Society for Academic Emergency Medicine
EVIDENCE-BASED EMERGENCY MEDICINE INTEREST GROUP
Minutes of Annual Meeting and Annual Report

MINUTES OF THE ANNUAL MEETING, MAY 22, 2000, San Francisco

ATTENDANCE

Registered Members*
Jeff Bazarian, Robert Bilkovski, Charles Brown, Michael Brown, Phil Clement, William Cordell, C. James Corrall, Carey Chisholm, Christopher Decker, Steve Hayden, Gloria Kuhn, Scott Polsky, Kevin Rogers, Brian Rowe, Nicola Shiebel, Peter Wyer

Non Registered Members*
John Allegra, Theodore Christopher, Stephen Emond, Thomas Lee, Jamie Syrett, Daniel Worman

Program Committee Liaison
Len Friedland

*Cf below under "Membership"

SUMMARY


Peter Wyer was re-elected chairman of the Interest Group (IG) for the coming year. The preliminary results of the survey of EM program directors were distributed and reviewed. The lack of faculty interest and training and of monetary and time resources were all identified as limiting to incorporation of EBM in the curricula. Projects identified for the coming year include development of a proposal for EBM didactic presentations at the 2001 SAEM annual meeting and a project to abstract the tables of sensitivities, specificities and likelihood ratios for elements of history and physical from the JAMA Rational Clinical Exam series into an online and printed resource for use by EM programs. Committees were established for each of these projects.

DISCUSSION

General

Peter Wyer (PW) opened the meeting by inviting nominations for chair of the IG for the coming year. He pointed out that SAEM bylaws requires a rotation after not more than 3 years, and expressed his interest in continuing for the coming year. A motion for nomination of PW was introduced and seconded. There being no other nominations, the election of PW was unanimous.

Carey Chisholm, the IG's liaison to the SAEM BOD, was invited to make some opening comments. He emphasized the importance of preparing proposals for didactic presentations in time for the official mid-August deadline. The priority list for the BOD for the coming year is as yet unofficial, awaiting the formal process of succession of Brian Zink as the incoming president. Faculty development is likely to constitute one of the major areas of emphasis.

PW reviewed the evolution of the IG during its first year of existence: The initial perspective revolved around the concept that the expanded resources of the IG might make possible the development of projects and initiatives in the area of EBM and emergency medicine. This perspective was, to some extent, fruitful. Developments over the past year have pointed the way towards an agenda more dynamically related to the needs of EM programs in this area and with more direct relationship to the educational mission of SAEM. PW identified the survey of EM program directors, an effort initiated and spearheaded by Gloria Kuhn, as a 'turning point' initiative in this respect. It intersects a rapidly growing interest in the importance of EBM in GME programs within federal agencies. An inquiry fielded by the AHRQ to CORD and to analogous groups within other medical specialties seeks information regarding programs that have incorporated EBM teaching to various levels of explicitness into their curricula for the purpose of a 'case study project'. It is likely that federal funding for EBM curricula and faculty development will become available over the coming months and years. With the help of the survey results, the IG can play a key role in facilitating and enhancing the competitiveness of EM programs in this emerging arena.

Preliminary Results of Survey

Gloria Kuhn (GK) presented results of the first 31 respondents to the survey of PDs, noting that it could easily reflect a skewed sample. Answers reflect that computer phobia is not an issue and that the great majority of programs have Internet access in the treatment area. A number of responses, including to "yes/no" questions and to qualitative questions point to lack of faculty expertise as a perceived limiting factor in advancing EBM within the program.

Some discussion of elements of the survey ensued. Some IG members with significant experience in EBM teaching suggested that one survey question, the number of didactic hours per year dedicated to EBM within a program, might not constitute a good estimate of the importance or effectiveness of EBM emphasis within a program. PW and others agreed with this but suggested that the question is still a good marker for EBM activity for all but the most sophisticated programs. PW also pointed out that respondents from programs using modalities other than lectures for EBM teaching would likely have taken advantage of the qualitative comment options in the survey. To date, no such responses indicate a high level of EBM emphasis in the absence of significant didactic hour commitments.

The survey effort will involve multiple postings on the CORD listserv and phone calls to PDs as needed. Carey Chisholm agreed to reinforce the importance of the survey at the CORD meeting. Brian Rowe will assist in tabulating the results.

Didactic Proposals for 2001 Annual Meeting

Len Friedland (leonard.friedland@astrazeneca.com) announced himself as the liaison for the EBM IG to the SAEM Program Committee, and outlined the criteria to be used by the Committee to evaluate proposals. In particular, he emphasized that the proposal needs to be consistent with the organizational mission of SAEM and should emphasis content relevant to research and education rather than clinical practice. The deadline for submission of the proposal(s) is August 28.

PW proposed that the presentation revolve around the theme of faculty development for an EBM curriculum and should identify and address the areas of knowledge and competency required of designated EM faculty for such a curriculum to be implemented.

Steve Hayden (SH) agreed to chair a sub committee charged with formulating the didactic proposal(s) on behalf of the IG. Members of the IG appointed to the sub-committee at the meeting included:

-Steve Hayden (chair)
-Brian Rowe
-Bill Cordell
-Scott Polsky
-Gloria Kuhn
-Mike Brown
-Kevin Rogers

SH commented on format options, including the possibility of a one-day workshop either the day before or during the conference. Subject to budgetary approval, computer stations and other AV resources can be incorporated into the proposal.

Development of Educational Content and Resource Perspectives

Some discussion was had on modalities appropriate to realization of a faculty development and broader educational EBM agenda, once formulated. Modalities proposed included:

-Workshops
-Teleconferencing
-Web-based learning instruments
-On-Site workshops by mobile EBM teaching/tutorial teams

Some discussion was had regarding the appropriateness of a kind of 'certification' for faculty EBM training. Some participants opposed this from the standpoint that EBM learning and development of skills constitute a process that cannot be adequately 'certified' as the result of a discrete course experience. Bill Cordell (BC) proposed "point-of-care" as the strategic guide to a curriculum design. Closing the 'evidence transfer gap' at the point where decisions happen-the bedside. GK proposed that BC formulate his proposal as a strategy statement that can be used to guide the development of a curriculum plan. Differentiation of learner-specific goals and identification of existing EBM training options were also mentioned as important considerations.

Rational Clinical Exam Series

GK described a project to compile and disseminate tables of likelihood ratios, sensitivities and specificities for elements of clinical examination as part of an educational vehicle for teaching EBM at the EM bedside. The Rational Clinical Exam series initiated by DL Sackett in JAMA as well as the recently revised edition of "Diagnostic Strategies for Common Medical Problems" published by the ACP, are possible sources of such information. A formatted and categorized bibliography of the RCE series has already been done by GK and can be obtained on the EBEM.org website. GK proposed a project to abstract the relevant tables from the RCE series, compile them and make them available on-line and possibly as a printed compilation through SAEM.

A committee was formed for the purpose of pursuing this project. The following members volunteered to serve:

- Gloria Kuhn (chair)
- Robert Bilkovski
- Nicola Shiebel
- C.J. Corrall
- Chris Decker

GK agreed to formulate a proposal for the project with an emphasis on the educational utility of the concept.

NOTE FROM CHAIR: I had occasion to briefly and informally discuss the project with JAMA editor Drummond Rennie (DR) after the latter's powerful, provocative and egregiously under-attended Kennedy Lecture on ethical issues in peer-reviewed publication. DR pointed out that a systematic compilation and distribution of tables from the RCE series would not be allowable at this time because of a forth coming book version of the entire series now under way under DR's personal direction. It is therefore my recommendation that this project committee direct itself not to a systematic compilation but to an educational research design involving a relatively small number of excerpts from the series and that we also suspend plans to abstract and post tables from the series on either the internet or via a printed reprint until after the appearance of the RCE book, which should be in press by the end of the year. At that time, such a plan will again be feasible, subject to authorization from the publishers of the book. This project remains, in my view, an imminently viable one, provided that it is framed in an appropriate way.

IG Membership Report

PW reported that 55 SAEM members are currently registered as members of the EBM IG on SAEM records. Up to 20 further SAEM members consider themselves EBM IG members but are not currently so listed on SAEM records. PW commented that a systematic updating of IG chairs by SAEM staff regarding enrollment of their IGs has not always happened and has led to discrepancies, confusion and failure to keep current members up-to-date on IG initiatives and activities. PW noted that this gap appears to have closed in the last month. PW was further able to confirm with Mary Ann Schropp that the chair will receive regular updates on IG membership from here on out.

A full listing of SAEM registered EBM IG members, with current email addresses, is appended to these minutes.

On-Line Resources Available to the EBM IG

PW noted that the Website (www.EBEM.org) initiated by the Evidence-Based Emergency Medicine Working Group at the New York Academy of Medicine as well as a related listserv, is at the full disposal of the Interest Group efforts. The Webmaster of this site, Ben Yeh (yeh@flashcom.net), is a member of the Interest Group.

PW noted that the above mentioned listserv has served as the principal vehicle for electronic communications for the IG for the last year. A listserv created by SAEM would constitute another option. It was commented that inappropriate use of the listserv for interpersonal communications has sometimes been a problem. PW noted that participants patience might have been tried by the flurry of communications leading up to the meeting, since it became necessary to poll IG members twice for the purpose of establishing the meeting time. The EBEM listserv does not allow a 'reply to sender only' option; all replys by individuals go to the entire group. An alternative of having IG members individually set up email groups on their own systems was offered. PW pointed out that the advantages of a listserv include a systematic updating of email addresses, as well as adding participants. There appeared to be no major objection to continuing to use the EBEM listserv for this purpose.

PW noted that the EBEM site has also housed applications to facilitate IG projects, including password-protected postings of preliminary IG working drafts.

LIAISONS

Len Friedland will serve as the Interest Group's liaison to SAEM program committee
Carey Chisholm will continue to serve as the liaison to the SAEM Board of Directors

The meeting was adjourned at 12 noon.
P. Wyer, Chair 6/7/00



Appendix: Current listing of EBM IG members as registered with SAEM as of 5/18/00

SAEM Evidence Based Medicine Interest Group Members (As of 5/18/00)
Brien A. Barnewolt, MD
Carol Leah Barsky, MD
Jeffrey J. Bazarian, MD
Robert N. Bilkovski, MD
Paul A. Blackburn, DO
Charles K. Brown, MD
Michael D. Brown, MD
Vijai V. Chauhan, MD
Carey Chisholm, MD
Phillip A. Clement, III MD
Stephen A. Colucciello, MD
William H. Cordell, MD
Randolph J. Cordle
C. James Corrall, MD
Robert J. Cox, MD
Peter Dayan, MD
M. Christopher Decker, MD
Wyatt W. Decker, MD
Michelle Grant Ervin, MD MHPE
Barnet Eskin, MD PhD
V. Jane Findlater, MD
Gary M. Gaddis, MD PhD
Timothy G. Givens, MD
Michael S. Gonzalez, MD
Philip Hubel, MD
Luc Huyghens, MD PhD
Stephen Hayden, MD
Kaveh Ilkhanipour, MD E-mail Addresses ?
Richard S. Krause, MD
Gloria Kuhn, DO
Michael Lahn, MD
Eddy Lang, MD
John F. Mahoney, MD
Julia Martin, MD
Dan Mayer, MD
David L. Meyers, MD
Kathleen Ann Neacy, MD
S. Scott Polsky, MD
Michael S. Radeos, MD
Kevin G. Rodgers, MD
Elliot Rodriguez, MD
Brian H. Rowe, MD MSc
Nicola Schiebel, MD
Manish N. Shah, MD
Sid M. Shah, MD
Prem C. Shukla, MD
Mona M. Singh, MD
Howard Smithline, MD
Masaru Suzuki, MD
Patricia L. VanDevander, MD
Ilene Wilets, PhD
Janet M. Williams, MD
Peter Wyer, MD (Chair)
Benson Yeh, MD
William F. Young, Jr MD