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| 8:00-9:30 am | Business Meeting, Marcus Martin,MD, Sam Keim, MD, et al |
| 9:30-9:45 am | NRMP/WebROLIC, Robert Beran, PhD, AAMC |
| 9:45-10:45 am | Frontiers of Technology in EM Education, Kevin Rodgers, MD, moderator |
| a. Real-time resources in EM education, William Cordell, MD | |
| b. Hardware/Software recommendations for clinical/educational use of digital & non-digital photography, Larry Stack, MD | |
| c. Virtual reality teaching tools, Dane Chapman, MD | |
| 10:45-11:00 am | Break |
| 11:00-12:30 noon | GME Funding and Emergency Medicine Residencies |
| a. Primer of GME Funding for the EM PD, Robert Wolford, MD | |
| b. Report of GME Funding Survey, Daniel Martin, MD | |
| c. What the Future may Hold in GME Funding, Michele Wagner, MD | |
| d. Question & Answer / Open Discussion | |
President's Message -- "Membership Survey"
I would like to express my deep appreciation to the CORD membership for responding to the CORD survey that was distributed in February 1999. Also, I would like to express my appreciation to Mary Ann Schropp and the CORD office personnel for their diligent efforts in distributing the surveys, coordinating the responses, and compiling the first draft of results and comments. Thanks also to Keith Wilkinson for his assistance with developing the survey tool. In the near future, Keith will review all the information we've received to date and provide a more detailed analysis.
In my first CORD newsletter, just 2 "short" years ago, I provided an overview of CORD's short but fruitful history. I ended that newsletter by discussing the tasks ahead for CORD for my two years as president and with the help of the CORD Board and the membership we have carried out much of what I projected for us. As an overview, we have accomplished the following:
Most importantly we maintained dialogue and supported new and established program directors. Now it is time to move into a new era as we approach Y2K. The purpose of the 1999 CORD membership survey was to tap the intellectual talents, diverse backgrounds and experiences of the membership to provide a road map for the future direction of CORD. It was also an opportunity for the members to contribute feedback on existing CORD programs and services. As of April 12, 1999, we had a total of 206 responses. This represents 2/3 of the membership. However, since the survey was only distributed a few months ago, we anticipate that we will continue to receive further responses. The comments to follow then are preliminary results from the membership based on responses received as of April 12, 1999.
Three elected members at large (3 years)
Yes=97%
No=3%
Faculty Development Course
Yes=60%
No=40%
CPC
Yes=83%
No=17%
Residency Coordinators?
Yes=60%
No=40%
Chief Residents?
Yes=48%
No=52%
Medical Student Educators?
Yes=48%
No=52%
The CORD membership is overwhelmingly satisfied with the current 3 members per program representation and do not feel that the membership should be opened to all faculty members of emergency medicine residency programs. The membership is emphatic about not opening CORD membership to the emergency medicine community in general, which obviously is not surprising. The membership feels that the leadership structure of CORD is open and accessible to the membership, and are satisfied with the length of terms for CORD board officers and members at large. The majority of members feel that the CORD meetings should be kept at 2 per year. There is satisfaction with the current CORD meeting format and content. While maintaining the meeting format at 2 per year, 61% of the membership suggests that we should hold the meeting at an alternative site to either SAEM or ACEP. Other venues receiving mention were the AAEM Scientific Assembly, AAMC Annual Meeting, the Faculty Development Conference Forum, and an EMRA/CORD combined conference meeting. However, there were only a few comments by the membership in support of specific sites alternative to SAEM or ACEP. The consideration of an alternative conference site is certainly an issue that the CORD Board should consider based on the membership input. The membership provided a list of other products that they would like to see CORD initiate. The following examples are some of the recommendations:
The membership does appear to be divided on the issue of whether CORD should market its educational products outside the membership. It appears that the majority of programs are participating in the chief residents' forum, the program coordinators' forum, the new program directors' workshop and the faculty development course. Of all the forums, the CPC has the most participation by membership. Members appears to be satisfied with the faculty teaching awards, the resident achievement award, the impact award, and the faculty development scholarships. There were several open-ended questions included in the survey with an excellent response from the membership. When asked what CORD could do to improve representation of women and minorities in emergency medicine, responses varied such as: "CORD has already done a good job of this;" "develop women and minority faculty/directors through the faculty development course"; and "such activity should not be the mission of CORD". In response to the question, "What could CORD do as an organization to sustain the quality of applicants to the specialty?", the majority of the answers related to promotion of emergency medicine in medical schools. Some responses referred to limiting the number of EM residency spots and continue to promote the quality of EM residency programs by assisting program directors in doing their jobs. The membership was asked to list issues of importance that they would like to see CORD address in the coming year. The responses were voluminous but tended to focus on the following:
To the question requesting recommendations for goals, programs, policies, task forces, or committees for CORD, responses included the following:
There were many positive comments about CORD as an organization such as: "CORD is probably the organization that I am most proud to belong to"; "CORD is a good and focused organization, keep it up", and the one I liked the most is "Damn good survey". Of course there were others that said get rid of surveys.
Again, thanks for each and every CORD members input into the survey. We have plenty of useful suggestions for the CORD Board, our upcoming president, Sam Keim, and the membership to address as we approach the new millennium. Thank you for your support of me as the CORD president for the 1997-99 term. I look forward to continued work with CORD as a member and past president.
Marcus Martin, MD
University of Virginia
Residency Vacancy Service
The Residency Vacancy Service has been very active in the past few months with up to 15 programs at a time listing their unexpected openings. Much of the activity has been centered around the Match, the unexpected closing of the Mt. Sinai program in Cleveland, program expansion, and the usual mix of life's surprises such as moves and changing specialties. The Residency Vacancy Service is now available on the web, which has proved very popular. It can be found on the SAEM web site at www.saem.org and is also linked to the CORD web site at www.cordem.org.
Programs with unexpected openings may contact CORD or SAEM to be added to the list. Information needed includes the contact person, number of positions available, prerequisites, etc. This information is added to the list to be accessed by prospective emergency medicine, who contact the residency programs directly. Programs are reminded to be sure to contact the SAEM office when their unexpected openings have been filled.
1999 Faculty Teaching Award Announced
CORD is pleased to announce the selection of Felix Ankel, MD, as this year's winner of the CORD Faculty Teaching Award. The award recognizes the contributions of a junior faculty member to the education of emergency medicine residents. Dr. Ankel is Assistant Professor of Clinical Emergency Medicine at the University of Minnesota Medical School and is the Associate Residency Director of the Emergency Medicine Residency Program at Regions Hospital, St. Paul, Minnesota.
Dr. Ankel completed his emergency medicine residency training at the University of Illinois Emergency Medicine Program in Chicago, Illinois. He is a graduate of the ACEP Teaching Fellowship and has served on the SAEM Undergraduate Committee, where he helped to develop a medical student home page. He is a member of CORD, has served on the CORD Faculty Development/New Program Director?s Orientation Committee and participated in the 1999 CORD/AACEM Faculty Development Conference. He has also served as a national lecturer at the ACEP Scientific Assembly and served as a reviewer for Annals of Emergency Medicine and Academic Emergency Medicine.
Robert Knopp, MD, Emergency Medicine Program Director at Regions, offered these comments about Dr. Ankel and his teaching in his nomination letter:
"Felix receives excellent evaluations from the medical students, who often comment that he was the best faculty teacher. Our emergency medicine residents consistently note that he provides the best clinical feedback of any of the emergency medicine teaching faculty."
"Dr. Ankel's interest and dedication to teaching and advising residents and medical students is invaluable to our program. Medical students seek out opportunities to work with him. His enthusiasm for teaching is obvious to all those who work with him. His conferences set a high standard for emergency medicine education. His diligent and conscientious efforts to improve our specialty serve as a model for both our residents and our faculty."
CORD will present the Faculty Teaching Award to Dr. Ankel in Boston on May 21 during a special lunch and awards presentation from 12:30-1:30 pm in Salon F of the Boston Marriott Copley Place.
1999 Resident Academic Achievement Award Announced
The Council of Residency Directors is pleased to announce the selection of Daniel P. Davis, MD, as this year's winner of the CORD Resident Academic Achievement Award. This award recognizes a resident who has demonstrated great potential as a future academic faculty member. Dr. Davis is currently chief resident in the University of California San Diego Medical Center emergency medicine residency program. He has published 14 papers as first or co-author in the emergency medicine literature and has authored four chapters in an emergency textbook in preparation called "The 5 Minute Emergency Medicine Consult." He also serves as a reviewer for the Journal of Emergency Medicine, and is involved in co-authoring a book with Dr. Peter Rosen on orthopedic skills in emergency medicine. In 1997-1998, Dr. Davis was singled out as the most outstanding housestaff officer of the year at UCSD Medical Center, an award that had never before been given to an emergency medicine resident.
Stephen R. Hayden, MD, Co-Director of the UCSD Medical Center Emergency Medicine Residency, offered these comments about Dr. Davis in his nomination letter:
"The mark of a true academician is excellence in all of the major academic pursuits, research, writing, lecturing, education, and administration. (Dr. Davis) has contributed significantly in each of these major areas. He has been incredibly productive and engaged in significant research in emergency medicine throughout his residency. He is a stellar educator."
"I could go on for several more pages detailing the accomplishments of this future superstar. I can honestly say I have never had the privilege of working with a more deserving individual of the CORD Academic Achievement Award. His academic and administrative accomplishments are of a level that a faculty member would be proud. (He) has elevated the educational experience of all the residents significantly. He is an outstanding educator, and administrator, incredibly productive as a resident investigator and is engaged in a degree of scholarly activity few residents ever achieve. He is truly the finest resident I have ever worked with. He has set a standard as chief resident that will be nearly impossible to equal, but simultaneously he inspires others to excellence. I assure you, you will find no resident more deserving or that has as bright a future in academic emergency medicine."
CORD will present the Resident Academic Achievement Award to Dr. Davis in Boston on May 21 during a special lunch and awards presentation from 12:30-1:30 pm in Salon F of the Boston Marriott Copley Place.
Call for Committee Members!
Incoming CORD President, Sam Keim, MD, invites CORD members to contact the CORD office at cord@cordem.org to express interest in serving on either of the following committees:
Program Committee - Members are needed to volunteer to serve on the Program Committee, which, with the Board's approval, develops the educational program for the CORD meetings that are held each spring at the SAEM Annual Meeting and each fall at the ACEP Scientific Assembly. If interested, please provide a brief statement regarding your interest and experience in serving on the Program Committee.
Technology Committee - Kevin Rodgers, MD, has been appointed chair of the Technology Committee that has been formed to educate members about existing technologies that will help with administration and the education of residents. If interested, please provide a brief statement regarding your interest and experience in serving on the Technology Committee. Plans include a meeting of the Technology Committee in Boston. All CORD members are invited to attend.
New Program Approved by RRC-EM
During the February meeting of the Residency Review Committee for Emergency Medicine, one new program was approved. This brings the number of approved programs to 122. CORD offers its congratuations!
Medical College of Virginia
Timothy Evans, MD
Program Director, Emergency Medicine
Medical College of Virginia
401 North 12th Street
P.O. Box 980401
Richmond, VA 23298-0401
Telephone: 804-628-0392
Fax: 804-828-4686
This is a 1,2,3 program and has been approved for 10 residents per year.
Report from the AAMC
The spring meeting of the AAMC was held March 25 - 28 in Vancouver, BC. There were several issues of particular interest to residency directors in emergency medicine. Perhaps the most concerning are three proposals of the Federation of State Medical Licensing Boards (FSMLB). They propose: 1) no student can enter graduate training until successful completion of both parts one and two of the USMLE. 2) That program directors in all specialties report to the state medical board yearly every disciplinary and remedial action concerning that program's residents. 3) That no resident will be eligible for licensure until completion of three years of postgraduate training.
The AAMC does not support these proposals and is well aware of the problems each raises. Dr. Jordan Cohen, president of the AAMC, says the most likely to pass is the third proposal which would delay the licensing of residents. He does feel a compromise at 2 years of postgraduate training for a limited license is a possibility. This is in the face of an average debt of medical students which has increased to $80,000. We know that students going into emergency medicine have among the highest debt loads of any specialty.
To make matters worse, there is decreasing sympathy for government funding of postgraduate medical education at all. Congress has appointed a task force to review all aspects of Medicare funding including reimbursement for Graduate Medical Education. The chairman is not sympathetic for such funding, reasoning that the government does not pay to train any other professions and physicians go on to become some of the wealthiest members of our society. Their report is due Aug 15, 1999.
The other issue of major importance to program directors is the Accreditation Council for Graduate Medical Education's (ACGME) intent to hold institutions more responsible for education of residents and depend less on the individual programs. The changes in the institutional requirements reflect this and we can expect more mandated oversight of our programs by local graduate education committees. One outcome from this is a core curriculum for all residents in all specialties. The AAMC has endorsed this and unveiled a draft copy of the AAMC Graduate Medical Education Core Curriculum Project stating "The institutional sponsor of every residency training program is responsible for assuring that these generic learning goals have been satisfied for all of its trainees." The areas they have chosen to include in this first draft include: Ethics, Scholarship and Life-long Learning, Physician as Teacher and Communicator, Personal and Professional Development and Medical Practice Issues. There are three to six learning goals under each of these areas. Currently there is no implementation timeline or even any ideas how such material will be covered for all the residents in an institution. Resident representatives had input into this document and apparently endorsed the idea. They did mention some concerns regarding the time such a curriculum would take from already full specialty curriculums. I have a copy of the draft document or one can be obtained from alruffin @aamc.org.
The AAMC has supported four goals for graduate medical education: 1) Learning objectives for all components of GME 2) Institutional accountability 3) Clinical service re-design (how this was to be done was not specified but increased use of physician extenders to free residents for more education activities seems to be the major theme) 4) Professionalism (this was the theme of the whole meeting and while interesting, nothing concrete came of it). This has come under the label of "putting the E back in GME."
Two web based programs the AAMC has undertaken, in conjunction with the AMA, specifically for medical students are: 1) MEDCAREERS: a tutorial to help choose a specialty and 2) MD2: a program to help students plan debt management. Neither one is available on the AAMC's web site to date. Both appear to be promising resources for the medical students we counsel.
The most important looming issues facing academic medicine (from the AAMC perspective) will be familiar to most of us. Roughly prioritized they are: 1) Fraud and Abuse - particularly compliance with mandated documentation and faculty involvement in patient care 2) Faculty Productivity / Accountability - there was much discussion on how to value and account for educational efforts of faculty, with little resolution 3) Racial / Ethnic Diversity Among Faculty - the AAMC is sponsoring "Project 3000 by 2000" to increase the enrollment of minorities in medical schools. Part of this initiative is to increase faculty role models for this group 4) Scholarship in the Electronic Age - how physicians conduct and communicate research as well as methods for lifelong learning.
Hal Thomas, MD
CORD representative to AAMC
Technology Corner: Using Endnote to Automate Manuscript Preparation
William H. Cordell, MD
Copyrighted 1999 by William H. Cordell, MD
Researchers, educators, and clinicians should embrace a genre of computer programs called "bibliographic databases," "reference databases," or "bibliography makers." These programs help import, manage, and store bibliographic information as well as automate the insertion and formatting of citations in manuscripts.
Over the past decade, I have used several bibliographic databases. I finally gravitated to EndNote because I found it easier to use and, perhaps more importantly, easier to teach. That being said, I also recognize that other clinicians and researchers may prefer other bibliographic databases such as ProCite (Research Information Systems; www.risinc.com) over EndNote. These products tend to match each other features as each new generation of software attempts to "catch up" or even "leap frog" the competition. However, because I am now most familiar with EndNote, I will confine my remarks to that product. Please note I have no financial interest whatsoever in the company that makes this product.
EndNote (Niles Software Inc., Berkeley, CA; www.niles.com) is bibliographic software that integrates reference database management, bibliography-making functions, and online searching. EndNote is available in a Windows version and (for those of you who disdain the Microsoft hegemony) a Macintosh version. The street price for EndNote is around $170 (far less than a half-year?s supply of Prilosec) and $99 for students.
Perhaps the most important timesaving use of EndNote is inserting and formatting citations during manuscript preparation. EndNote works with (and from within) several word processing programs including Microsoft Word, WordPerfect, and Ami Pro to insert and format reference citations in manuscripts. This is particular important, since many medical journals forbid the use of Microsoft Word's Insert-Footnote command to insert a footnote (more correctly termed an endnote). The reason for this has to do with how journal articles are published. When authors submit their manuscripts on disks to the journals, the file is sent to the publisher where it is converted to a desktop publishing file, and printed. When Word inserts a footnote or endnote, it inserts hidden commands that disrupt the translation to desktop publishing.
There is an even more compelling (and less apparent) reason to use EndNote for inserting citations. By using EndNote to retrieve and store Medline (and other electronic database) searches, authors can almost completely rid their manuscripts of citational errors. A 1993 study by Goldberg et al1 reported that major and minor citational errors were found in 10.3% and 17.2% of reference listings, respectively. They defined a "citational error" as any error that occurred in identifying a reference in the bibliography. Major errors involved incorrect listing of the journal, year, volume, or author while minor errors included incorrect listing of pages or inaccurate spelling of the title. Such errors in the listing of references of the bibliography may impede the retrieval of a reference. Goldberg et al noted that computerized databases "have an extremely low tolerance for misspellings, incorrect years, or volume numbers."
How do citational errors occur? I have watched many a student and physician sit at their computer in the library or office, conduct a Medline search, and then print off paper copies of dozens of references (resulting in a stack of paper I call ?the Dead Sea Scrolls.?) This cumbersome, inefficient habit wastes time and increases the potential for minor citation errors when the paper-based references are keyed into the manuscript. Fortunately, EndNote affords a better means for automating manuscript preparation.
Instead of printing out references from searches, always store searches to disk, then import them into EndNote. This saves time and trees and helps ensure that references are properly cited. (The reference goes straight from Medline to your manuscript.) Furthermore always cite as you write instead of waiting until 6 months have passed to figure out the source of reference or quote in the manuscript. Many projects languish in the manuscript phase and trying to figure out which reference goes where is one cause of delay or manuscript death.
To illustrate these uses of EndNote, let me describe the steps for inserting the citation for the Goldberg et al article referenced earlier:
And if this all sounds a little mysterious, don't worry. We'll discuss the cool* timesaving features of EndNote in more detail in future installments. For example, EndNote has the capability of searching many databases including Medline and the Library of Congress from within the program. This obviates having to save and import a search (though the EndNote search capabilities are nowhere near as elegant as the Ovid search engine). In a future issue, we'll detail how to conduct quick searches from within EndNote as well as import Ovid searches.
*Following one of my lectures, one person expressed offense at my use of the word "cool." I use "cool" here only in its most scholarly and rigorous sense. (By the way, this is a footnote. What goes at the end of a manuscript in the References section is an endnote.)
References
1. Goldberg R, Newton E, Cameron J, et al. Reference accuracy in the emergency medicine literature. Ann Emerg Med 1993; 22:1450-4.
Don't Forget the CPC Competition!
The 1999 CPC Competition will be held in Boston on Wednesday, May 19 at the Boston Marriott Copley Place. The five simultaneous sessions will each include the presentation and discussion of ten cases, starting at 8:00 am and ending at 4:30 pm. There is no charge to attend and CME credit is offered, so be sure to stop by and support the residency programs participating in this year's competition. The CPC Reception will be held on the evening of May 19, where the Best Discussants and Best Presenters will be announced. Be sure to attend.I Was Wondering . . .
Larry Sulton, PhD, will be answering questions as a regular column in the CORD Newsletter. CORD members are asked to submit questions to Dr. Sulton at em@acgme.org.
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