Society for Academic Emergency Medicine
INTEREST GROUP FOR EVIDENCE-BASED MEDICINE
Interim Meeting ACEP Scientific Assembly, Las Vegas
Peter Wyer, October 10, 1999 5-6:30 PM

Present:

John Allegra, Kathleen Brown, C James Corrall, William Cordell, Stephen
Emond, Gloria Kuhn, Elliot Rodriguez, Brian Rowe, Peter Wyer

Discussion:

Ongoing projects

Expanded EBM Workshops

Peter Wyer reported in the absence of Steve Hayden, who will submit a
summary of a survey conducted through CORD on the preferences of potential
participants for the timing and location of multiple day EBM workshops. The
survey showed divided preferences, with some preferring that such workshops
be scheduled in direct conjunction with national meetings (ACEP/SAEM) and
others preferring they be entirely separate.

IG members present at the interim meeting felt that the
national-meeting-adjunct option for expanded workshops is problematical for
two reasons. Firstly, the feeling was that taking an extra 3-5 days off in
direct conjunction with the national meeting would be unfeasible for many
prospective participants. Secondly, the availability of a computer lab with
the appropriate databases and facilitators would be a formidable obstacle in
a constantly changing venue not inherently equipped for EBM teaching
purposes.

Candidate venues for possible independent (of national meetings) workshops
were mentioned:

New York Academy of Medicine
- Advantages: Library, Computer lab, all relevant resources, EBM trained
librarians
- Disadvantages: High cost of living, hotel expenses; availability of
meeting rooms, other resources would have to be negotiated with NYAM

U Alberta, Edmonton
- Advantages: Informatics center, Low cost of living
- Disadvantages: Availability of adequate meetings rooms and other logistics
would have to be explored

It was pointed out that ACEP sponsors 3 day workshops in ultrasound that are
independent of the annual meeting. Kathy Brown (brownkm@mailbox.hscsyr.edu)
observed that she is on the ACEP program Committee and agreed to explore the
possibility of ACEP sponsorship for an analogous EBM workshop. It is likely
that multiple sources of funding would be necessary.

Big CAT Review Protocol

A preliminary report from Peter Dayan (dayanpe@cpmc3.cpmc.columbia.edu) on
this project was distributed in absentia. This will be distributed
independently through the listserv. Joe Kahn (jkahn@bu.edu) has agreed to
share responsibility for this initiative.

Field Effort for Systematic Reviews

Brian Rowe (brian.rowe@ualberta.ca) reported on the progress to date of
this initiative. Information gleaned from a recent successful effort to
establish a field effort within the Cochrane Collaboration indicates:

? It takes a sustained effort, extending over several years to establish a
field.
? Specialty societies (such as SAEM) may play an important facilitating
role.
? Liaisons with the Collaboration also play an important role.
? International representation is important.

Emergency medicine qualifies as a field by current criteria within the
Collaboration. Although several Collaborative Review Groups currently
address topic areas of interest to emergency medicine, EM encompasses a very
broad range of primary and specialty practice areas and is therefore not
adequately addressed by the review groups that exist. The activities of a
field, as will be elaborated by Brian in subsequent communications, include
organized hand searching of appropriate literature, identification of key
areas where systematic reviews are necessary, coordinating with the Review
Groups in this regard, recruiting qualified individuals to lead important
reviews and fundraising to support such reviews.

Brian identified the limiting factor at this point as establishing a
preliminary positive liaison with the Cochrane leadership. It was agreed by
the attendees of the interim meeting that, if Brian is successful in the
next few weeks in the latter endeavor, then it would be appropriate to
consider defining the Interest Group meeting at the 2000 SAEM annual meeting
in May as an "exploratory meeting" for the establishment of an EM field.

COMMENT FROM THE CHAIR: This initiative, if successful, would have
significant and lasting impact on the specialty and on its relationship to
the house of medicine. Although its pursuit would require a major effort and
also a substantial expansion of the current ranks of the Interest Group, its
achievement would be momentous. I wholeheartedly support this endeavor.







New Initiatives

Survey of Cochrane Database of Systematic Reviews for EM Relevant Reviews

Brian Rowe suggested that an important piece of information pertaining to
the Cochrane Field perspective would be a survey of current CDSR entries for
items of relevance to EM. Volume 3, 1999 of the Cochrane Library lists 628
completed reviews and 593 protocols. Both of these components of the CDSR
should be surveyed. Subsequently to the survey, a quarterly update could be
supplied, following the quarterly updates of the CL. Bill Cordell suggested
that this would fit the "Links" sub-component of the Annals of Emergency
Medicine's "Updates, Feedback and Links" EBEM section.

Steve Emond (semond1@idt.net) offered to lead this. I would think that Brian
should also be involved as well as Bill and myself as the Annals section
editors.

Brian will shortly issue a further recommendation in this regard.

EBM Workbook for On-site and Workshop Teaching

Bill Cordell outlined his idea for designing a workbook for EBM instruction
to be made available to individuals and programs. He suggested the syllabus
that has been used for the last several workshops that he and Steve Hayden
have led at ACEP and SAEM might serve as a model. Two approaches would be a
book made available for a price by SAEM or an on-line book that could be
downloaded. Peter Wyer agreed to determine whether either or both of these
options are feasible through SAEM and what the process would be.

Peter Wyer suggested that the current set of modules being used for the EM
track at the McMaster workshop would also be relevant to this initiative,
and pointed out that McMaster has always been very liberal in supporting use
of the Workshop materials in other venues. It was also suggested that
components beyond the purely didactic be considered, including emphasis upon
access to relevant materials at the bedside, office and home and issues of
implementation and evaluations. As such, several Workgroups of the Interest
Group might be involved in this project.

Needs Assessment Survey of EM Programs

Peter Wyer reported that EM participants in a focus group conducted in the
course of a recent 3 day EBM workshop at the New York Academy of Medicine
felt that an appropriate statement concerning the importance of on-line
access in emergency treatment areas would enhance their ability to secure
such access. Several programs represented by the 16 participants do NOT
currently have such access.

Several attendees of the interim meeting questioned whether this is a
sufficiently widespread problem to justify such an intervention. It was
agreed to try to arrange for an impromptu poll of the attendees of the CORD
meeting on this question.

At the same time it was suggested that a more systematic poll of EM
programs, covering a number of areas of potential need with respect to EBM
teaching and practice, would be appropriate for the Interest Group to
undertake. Such a survey might include areas such as the need of EM programs
for curriculum materials for EBM teaching. Gloria Kuhn agreed to lead the
development of a "needs assessment" questionnaire. A committee was formed
for this purpose:

Gloria Kuhn (Chair) (gjkuhndo@aol.com)
Elliot Rodriguez (Rodrigue@mailbox.hscsyr.edu)
Bill Cordell (WCordell@clarian.com)

Survey of EM Residents During ABEM In-Service Exam

Overlapping the preceding initiative, Carey Chisholm
(CChisholm@clarian.com), our representative to the SAEM Board, in a
discussion immediately following the Interim Meeting, suggested that we
consider a parallel survey of EM residents. Such surveys are done every year
in the context of the ABEM in-service examination and are published in Acad
Emerg Med. Two surveys done in this fashion appear in the October issue of
this journal (6:1036-1043; 6:1044-1049). The process here requires approval
by the SAEM Board. The survey questions and a description of the purpose and
rationale of the survey must be in the hands of the Board by December 1,
1999. The questionnaire should have a focus commensurate with a publishable
survey. It might be directed at resident awareness of and perceived need
for EBM in the core curriculum, for example.
I would suggest that Gloria's group take this on, if they are up to it, as
an adjunct to the above effort. I would also suggest that Barney Eskin
(phdmd@prodigy.net) be involved, since he has been working on evaluations of
EBM teaching and has developed several questionnaires/"exams" in this
regard. I would request to be involved as well, as chair of the Interest
Group.