target priorities. Those being: 1) improving the quality and success of residency administration; 2) the CORD meeting; and 3) the CORD communication tools. I strongly believe that CORD has been instrumental in bringing the quality of residency education in our specialty to the forefront of medicine. This I feel has primarily been done by exposing the membership to the variety of successful administrative and educational methods being used by our peers. We have developed a great degree of parity as a result and that is a very good thing; especially for the future professionals of emergency medicine: our residents.
Three targets
Program Administration
Supporting the daily activities of program administration, I believe, is as close to the heart of our mission as is possible. We should each be able to say we are more successful at what we do because of our relationship with CORD. I will therefore promote the following issues: 1) program director career development, such as the New Program Directors' Workshop; 2) program director longevity, including wellness and success; 3) assistant and associate program director validity, including career development and longevity; and 4) residency office success, including career development for coordinators and secretaries of programs and improving office technology.
CORD Meeting
The CORD meeting is the cuvee. It is the centerpiece of our organization. The meeting should therefore be of the highest possible quality. It should educate members on the latest developments and review proven successful administrative and educational techniques. Perhaps most importantly, it should provide an opportunity to network among the CORD members.
Communication
We learn and grow because we communicate. I think CORD should prioritize the continued development of an infrastructure that allows free discourse. Undoubtedly, electronic communication has improved our membership's capacity to do this. The listserv is maturing well but we also need to continue in developing the web site and its value to each residency.
The success of the my term, I feel, depends on the realization of these goals. Hopefully, as with your new residents, you will provide the Board and I feedback on our productivity.
Sam Keim, MD
University of Arizona
Semi-Final CPC Competition Results
On May 19, fifty Emergency Medicine Residency Programs competed in the Tenth Annual Semi-Final CPC Competition. A resident from each participating program submitted a challenging unknown case for discussion by an attending from another residency program. The faculty discussion had 20 minutes to develop a differential diagnosis and explain the thought process leading to the final diagnosis.
Winning presenters and discussants were selected from each of five regions and these individuals will represent those regions at the national competition. The CPC finals will be held at the ACEP Scientific Assembly in San Diego on October 13 from 8:00-11:30 am. It is not necessary to register for the Scientific Assembly if you plan only to attend the CPC. The CPC Competition is sponsored by ACEP, CORD, EMRA, and SAEM.
Congratulations to the 1999 Regional Winners!
Region A
Best Presenter: Brian Chinnock, MD, University of California, Fresno
Best Discussant: Steve McLaughlin, MD, University of New Mexico
Region B
Best Presenter: Michael Hocker, MD, University of Massachusetts
Best Discussant: Dino Rumoro, MD, Resurrection Hospital
Region C
Best Presenter: Gene Hern, MD, Highland Hospital
Best Discussant: Gretchen Lipke, MD, Texas Tech University
Region D
Best Presenter: Mitchell Palmer, MD, Hennepin County Medical Center
Best Discussant: David Wald, MD, Temple University
Region E
Best Presenter: Troy Dinkel, MD, Resurrection Hospital
Best Discussant: Gregg McDonald, MD, Baystate Medical Center
Technology Corner
The Three Most Important Words in Personal Computing Backup! Backup!! Backup!!!
Introduction
It's not a pretty sight to see grown men and women cry. But cry they do when their computer's hard drive, where all their programs and data are stored, crashes and dies and they don't have copies of the files. Months of work on a research project or journal manuscript or years of personal financial data can disappear into a "black hole of lost data" in the blink of an eye. Such catastrophic data lost can result not only in tears, but stress, frustration, despair, and outright cynicism towards computing. They are the consequence of failing to heed the three most important words in personal computing Backup! Backup!! Backup!!!
Data are the single most precious asset in the Computer Age. Yet data storage and security are often given short shrift or simply ignored. Academicians may store years of lectures, manuscript development, research projects, correspondence, and other work on their computers. If the computers are part of a network and that network has a competent administrator, these data are being scrupulously backed up. However, many scholars store important data on non-networked computers - including office computers, laptop computers, home computers, and handheld computers - without having effective strategies for backing up and recovering lost data.
Fortunately, loss of precious data is a remediable if not preventable computing problem. In this installment, I will discuss the single most important skill of personal computing backing up data stored on personal computers. (Network data storage is beyond the scope of this installment.)
Why Backup?
The goal is to conscientiously backup data on a storage device and on a schedule most appropriate to the data being stored so that data lost for any reason can be recovered. "Backing up" means making duplicates of all important files data, application program, or setup - on a regular schedule, then storing the data in a safe place. In the event the original data are lost, they can be replaced (restored) to the original location.
For example, if you have spent 16 hours writing a book chapter with over 100 references, you should have a strategy for backing up such an important, labor-intensive document file. At the end of each writing session, after you have saved the file and closed the word processor program, you should immediately and without fail copy the file to either a floppy disk or (my personal favorite) a Zip disk. The disk should be stored in a secure place such as a locked drawer or cabinet.
A physician friend of mine has for years backed up all his financial, academic, and personal data onto a single high-capacity tape cartridge. The files are so precious to him that he carries a copy of the tape with him even when he travels out of town. I have a similar strategy for my home computer utilizing two tape cartridges. I regularly (every couple of days) back up my home computer hard drive (over 5 gigabytes of files and data) onto a tape cartridge. Every 3-4 weeks, I take the tape cartridge from home and store it in a locked cabinet in my office at work. I bring the second tape home and begin using it for backing up my hard drive. (Just so you know, my office computer is part of an institutional network and is backed up on a daily basis.)
When I discuss such backup strategies with younger scholars or those just starting to use personal computers, they appeared stunned by the seemingly overly compulsive nature of these backup regimens. I tell them that the amount effort one puts into storage and security is proportional to the value of what one is protecting. (If there are no valuables in the house, why lock the door?) But when there are years of valuable, irreproducible data stored on a computer, there is a huge incentive to become backup compulsive.
Why isn't everyone devout about backing up critical data? E.T. Hill, in an on-line article, wrote that even though there are many convincing reasons for performing backups, people still do not do them. Reasons include a lack of understanding of the importance of backups because they have not tasted a data disaster, they don't know how to do a backup, they don't have a backup routine, or they can't be bothered with what they perceive as a time-consuming chore.
Such a "it can't happen to me," "head in the sand" attitude is the computer equivalent of playing Russian roulette with data. There are just too many threats both internal and external to the computer that can destroy data. One of the worst computer failures is a hard disk crash because all the computers programs and data are stored there. Once the hard disk dies, it is at best very difficult and expensive to recover data. (The crashed hard disk must be sent to companies who specialize in such data recovery.) In addition to hard drive failures, personal computers (especially laptop and handheld computers) are increasingly being stolen. Other potential threats to data include computer viruses, file corruption, computer sabotage and vandalism, fire, and natural disasters such as tornadoes, hurricanes, floods, and earthquakes. Protecting data against these threats requires both the right storage device and an effective strategy for data storage and security.
Storage Devices
Different storage devices such as floppy disks, Zip disks, CD-ROMs, and tape have different storage capacities, speed, ease-of-use, and ability to be used on other storage devices. The major storage devices relevant to non-networked personal computers are listed in the Table. I strongly recommend that scholars and academicians with serious computing requirements invest in both a 100 megabyte (MB) Zip drive ($100-$150 depending on the version) and a tape drive (around $300 for a 14 gigabyte capacity). I prefer external (not housed inside the computer) versions of these drives for ease of portability. And because of their true "plug-and-play" capabilities, I recommend USB versions if available. (At the time of this writing, I am unaware of any USB tape drives.) USB stands for "Universal Serial Bus" and is a standard "plug" (interface) for connecting the computer to the device.
For archiving large hundreds of megabytes worth of data, consider adding a CD-R (compact disk-recordable). A fairly new option not to be overlooked is the ability to store your data off-site using an Internet browser and connection through what is called "on-line backup." I tried one of these services and found it a great option for backing up megabytes (not gigabytes) worth of essential data. I also learned that on-line backup is inappropriate for backing up hard drives.
Backup Strategies
Storage devices alone, however, are not enough as illustrated by the following true story. A friend and colleague of mine had just purchased a new laptop computer for home use. He and his wife decided to transfer their previously paper-based personal financial data to the computer. Not more than a few days later, while they were both at work, some scofflaws brazenly kicked down the front door of their house and looted all their electronic equipment, including the new laptop computer. Fortunately, the couple had appropriately and wisely stored a copy of the financial data file on a Zip disk. Unfortunately, the backup disk was still in the Zip drive that the thieves carried out. To help prevent such data loss, I recommend the following strategies for protecting data:
Develop a Backup Habit
As with not putting on a seat belt, not backing up your computer data and hard drive on a regular basis should make you feel uncomfortable. You don't have to necessarily have the daily file archiving strategy that companies use to backup networks. But backups should be frequent and regular. Many backup programs allow users to automatically schedule backups. A typical time is in the early morning hours when most people are sleeping.
Backup Your Hard Drive
Often, I hear computer users say, "I don't need to backup my programs. If something happens, I'll just reload them." This strategy may work if you have only a few programs, but imagine trying to reload them if you have 50-100 programs (like I do) on your computer. Furthermore, if you don't make a copy of your hard drive, all the customization you have created, such as favorite Web sites, will be lost. The best strategy is to regularly backup the hard drive to a tape drive. In the event of a hard drive failure, a new or repaired drive can be installed and the complete copy of all programs and data files completely restored to the new drive from tape.
Store Copies of Essential Data Off-Site
This strategy called "rotation" helps protect data in case one site (such as the home) is robbed or damaged or destroyed by fire or a natural disaster.
Data Storage and Security Go Hand-in-Hand
As underscored by the story of my friend who was robbed, personal data should not only be backed up, but password protected and encrypted to protect them from prying eyes in case they are stolen.
Become Backup Compulsive
No one thinks twice about meticulously maintaining lifeboats on ocean liners or parachutes in jet fighters even though they are only occasionally if ever used. It's better to be safe than sorry when it comes to protecting our most precious computer asset data.
Please e-mail comments and questions regarding academic computing to wcordell@clarian.com
Copyright 1999 by William H. Cordell, MD
William H Cordell, MD
Methodist Hospital of Indiana
Evidence Based Medicine Resources
At our most recent meeting in Boston, a presentation on computer resources for EBM was presented by Dr. Jim Jones (aka Bill Cordell). As interest in EBM grows exponentially, web-based resources that assist in translating scientific evidence into clinical practice are invaluable. These resources help to establish the interface between scientific evidence, clinical practice, values, information technology, global collaboration, and team learning. As we become more experienced in using EBM techniques, these resources will serve as powerful tools for delivering evidence based clinical practice to the point of care. Here are the addresses for some of the more valuable on-line EBM sites.
Evidence Based Emergency Medicine (EBEM Center)
http://www.ebem.org
EBM Resources Ottawa Hospital
http://www.ogh.on.ca/library/evidence.htm
Bandolier
http://www.jr2.ox.ac.uk/bandolier
Center for Evidence Based Medicine
http://cebm.jr2.ox.ac.uk
Users' Guides to the Medical Literature
http://hiru.mcmaster.ca/ebm/userguid/
http://hiru.mcmaster.ca/cgi/hirexs.exe?LINK=20@ebm
The Cochrane Collaboration
http://www.hiru.hirunet.mcmaster.ca/cochrane
EBM Tool Kit
http://www.med.ualberta.ca/ebm/ebm.htm
Frequently Asked Questions of the RRC
Thanks for the presentation at SAEM recently. One of the things that you talked about pertained to the ACGME workshop. Would this be a helpful workshop for a program director?
Richard Shih, MD
Each year the ACGME offers an accreditation workshop called Mastering the Accreditation Process. Workshops are designed to provide the most current information about the ACGME, institutional and program requirements, and the interpretation of each RRC's policies and practices. The Workshop is very valuable for program/residency coordinators interested in strengthening their understanding of the mechanics of accreditation. The next Workshop is scheduled for March 2 and 3, 2000 in Chicago. For additional information, please contact Linda Gordon at the ACGME. (email: LAN@acgme.org; phone: 312-464-4684). The intent of the Workshop is to meet the requirements of those involved in Graduate Medical Education, so Linda would be pleased to receive ideas and suggestions on topics, areas of interest, or continuing education needs which may be incorporated in the Workshop planned for 2001.
In the past, programs were specifically requested to NOT "wordprocess" the Program Information Form (PIF). Program secretaries and/or coordinators typed information directly into the PIF. This seemed like a waste of time. Is this still the case?
Sam Keim, MD
No. In fact, the only requirement is that the information requested in the PIF must be provided to the Residency Review Committee, in a clear, concise, and readable form. In the past, tabbing sections of the PIF was also discouraged. Committee members generally agree that PIF's indexed with a Table of Contents and Tabs are easier to navigate. To the extent that programs in emergency medicine were able to do so, adding Tabs and a Table of Contents is encouraged (Other RRC's may have different requirements). The Committee is working with ACGME computer staff to develop an "Electronic Program Information Form" which incorporates key information/section folders and pop up screens. Preliminary plans call for pilot testing the Electronic PIF next year.
The Emergency Medicine and Pediatric residency programs in our institution are interested in starting a combined 5-year residency program. Both of our programs are fully accredited. What forms need to be completed to get RRC review and approval?
Hebert Bivins, MD
The ACGME does not accredit combined training, though this may occur sometime in the future. Since specialty Boards approve combined training, it is necessary to contact the Boards of the participating specialties for information on review and approval mechanisms. Following approval of combined training programs involving Emergency Medicine, the Residency Review Committee must be notified. The number of "combined" positions must be designated which the Committee will review and approve based on program resources. Other Committees may have different requirements covering notification or approval of positions. Please check with the appropriate Executive Director. Please refer to the ACGME website http://www.acgme.org for ACGME staff contact information.
Please direct future questions to Dr. Larry Sulton, PhD at em@acgme.org
CORD EKG Taskforce - Solicitation for Additional Authors
The CORD EKG taskforce is currently recruiting additional EM faculty interested in contributing to our project. Authors and editors would be reading actual EKGs on-line. We currently have over 30 authors as well as 5 Emergency Medicine ACC-certified editors. We have over 300 EKGs in the database that can be accessed and used. The website electronic tool and its editorial process are complete. Our current authors and editors have been working full speed to have as many of our EKGs read and edited in a unique interactive format. We need additional authors.
We are not soliciting contributions of ECGs at this time. All currently included ECGs have been collected and loaded onto the CORD ECG database. Authors will need to access their assigned ECGs by going on-line and have access to a computer with version 4.x of Internet Explorer. Internet access may be either by modem or direct connection. Authors will be assigned 5 EKGs, which they will view on-line.
Reading an ECG involves:
The final database will be accessible only via a link form the CORD web site, only to CORD members, using an assigned username and password. Due to possible use of these ECGs by program directors for testing, authors must agree not reproduce or otherwise distribute copies of the ECGs. Editors will review and approve all submissions before they are released. Contributors can be either CORD members or on faculty in an EM residency program.
Marc Squillante, DO
Ed Michelson, MD
Antoine Kazzi, MD
and the CORD EKG Taskforce
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