"Sink or Swim"-A National Qualitative Study Examining Negotiation Experiences of Early-Career Emergency Medicine Researchers.

Career development awards for new investigators from foundations, specialty societies, the National Institutes of Health (NIH), and other organizations have been considered critical to developing independent researchers. These grants provide awardees salary support (thus protected time) for research training and supervised research and ensure that they receive mentorship from accomplished researchers. This experience then provides the foundation for awardees to successfully compete for larger research grants (such as NIH R awards) and achieve research independence as recognized experts in their fields. The NIH and Agency for Healthcare Research and Quality (AHRQ) support this model and fund a career development award (K award) portfolio that has awarded over $8 billion since 1957.1 In the early 1990s, the Society for Academic Emergency Medicine (SAEM) sought to reduce the challenges faced by emergency physician-scientists who aim to become independent researchers and to advance the science of emergency medicine (EM).2 SAEM funded several training grants and specifically established the Research Training Grant (1998) and the Institutional Research Training Grant (2002) as the flagship opportunities. Now funded by the SAEM Foundation, these grants are thought to be important initial opportunities for new investigators who desire to successfully compete for NIH and AHRQ K awards. However, the evidence for the value of these awards has been limited to a description of the trajectory of SAEM grant recipients.3 The Society had intended for the SAEM grants to prepare EM researchers to apply for K awards, just as the K awards prepare researchers to compete for and receive NIH independent research grants (R01).1 Assessing the value of research grants is critical for multiple reasons. First, individuals who contribute to the organizations that fund the SAEM Foundation's awards want to know that their donations are being invested efficiently and effectively with a high “return on investment.” This return is commonly measured by assessing researchers’ success at publishing their findings and securing additional research funds. Second, information related to the value of the awards can guide organizations such as SAEM to revise funding mechanisms, invest additional resources, or create new funding mechanisms to meet their missions. Third, department chairpersons pay a significant share of the costs for each of their faculty members who receive an SAEM research award, often in excess of $100,000 per year. To make this investment, the chairperson needs to be confident that the award will improve the likelihood of that faculty member developing into an independent researcher, with additional grant funding and publications. In this issue of Academic Emergency Medicine, Dr. Safdar and collegues,4 on behalf of the SAEM Grants Committee, have built on previous work and they compare individuals who received and who did not receive SAEM Research Training Grant and Institutional Research Training Grant awards. They found that SAEM training grant recipients were more successful in obtaining federal funding and received greater monetary awards than those who did not receive the SAEM awards. Both recipients and nonrecipients have similar numbers of publications after their awards. This study has important limitations, which include only using NIH RePORTER to capture postaward funding, not measuring manuscript quality and having only a small number of grant recipients and nonrecipients. Despite these limitations the study has two key implications. First, donations to support research at SAEM have significant value in developing federally funded EM researchers, congruent with the goal of improving the disproportionately low level of NIH funding to EM. Thus, when individuals are considering the targets for their charitable giving, they should strongly consider supporting the SAEM Foundation research grants. Second, SAEM should use these findings, in conjunction with the funding environment, to consider the makeup of its grant portfolio. After the doubling of the NIH budget between 1998 and 2003, a so-called “euphoria” period, the research community has experienced the “hangover” and now is experiencing the effect of a net decline in funding.5 These funding realities are reflected in the number of active NIH K awards each year, with only 346 K08 awards and 555 K23 awards being active in 2013. This was the lowest combined total since 2000, the second year of the K23's existence.6 To successfully compete for federal research funding in this environment, it is even more important to ensure that EM researchers are prepared. As the Research Training Grants have been considered a first step in obtaining an NIH Career Development Award (K08 or K23), these preliminary awards are even more important in this difficult funding environment to ensure that EM applicants for NIH K awards are highly competitive. Thus, increasing the number of training grants will strengthen the pipeline of emergency care researchers and support SAEM's mission of leading the advancement of emergency care through research.7 Emergency medicine research has come a long way since the Future of Emergency Medicine Research Conference in 1997. Because SAEM has invested in training grants to build the pool of active researchers, EM research has grown significantly.2 Nevertheless, a shortage of adequately trained investigators still exists.8 Continued support of the career development awards is necessary to sustain the momentum. We now have evidence to justify that support.

NIH Launches Emergency Care Research Office: Coordinating Center Lauded but Challenges Noted

We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilitators and barriers for Canadian emergency medicine researchers, and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity. We performed a systematic review of MEDLINE and Embase using search terms relevant to emergency medicine research fellowship/graduate training. We conducted an email survey of all Canadian emergency physician researchers. The Society for Academic Emergency Medicine (SAEM) research fellowship program was analysed, and other similar international programs were sought. An expert panel reviewed these data and presented recommendations at the Canadian Association of Emergency Physicians (CAEP) 2014 Academic Symposium. We refined our recommendations based on feedback received. Of 1,246 potentially relevant citations, we included 10 articles. We identified five key themes: 1) creating training opportunities; 2) ensuring adequate protected time; 3) salary support; 4) infrastructure; and 5) mentorship. Our survey achieved a 72% (67/93) response rate. From these responses, 42 (63%) consider themselves clinical researchers (i.e., spend a significant proportion of their career conducting research). The single largest constraint to conducting research was funding. Factors felt to be positive contributors to a clinical research career included salary support, research training (including an advanced graduate degree), mentorship, and infrastructure. The SAEM research fellowship was the only emergency medicine research fellowship program identified. This 2-year program requires approval of both the teaching centre and each applying fellow. This program requires training in 15 core competencies, manuscript preparation, and submission of a large grant to a national peer-review funding organization. We recommend that the CAEP Academic Section create a process to endorse research fellowship/graduate training programs. These programs should include two phases: Phase I: Research fellowship/graduate training would include an advanced research university degree and 15 core learning areas. Phase II: research consolidation involves a further 1-3 years with an emphasis on mentorship and scholarship production. It is anticipated that clinician scientists completing Phase I and Phase II training at a CAEP Academic Section-endorsed site(s) will be independent researchers with a higher likelihood of securing external peer-reviewed funding and be able to have a meaningful external impact in emergency medicine research.

Community Consultation for Emergency Exception to Informed Consent: How Much is Enough?

All academic medical specialties have the obligation to continuously create new knowledge that will improve patient care and outcomes. Emergency medicine (EM) is no exception. Since its origins over 50years ago, EM has struggled to fulfill its research mission. EM ranks last among clinical specialties in the percentage of medical school faculty who are National Institutes of Health (NIH)-funded principal investigators (PIs; 1.7%) and the percentage of medical school departments with NIH-funded PIs (33%). Although there has been a steady increase in the number of NIH-funded projects and total NIH dollars, the slowing growth in the number of NIH-funded PIs and lack of growth in the number of EM departments with NIH-funded PIs is cause for concern. In response, the Association of Academic Chairs of Emergency Medicine (AACEM) Research Task Force proposes a set of 2030strategic goals for the EM research enterprise that are based on sustaining historic growth rates in NIH funding. These goals have been endorsed by the AACEM Executive Committee and the boards of Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), and American Academy of Emergency Medicine (AAEM). The 2030strategic goals include 200NIH-funded projects led by 150 EM PIs in at least 50 EM departments with over $100M in annual funding resulting in over 3% of EM faculty being NIH-funded PIs. Achieving these goals will require a targeted series of focused strategies to increase the number of EM faculty who are competitive for NIH funding. This requires a coordinated, intentional effort with investments at the national, departmental, and individual levels. These efforts are ideally led by medical school department chairs, who can create the culture and provide the resources needed to be successful. The specialty of EM has the obligation to improve the health of the public and to fulfill its research mission.

Citation characteristics of research published in emergency medicine versus other scientific journals

Much of emergency medicine care and quality standards are rooted in evidence-based guidelines. The Society for Academic Emergency Medicine (SAEM) and the journal Academic Emergency Medicine through publications, conferences, and various initiatives have encouraged the emergency medicine community to create and disseminate evidence-based guidelines. New and updated guidelines must also be implemented into practice. Increasing numbers of publications in this journal and elsewhere are shining light on how the theories and frameworks of implementation science can increase the uptake, reach, and sustainability of evidence-based guidelines in emergency medicine.

The Clinical and Translational Science Awards (CTSA) represent a major new funding pathway for health science investigators seeking National Institutes of Health (NIH) funds. This new pathway provides institutional-level support for clinical and translational research and is not tied to one organ system or disease process, fitting well with emergency medicine (EM) research needs. These awards open unique opportunities for advancing EM research. The CTSA mechanism provides institutional support from the NIH to promote both clinical and translational science. Of the 60 expected awards, 38 sites are currently funded. EM investigators can benefit the institutions applying for these awards and simultaneously gain from involvement. Some opportunities for participation provided by the CTSA include research training programs, joining multidisciplinary research teams, seed grant funding, and use of the CTSA-developed research infrastructure. Involvement of EM can benefit institutions by enhancing acute care research collaboration both within and among institutions. Emergency medicine researchers at institutions either planning to submit a CTSA application or with funded CTSA grants are encouraged to become actively involved in CTSA-related research programs.

Toward Emergency Department Preparedness: One Step at a Time

The Society for Academic Emergency Medicine (SAEM) annual meeting is the primary research conference in emergency medicine. An abstract presented at the 2000 SAEM meeting found a trend of decreasing publication rates of articles based on SAEM abstracts from 47% in 1995 to 33% in 1997. The authors wished to determine whether the publication rates of articles based on SAEM abstracts continued to decline since 1997. A MEDLINE search of all SAEM abstracts from 1997 and 1999-2001 was conducted. The primary outcome was the publication rates of articles based on abstracts presented each year. Secondary outcomes included comparison of publication rates by oral versus poster presentation and category of research. Thirty-eight percent of 2,054 SAEM abstracts were published as articles by fall 2003, with 40% in 1997, 40% in 1999, 38% in 2000, and 35% in 2001. The publication rate was higher for oral presentations (50%) than poster presentations (34%). Publication rates ranged from 32% to 53% by category of research; the highest rates were in wound (53%) and cardiopulmonary resuscitation/resuscitation (51%), and the lowest rates were in administration (32%) and cardiovascular (33%). Twenty-six percent of articles were published in emergency medicine journals. The times to publication were similar across the years: 4%-7% were published in the same year of the meeting, 15%-17% one year later, 10%-11% two years later, 5% three years later, and 3%-5% after three years. The publication rate of articles based on SAEM abstracts has held steady at 40% in recent years when the time delay to publication is taken into account.

The objective was to describe the common educational goals, curricular elements, and methods of evaluation used in international emergency medicine (IEM) fellowship training programs currently. IEM fellowship programs have been developed to provide formal training for emergency physicians (EPs) interested in pursuing careers in IEM. Those fellowships are variable in scope, objectives, and duration. Previously published articles have suggested a general curriculum structure for IEM fellowships. A search of MEDLINE, EMBASE, and CINAHL databases from 1950 to June 2008 was performed, combining the terms international, emergency medicine, and fellowship. Online curricula and descriptive materials from IEM fellowships listed by the Society for Academic Emergency Medicine (SAEM) were reviewed. Knowledge and skill areas common to multiple programs were organized in discrete categories. IEM fellowship directors were contacted for input and feedback. Eight articles on IEM fellowships were identified. Two articles described a general structure for fellowship curriculum. Sixteen of 20 IEM fellowship programs had descriptive materials posted online. These information sources, plus input from seven fellowship program directors, yielded the following seven discrete knowledge and skill areas: 1) emergency medicine systems development, 2) humanitarian relief, 3) disaster management, 4) public health, 5) travel and field medicine, 6) program administration, and 7) academic skills. While IEM fellowships vary with regard to objectives and structure, this article presents an overview of the current focus of IEM fellowship training curricula that could serve as a resource for IEM curriculum development at individual institutions.

Many medical students are excited about emergency medicine (EM) following a standard clerkship and seek out additional learning opportunities. An advanced EM elective may accomplish several educational goals, including development of clinical skills in evaluating the undifferentiated patient, broader exploration of the field of EM, and more focused study of one particular aspect of EM. Previously cited examples include pediatric EM, medical toxicology, occupational medicine, sports medicine, and EM research. Numerous other EM specialty courses for senior medical students are emerging, as reflected in the “Undergraduate Rotations” listings on the Society for Academic Emergency Medicine. A few examples drawn from the list include emergency ultrasound, international EM, wilderness medicine, disaster medicine, geriatric EM, and hyperbaric medicine. Educators aspiring to develop, or in the process of developing, an advanced EM elective may benefit from a brief overview of necessary course considerations, including didactic format, the clinical role of the medical student in the emergency department, and involvement with patient procedures. Suggestions are made regarding additional educational opportunities, including follow‐up of patients seen in the emergency department and development of an emergency department radiology case file. This article also addresses several related concerns, including suggested prerequisites, administration and cost considerations, appropriate didactic topics, and methods for evaluating students. Several EM subspecialty areas, namely pediatric EM, medical toxicology, and out‐of‐hospital care, are specifically discussed. Formal advanced cardiac life support training is also often included in an advanced EM elective and is briefly discussed. The overall intent of this article is to provide medical student educators with resources and ideas to assist them in developing a unique advanced EM elective.

The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefit survey for all 1995 Residency Review Committee in Emergency Medicine (RRC-EM)-accredited programs using the SAEM third-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. Seventy-six of 112 (68%) accredited programs responded, yielding data for 1,032 full-time faculty among the four Association of American Medical Colleges (AAMC) regions. Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by 115 separate criteria such as program regions, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to AAMC. Demographic data from 132 categories were analyzed and included number of staff and residents per shift, number of intensive care unit (ICU) beds, obstacles to hiring new staff, and specific type and value of fringe benefits offered. Data were compared with those from the 1990 and 1992 SAEM and the 1995-96 AAMC studies. Mean salaries were reported as follows: all faculty, $158,100; first-year faculty, $131,074; programs reporting data to AAMC, $152,198; programs not reporting data to AAMC, $169,251. Mean salaries as reported by AAMC region: northeast, $155,909; south, $155,403; midwest, $172,260; west, $139,930. Mean salaries as reported by program financial source: community, $175,599; university, $152,878; municipal, $141,566. Reported salaries for full-time EM residency faculty continue to rise. Salaries in programs reporting data to the AAMC are considerably lower than those not reporting. The gap between ABEM-certified and non-ABEM-certified faculty continues to widen. Residency-trained faculty are now shown to earn more than non-residency-trained faculty. Significant regional differences in salaries have been present in all three SAEM surveys.

The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefits survey for all 2001 residency review committee (RRC)-EM-accredited programs using the SAEM fifth-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. Data represent compensation paid for the 2001-02 academic year. Seventy-six of 124 (61%) accredited programs responded, yielding usable data on 1,355 full-time faculty representing all four Association of American Medical Colleges (AAMC) regions. Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by criteria such as program region, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to the AAMC. Demographic data were analyzed with regard to numerous criteria, including department staffing levels, emergency department (ED) volumes, ED length of stay, department income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with those from previous SAEM studies. Mean salaries were reported as follows: all faculty, $180,913; first-year faculty, $147,746; programs reporting data to the AAMC, $174,354; programs not reporting data to the AAMC, $191,397. Mean salaries as reported by AAMC region: northeast, $178,593; south, $176,314; midwest, $200,095; west, $166,779. Full-time emergency medicine residency program faculty work an average of 1,129 clinical hours per year. Reported salaries for full-time EM residency faculty have risen approximately 8.7% since the last survey. Up to approximately 1,200 clinical hours worked per year, salary varies inversely with clinical hours worked. Total per-faculty patient contact time (overall workload) has grown approximately 13% since the last survey. Patient wait times have increased approximately 27% since the last survey. Significant regional differences in salaries have been present in all five SAEM surveys. Emergency medicine residency faculty continue to work at the upper extremes of patient encounters per physician, patient acuity levels, and department lengths of stay.

Academic Emergency MedicineVolume 3, Issue 11 p. 1065-1076 Free Access Physician-Patient Communication in the Emergency Department, Part 1 Robert Knopp MD, Corresponding Author Robert Knopp MD Chair Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this authorSteve Rosenzweig MD, Corresponding Author Steve Rosenzweig MD Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this authorEdward Bernstein MD, Corresponding Author Edward Bernstein MD Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this authorVicken Totten MD, Corresponding Author Vicken Totten MD Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this author Robert Knopp MD, Corresponding Author Robert Knopp MD Chair Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this authorSteve Rosenzweig MD, Corresponding Author Steve Rosenzweig MD Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this authorEdward Bernstein MD, Corresponding Author Edward Bernstein MD Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this authorVicken Totten MD, Corresponding Author Vicken Totten MD Society for Academic Emergency Medicine, Lansing, MI, Task Force on Physician-Patient Communication 2HealthPartners, Ramsey Emergency Center, 640 Jackson Street, St. Paul, MN 55101–2595. Fax: 612–221–8756; e-mail: [email protected] *Society for Academic Emergency Medicine, 901 North Washington Avenue, Lansing, MI 48906–5137. Fax: 517–485–0801; e-mail: [email protected]Search for more papers by this author First published: November 1996 https://doi.org/10.1111/j.1553-2712.1996.tb03357.xCitations: 44AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume3, Issue11November 1996Pages 1065-1076 RelatedInformation