Council of Emergency Medicine Residency Directors

Scholarship Recipients

CORD is pleased to announce the recipients of the CORD Scholarships to attend the CORD/AACEM Faculty Development Conference on February 28 - March 2. As you will recall, all residency programs were asked to send in the names of one senior resident and one junior faculty member. All the names were thrown in a hat and 4 names were drawn. The recipients are:

Senior Residents:

Troy Schaff, MD, William Beaumont Hospital Manish Shah, MD, Ohio State University Junior Faculty:

Karen VanHoesen, MD, University of California, San Diego Ellen Westdorp, MD, Truman Medical Center

Each of these recipients will receive a $500 scholarship to be used to cover registration fees and expenses associated with attending the conference.

CORD would like to thank EMRA for its support of the CORD/AACEM Faculty Development Conference. EMRA also awarded two $500 Scholarships for the conference. These Scholarships were awarded to:

Brigitte Baumann, MD, University of Pennsylvania
Flavia Nobay, MD, Highland Hospital/UCSF

Membership Survey

A CORD membership survey developed by Keith Wilkinson and approved by the CORD Board of Directors has been distributed to the membership. All CORD members are urged to complete and return the survey by March 1. Results will be reported during the May 21 CORD Meeting in Boston.

CPC Update

The 1999 Regional CPC Competition will be held on Wednesday, May 19, in Boston. Sixty-six cases were submitted for consideration and are currently under review. Fifty cases will be selected for presentation and notification of accepted cases is expected by mid-March. This year's CPC Competition is being chaired by Terry Kowalenko, MD, from Grace Hospital.

President's Message -- "Product Use by Members"

CORD has developed several educational products for membership use. The most notable of these products include the slide bank, question and answer bank and EKG bank. From time to time members and nonmembers request use of the educational material in a format outside of the direct membership. The CORD office receives requests for permission to reprint CORD materials in journals and for utilization in other venues outside the membership. The CORD president and board members also receive requests from individuals to utilize CORD material outside the membership. These types of requests for utilization of materials are not unique to CORD. Other emergency medicine organizations have had to address this issue as well.

The Bylaws Committee for CORD was asked to write a policy for the CORD Board to review concerning product use by non-members. The policy is reprinted in this newsletter edition. Although, CORD product use is restricted to the membership marketing of CORD products outside the membership is possible with Board approval. The policy was approved by the CORD Board on January 14, 1999 during a teleconference. We would like your feedback on this policy either directly to CORD Board members or to the CORD office. You will also have an opportunity to respond through a member survey coming your way soon. One of the questions in the survey concerns product use outside the membership. It is anticipated that more educational products will be developed in the future. With the rapid advance in technology and growing interest of the membership, development of additional teaching tools ie radiologic\imaging and virtual teaching tools will inevitably be developed by CORD members for the membership. Therefore, this policy is ever so important.

I also want to take this opportunity to recognize another type of educational product developed and sponsored by CORD and the Association of Academic Chair's of Emergency Medicine. The 3rd Annual Faculty Development Conference ANavigating the Academic Waters: Role for Emergency Medicine@ will be held February 28 B March 2, in Washington, DC. The Faculty Development Conference Task Force led by Mary Jo Wagner has done a wonderful job in putting together the conference. Approximately 100 registrants will participate in the conference. This same task force is currently planning the new residency directors workshop to be held in Boston in May. This task force is to be commended. This is the type of educational product CORD readily extends to its members as well as others such as residents and junior faculty who may not be CORD members.

While CORD products are currently few in number they are all of high quality and represent an important resource for our membership. CORD products will grow in numbers over time. The policy governing product use will be helpful to the CORD President and Board as requests for use outside the membership are received. The CORD board appreciates the support of the membership regarding this policy.

Marcus Martin, MD
University of Virginia

Policy Statement: Product Use by Members

From time to time, the Council of Emergency Medicine Residency Directors (CORD) develops products. These products are the work of the membership. The following policy will apply to product use:

1. CORD materials are the property of CORD and their use will be governed by this policy.
2. CORD materials are copyrighted and cannot be reproduced or used except with written permission of the CORD Board of Directors.
3. CORD products may be used only by CORD members. Members may not forward or copy the products for non-members.
4. CORD members may use the products for educational purposes for emergency medicine residents, medical students and faculty.
5. CORD members may not use CORD products for any activity outside of their residency, including those for which they receive compensation of any kind.
6. Questions about this policy should be referred to the CORD office.
7. This policy may be changed by the CORD Board.

Preliminary Agenda: CORD Meeting, May 21, 1999, Boston

8:00-9:00 am	Business meeting
9:00-10:15 am	Frontiers of Technology in EM Education, Moderator: Kevin Rodgers, MD
	Facilitating real-time Evidence-Based Medicine in EM
	Hardware/Software Recommendations for clinical/educational use of digital photography (What to Buy)
	Database management and use in EM training and record-keeping
	Teaching tools (i.e. virtual reality)
10:15-10:30 am	Break
10:30-12:00 noon	GME Funding
	Primer on GME Funding for EM Program Directors, Dan Martin, MD
	HCFA Update - resident complements, ratios, new resident positions, etc HCFA presenter (to be determined)
	Q/A with HCFA presenter
12:00-1:30 pm	Lunch and Award Presentations

Is your computer expertise limited to word processing? Do you know how to set up a database and make it functional? Are you using digital technology to capture clinical photographs and videos? Are you familiar with and/or using software applications to store, manipulate, and present digital images? Are you adept at searching on-line for "the best evidence" to answer clinical questions during your ED shifts? Can you set up a "server" that will provider access by multiple users to electronic texts in the ED or resident office? As the twenty-first century rapidly approaches, these are but a few of the technological advances that program directors and faculty should be using to enhance their programs and educate residents.

A recent CORD meeting small group discussion centered on the use of technological advances by EM residencies as we catapult into the next century. It was clear from the discussion that interest is high but actual experience is highly variable from person to person and program to program. Would you be surprised to hear that some of our colleagues are just starting to use E-mail or present lectures electronically? Indeed, some were even willing to admit in public that they are technologically challenged. However, they are not alone. As rapidly as technology advances these days, it's a challenge for even the most technologically advanced to keep up.

Beyond the basic computer skills of word processing, slide making, and electronic communication lies an almost infinite array of technological assets that can aid us in educating residents and running training programs more efficiently. Examples include completely computerized data bases for tracking procedures or your curriculum, virtual reality training aids, electronic textbooks that are continuously updated, digital photographs and video loops, and electronic libraries of CD-ROM text books. Many programs have gone electronic to include interactive quizzes, electronic lectures, yearly CD-ROM handouts, statistical packages for research, and telemedicine conferencing for off-campus residents. Even the application of Evidence Based Medicine requires that we have the ability to formulate rapid real-time searches of medical databases. Another area that technology will greatly impact is the identification and sharing of information. Identifying web sites that are useful for EM education; providing and protecting teaching files of clinical photos / EKGs / quiz questions; and networking on new educational ideas or technology are but a few areas that information sharing will enhance. Finally, we must also be committed to teaching our residents how to use and apply these technological advances as they continue their "life long learning".

Unfortunately, keeping up with the technology requires commitment, energy, time and money. The final two of these are often the limiting factors. Do not dismay, your friends and colleagues are here to help with their expertise (not their $$). The CORD Newsletter is interested in hearing about new technology and its application. These articles will appear regularly in "The Technology Corner". There will be a session at the CORD meeting in Boston dealing with technological advances. Finally, we can share new ideas on technology via the CORD list server. The bottom line is, "Don't get left behind!"

Kevin Rodgers, MD
Indiana University-Methodist

Legal Issues II

Scenario: In your residency program, you have a married couple about to have a baby. They've requested that you give them a combination of maternity and paternity leave totaling 24 weeks under the Federal Family and Medical Leave Act. How does this law apply to your residents and other residency employees?

Family and Medical Leave Act:

The Federal Family and Medical Leave Act (FMLA) allows for eligible employees to take up to 12 work weeks of "Family and Medical" leave (FML) during a leave year. Eligibility for taking FML is dependent upon the length of service; number of hours worked in the preceding 12 month period and the employee's job status, all of which are defined by federal law. Qualifying reasons for using FML include a serious medical condition affecting an employee or their spouse that prevents them from performing the essential functions of their job; or for the birth, adoption or foster placement of an employee's child. It is therefore important that a job description exists that defines the essential functions of the employee's job. Any ambiguity may expose the employer to unfounded claims.

A "serious health condition" includes any illness, injury, impairment, physical or mental condition that requires inpatient care, absence of at least 3 days plus extended treatment, pregnancy, chronic conditions with episodic periods of incapacity requiring treatment, or permanent long term conditions requiring supervision. The employee is required to furnish the employer with a written certification of their "serious health condition". It should provide enough information to confirm the condition exists, the probable duration of the condition, and the specific period(s) of incapacity. If the FML is taken for the care of a child, spouse, or parent, the certification must describe the care and an estimate of its duration. Supervising physicians should not also fulfill the role of the "certifying" physician (potential conflict of interest).

The proposed schedule of leave may be continuous, intermittent (periodic), or a reduced work schedule of partial days or weeks whereby only the absence is covered by FML. FML for birth, adoption, or foster care placement must be completed within 12 months of the event and must be taken in continuous workweeks unless the employer and employee mutually agree to a different schedule. If a husband and wife are both employed by the same hospital and eligible for FML, their combined FML allowance for birth, adoption, or foster care placement is limited to 12 workweeks.

Upon receipt of a request for FML, the supervisor shall determine the employee's eligibility for FML and will notify them within two working days whether the leave will be considered as FML. Although typically it's the employee who requests FML, a supervisor/administrator has the right to designate any eligible employee's FML qualifying absences as part of their FML entitlement. When the leave is foreseeable (e.g. childbirth, planned medical treatment) the request for FML must be submitted in writing at least 30 calendar days in advance. The request must contain enough information for the supervisor/administrator to determine that a FML qualifying reason exists. The request must also specify a schedule of leave dates including a breakdown of when accrued paid leave versus unpaid leave is to be used. The department shall keep an accurate record of FML taken including when accrued paid leave and unpaid leave is used. Use of accrued compensatory time may not be counted as part of an employee's 12 workweeks of FML.

By definition, a leave year starts 12 months prior to the date the current leave request begins. If the employee used any FML (must have been specifically designated as FML) during the "leave year", the 12 week maximum is reduced by that amount.

When an employee returns from FML taken for their own serious health condition, the employer can require they obtain a fitness for duty evaluation. The health care provider performing the evaluation should be provided with a job description in order to certify that the employee can perform the essential functions of their job. Employees returning to work on or before the expiration of their FML shall be reinstated to their position or a comparable position at a pay rate not less than their former rate. An employee on FML may be voluntarily terminated if they advise their employer of their intention not to return to work; or if they fail to return upon expiration of FML and they have not requested and been granted the use of any remaining accrued paid leave or unpaid leave.

The employer will continue to pay their portion of any group health and dental insurance premiums for the duration of the FML. During weeks of unpaid leave, the employee will be required to pay their portion of the premium. If an employee on FML voluntarily terminates employment, they can be required to return to the employer health and dental insurance premiums paid by the employer on their behalf during the period of unpaid FML. No refund of any retirement contributions is made upon commencement of FML since the return of the employee is anticipated. Time in service shall continue to accrue during the period of FML.

Answer: The couple is allowed to take a total of 12 weeks of FML since they are both employed by the same hospital. This leave must be taken within one year of the birth and must be taken in continuous work weeks unless a different mutually agreed upon schedule is developed.

Adapted from a presentation on "Tricky Legal Issues" by Vicki Gotkin, Esq.

Kevin Rodgers, MD
Indiana University-Methodist

Report of AAMC Meeting Held in New Orleans, October 30-November 5

In a plenary session Dr. Jordan Cohen, AAMC President, provided an excellent perspective on future directions for graduate medical education based on a view of society's needs. He approached this issue based on three questions; 1) What do people today find lacking in their doctors? 2) Are these concerns valid? 3) What can be done to correct these deficiencies? Common perceptions of the public about today's physicians are that "They don't care; they are narrow-minded; they don't maintain our trust." In several public polls, for instance, 80-90% of the public questioned felt that physicians "don't listen" and "don't involve families in decision making." Currently, many people also have a more negative perception of physicians as a group concerned only with protecting their special interests.

His suggestions for educators in GME residency programs to counter these trends and perceptions are the following:

1. Enrich the educational content
   
   Dr. Cohen believes that programs must raise their expectation of what residents need to demonstrate, particularly focusing on:
   1. better communications skills emphasizing shared decision making
   2. better exposure to the basic sciences in the context of the resident's specialty
   3. instilling in the resident habits of lifelong learning
   4. including in the curriculum topics related to clinical resource management, health education for patients, disease prevention, team building, population health issues, and basic science objectives.
   
   
2. Strengthen institutional authority

   Dr. Cohen recommends local, regional and state coordination of GME by means of integrated delivery systems or consortia, with joint programs to oversee the development and implementation of core curricula, to appoint and credential cross-disciplinary faculty, to monitor educational quality, and to assist with the evaluation of residents. He suggests that the ACGME develop requirements based on outcomes rather than process and enforce more accountability of institutions for these outcomes as the institutions consolidate.

3. Reorder priorities.

   Dr. Cohen believes that there must be a continued shift in priorities for resident activities from service to education. Residents roles and responsibilities should be based not on the need for service but instead on a prospective examination of needs related to the development of clinical, procedural and attitudinal skills. This shift toward education as the top priority is in keeping with the current trend to utilize attending physicians, subspecialty fellows and non-physicians to provide care. The AAMC and the Council of Teaching Hospitals (COTH) are currently engaged in developing initiatives for alternate models of patient care.

4. Use the power of the "hidden curriculum" Dr. Cohen described the "hidden curriculum" as professional behavior learned by the resident through faculty example. Faculty in this regard must visibly embrace professionalism in their own activities. They must also treat residents as colleagues, not as service providers to be exploited. As he stated, "Whenever we show disrespect towards a colleague, or worse yet, towards our patients, our residents see and understand all too well that our rhetoric about the Hippocratic ethos is aspirational and not inspirational."

In summarizing , Dr. Cohen emphasized that unless graduate medical education programs listen closely to the public's complaints and address its concerns with the appropriate remedies, the public will lose its faith in the ability of doctors to meet its expectations. It will then become even more difficult to advocate on behalf of medical schools and teaching hospitals.

Joseph LaMantia, MD
AAMC/CAS Representative
North Shore University Hospital

New Program Directors Workshop

Due to the success of previous workshops, CORD is once again planning a new New Program Directors' Workshop to be held in conjunction with the CORD Meeting in Boston. Current plans call for the CORD Meeting on the morning of May 21 and the New Program Directors' Workshop to be held in the afternoon. Mary Jo Wagner, MD, Saginaw Cooperative Hospitals, Inc., will be chairing the task force that is developing the workshop. CORD members are encouraged to send their comments or suggestions to Dr. Wagner at . New Program directors and others are invited to attend the workshop. There is no fee to attend the workshop however pre-registration is requested.

Chief Residents' Forum, May 19, Boston

Chief residency is a demanding position for which there is little formal or structured preparation. Most new chief residents have not had the benefit of training in the essential administrative, academic and leadership skills that will be required of them. This one-day course will include twelve interactive sessions led by experienced program directors and academic leaders in the specialty of emergency medicine. The program will address a variety of administrative and academic topics relevant to new chief residents. A lunch session and coffee breaks will provide opportunities for chiefs from difference programs to meet and exchange ideas. Pre-registration required (limited to 115). Registration fee: $90.

This forum will help the chief resident to:

• Develop an understanding of the respective roles of the various organizations involved in developing and maintaining standards for program and resident certification/accreditation.
• Develop an understanding of key Special Requirements that govern the residency training programs.
• Learn basis characteristics of good leadership.
• Learn basic time management principles.
• Learn basic concepts of administration and problem solving.
• Discuss the management of difficult situations and personalities, and effective recognition / intervention skills for the problem resident.
• Learn tips of successful scheduling.
• Review common pitfalls faced by chief residents
• Review potential ethical issues likely to be faced by chief residents.
• Review the history of the relationship between resident education and the biomedical industry and to discuss a professional and ethical method of interaction with the pharmaceutical industry representatives.
• Review the role of the chief resident in the clinical and didactic education of residents and students and to discuss characteristics of successful teachers.
• Present an approach to professional development and success as a chief resident.

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