CONCEPTS
academic emergency medicine
A
cademic Emergency Medicine in Uni ted
States Medical Schools
From the Department of
Alexander T Trott, MD
Emergency Medicine, University
Thomas H Blackwell, MD
of Cincinnati College of Medicine, Cincinnati, Ohio. Received for publication October 7, 1991. Revision received February 11, 1992. Accepted for phblication =March 2, 1992. Presented at the Society for Academic Emergency Medicine Annual Meeting in Washington, DC, May 1991.
Objective: Todetermine the current Standing of academic units of emergency medicine in allopathic medical schools and to measure the attitudes of medical school deans toward the specialty. Design: An investigator-blinded survey of the senior deans of 123 allopathic medical schools in the United States. [Results: Ninety-four of 123 (76%) survey instruments were completed. Fifty-six medical schools reported having academic units of emergency medicine (five divisions of the dean's office, 16 full departments, 35 divisions/sections of other departments}. Twenty-five of 56 units were reported to be academically less productive when compared with other specialty academic units of similar size. When overall mission (academic plus clinical/administrative} was considered, 46 of 56 units were reported as adequately fulfilling or exceeding mission expectations. Thirty-eight schools reported not having an academic unit of emergency medicine. 0nly ten of the 38 reported have no institutional support or plans for academic emergency medicine. Conclusion: Medical school deans are generally satisfied with the clinical/administrative performance of academic emergency medicine units but are less so with academic productivity. Despite the small numbers of full departments and disparate status of established units, it is noteworthy that only ten of the 94 respondents to this survey reported no support whatsoever for academic emergency medicine. [Trott AT, Blackwell TH: Academic emergency medicine in United States medical schools. Ann EmergMedAugust 1992;21:952-955.]
78/952
ANNALS OF EMERGENCY MEDICINE 2 1 : 8
AUGUST1992
ACADEMIC EMERGENCY
MEDICINE
Trott & B l a c k w e l l
INTRODUCTION The American College of Emergency Physicians has taken the position that there is a "severe shortage of a p p r o p r i a t e l y trained and certified emergency physicians" in the United States. ~ This position is supported by the G r a d u a t e Medical Education National Advisory Commission Report of 1980, which predicted that by 1990 emergency medicine would have a 6,000-physician shortfall. 2 Because medical schools play a central role in both u n d e r g r a d u a t e and graduate medical education, it is useful to periodically gauge the standing of academic emergency medicine in US medical schools. The purpose of the survey r e p o r t e d here was to determine not 0nly the administrative status of academic emergency medicine in US medical schools but also to measure attitudes of medical school deans toward the specialty. Information, such as reported here, can possibly assist efforts to eventually increase the number of training programs in emergency medicine in medical school environments.
school with an academic unit currently being established, school with unit in planning stages, school with institutional support present but no actual plans u n d e r consideration, or school with no support or plans for academic emergency medicine. The participants in this study included 123 senior deans of allopathic medical schools registered in 1990 with the American Association for Medical Colleges. Because of the sensitive nature of the information requested, the survey was blinded to the investigator. This measure was explained carefully in the cover letter accompanying the survey, and the survey instrument was designed to be free of potentially identifying information. Blinding of the responses was carried out in an attempt to maximize survey r e t u r n and to elicit accurate and true opinions from individuals completing instruments. F o r this reason, information about individual schools or geographic areas could not be derived. Statistical analysis for this study was carried out by applying the Mann-Whitney U method.
MATERIALS AND METHODS A survey instrumen t was designed to elicit both objective information and subjective observations regarding the position and status of academic emergency medicine within allopathic US medical schools. Schools with and without academic units of emergency medicine were surveyed. An academic unit in emergency medicine is defined as a clinical/educational/ research unit with duties and responsibilities comparable with other traditional academic units of a medical school. No attempt was made to distinguish between academic units with and without associated residency programs. Of medical schools with academic units, the following information was requested: administrative status of the academic program, availability of promotion and tenure to emergency medicine faculty, estimated academic productivity of the program, and fulfillment of overall mission of the academic program. Academic productivity was defined as research, scholarly output, and teaching effort. Overall mission was defined as clinical and administrative activities in addition to academic activities. When completing this survey, the deans were asked to make their assessments based on comparisons with other academic units of similar faculty size and budget strength. For schools without academic units, the deans were asked to categorize their school in one of four ways. These were
RESULTS Of 123 surveys sent, 94 were r e t u r n e d for a response rate of 76%. Fifty-six of those 94 (60%) schools r e p o r t e d having academic units of emergency medicine as defined above. Thirty-eight of the 94 (40%) schools r e p o r t e d not having academic units. The distribution of administrative status of schools with academic status was as follows: 16 full departments, five divisions of the dean's office, and 35 divisions or sections of other specialty departments. Forty-one (73%.) of the 56 schools with units reported tenure t r a c k eligibility for emergency medicine faculty. In schools with academic units, 25 of 56 deans (45%) believed that these units were less productive academically when compared with other specialty academic units with comparable budgets and faculty strengths. Twenty-six (46%) believed that they were equally productive, and five (9%) believed that they were more productive. However, 36 of 56 deans (64%) believed that academic units of emergency medicine were fulfilling their overall mission when administrative and clinical duties were considered along with academic output. Ten deans (18%) believed that academic units were exceeding expectations, and ten (18%) believed that they were not meeting expectations. Eighteen percent of the units were considered to be exceeding the dean's expectations for overall mission fulfillment.
Table1.
Table 2.
Comparison of deans" assessment of academic productivity between medical schools with full departments and those with divisions or sections of emergency medicine
Comparison of deans' expectations of overaU mission fulfillment between medical schools with full departments and those with divisions or sections of emergency medicine
Academic Productivity
Deans" Assessment of Mission Fulfillment
Full Departments
Divisions/Sections
(N=16)* (%)
(N=40)* (%)
Less productive Equally productive More productive
4 (25) 8 (50) 4 (25) Total 16 (100) * Differencebetween groups (as a whole) is significant at P < ,03.
AUGUST1992 21:8
ANNALS OF EMERGENCY MEDICINE
21 (52.5) 18(45.0) 1 (2.5) 40 (100)
Does not meet expectations Meets expectations Exceeds expectations
Full Departments (N=16)* (%)
2 (12.5) 10 (62.5) 4(25,0) Total 16 (100) * Difference between groups (as a whole) is significant at P< .32.
Divisions/Sections (N=40)* (%) 8 (20) 26 (65) 6 (15) 40 (100)
993/79
ACADEMIC Trott
EMERGENCY
MEDICINE
& Blackwell
Academic productivity and fulfillment of overall mission were further analyzed by comparing schools with academic departments (16) against the schools with divisions of the deans’ office or divisions and sections of existing departments (40). Tables 1 and 2 show the distribution of deans’ comparative responses for the two groups. A significant difference (P < .03) exists between groups for academic productivity. Deans of schools with academic departments are more likely to find academic units of emergency medicine more productive than schools with divisions and sections. When fulfilhnent of overall mission was assessed, there was no difference between groups (P < .41). When the two groups were compared for tenure eligibility, there was no significant difference (P < .32 ). In 11 of 15 schools with full departments, tenure was available to emergency medicine faculty. Of schools without full departments, 28 of 36 made tenure available. Five schools did not offer tenure to any clinical faculty for any specialty. For schools without academic units, an attempt was made to assess institutional support for and commitment to academic emergency medicine. The Figure summarizes that assessment from the 38 schools without academic programs. It is apparent that most of these schools have support for or demonstrated interest in academic emergency medicine. DISCUSSION Although it is widely recognized that data derived and conclusions made from surveys must be weighed against the imprecise nature of this investigational methodology, they can reveal types of information about the area or field being studied that are not otherwise measureable by rigid objective data collection. This survey was carried out with that understanding, and the results were interpreted accordingly. Of the respondents to the survey, only 60% of US medical schools have formal academic units of emergency medicine in place. Given the current shortfall and the prediction for continuing shortage of residency-trained emergency physicians, US medical schools are not close to training capacity. It is also evident that there is no consistent administrative Figure. Current existing
plans and supportfor academic units
7/38(18%)
academic
emergency
medicine
in schools without
Schools with units currently being established
4/38 (10%) / p;E$;$;;;“s
17/38 (40%) IO/38 (26%)
80/954
Institutional support present for academic emergency medicine but no current plans No institutional support or plans for academic emergency medicine
position for academic units of emergency medicine in medical schools. In this survey, only 16 units were identified as full departments. More up-to-date information indicates that as of July 1991, there were 21 full academic departments.3 Most units (35 in this survey) were identified as divisions or sections of other departments. A survey carried out in 1989 noted that most of these sections and divisions fall within departments of internal medicine and general surgery.4 It is probable that academic units were born of clinical necessity and were established in administrative and political environments peculiar to individual medical schools. Against considerable resistance, these units have largely survived and, in many cases, thrived. However, the fragmentation of administrative status, with only a relatively small number of full departments, remains problematic. Unlike for traditional departments, there are no clear and consistent lines of reporting within medical school hierarchies. This lack of consistency is a potential impediment, at the local as well as national level, to the growth and expansion of academic emergency medicine. To medical school decision makers, the specialty has yet to present itself as well defined and unified, at least at the administrative level. When asked to render an opinion regarding the academic productivity and fulfillment of overall mission of academic emergency medicine, an interesting dichotomy was noted. Clearly, significant negative opinion is held by many deans regarding the academic productivity of academic units of emergency medicine. However, the deans appeared to be generally satisfied with most units’ fulfillment of the overall mission when administrative and clinical are included in the assessment. When assessment of academic productivity is compared between schools with and without full departments, it is not surprising to find that deans of schools with full departments are generally more satisfied (Table 1). To be granted department status, academic productivity must be demonstrated. When fulfillment of overall mission was assessed, there was no difference between groups (Table 2). Again, emergency medicine has a strong tradition of clinical service, and that service may be the primary expectation of many deans. The negative impression held by many deans of academic productivity stems, in part, from the well-recognized difficulties in initiating and maintaining research programs in emergency medicine. There are still only a small number of full-time, experienced researchers in the field. An even smaller number receive significant extramural funding. Procurement of funding is certainly not aided by the apparent lack of research focus and fields of investigation that can be clearly identified as being unique to emergency medicine.5.7 Research productivity is also impeded because many emergency medicine faculty carry clinical loads that preclude meaningful and concentrated research.8 The numbers and quality of researchers are not likely to be augmented in light of surveys and observations that show a relatively small interest in
ANNALS
OF EMERGENCY MEDICINE
21:8
AUGUST
1992
ACADEMIC EMERGENCY M E D I C I N E
Trott& BlackweU
research careers by resident trainees and medical students entering training in emergency medicine. 8-10 Despite the well-recognized difficulties, it has been urged in various forums that emergency medicine must increase its efforts in academic endeavors familiar to traditional specialties.Z,8 Of the different academic endeavors, the training of investigators and building research programs currently require the most attention. A strategy that has potential to aid this process is collaboration with established investigators in other fields.8 With the growth in research, a greater number of truly academic positions, as opposed to clinical appointments, in medical schools will become available. 5 Fortunately, as this survey shows, eligibility of emergency faculty for tenure tracks is not an issue in most medical schools that currently have academic units. Therefore, access to academic positions is not artificially impeded. Although 60% of medical schools r e p o r t e d having academic units Of emergency medicine, not all are associated with residency training in the specialty. Our study was not able to identify the schools with residency programs, but according to the 1989-i990 Directory of Graduate Medical Education Programs, only 44 of 123 (36%) medical schools had established emergency medicine residencies. This difference might be explained in p a r t because schoolswith residency programs in emergency medicine might have been more inclined to return this survey than schools without programs. However, it also reflects that many emergency medicine programs gained footholds in academic centers strictly as clinical service units. Emerging residencies have followed as the units have grown beyond their service responsibilities. No doubt the granting of p r i m a r y b o a r d status has and will accelerate the growth of residency programs. In the 1991-1992 Directory, the number of residency programs in emergency medicine in US medical schools had increased to 52. The value of residency training programs to academic units of emergency medicine was clearly shown in a 1989 survey of all US medical schools carried out by the Society for Academic Emergency Medicine. 4 Several interesting and pertinent facts were revealed by that survey relevant to schools with and without residency programs. In schools with emergency medicine residency training programs, 80% of emergency medicine faculty were board-certified in emergency medicine as compared with 50% of emergency medicine faculty in schools without residencies. Twenty-four-hour-per-day coverage was provided by faculty in 96% of emergency medicine residency training program schools as compared with 73% in emergency medicine faculty in schools without residencies. One of the most telling findings of the survey was that 66% of all schools reported difficulty in recruiting new faculty. However, only 25% of emergency medicine residency training program schools reported that difficulty as compared with 75% of emergency medicine faculty in Schools without residencies. The problem of faculty recruiting is well recognized,5,8 but it appears that striving for and obtaining a residency program adds a clear advantage.
AUGUST1992
21:8 ANNALSOF EMERGENCY MEOICINE
In the arm of the survey that sampled schools without academic units Of emergency medicine, significant support for emergency medicine was revealed. Only ten of 38 schools without units indicated no plans or even institutional supp o r t for the establishment of a unit. This finding confirms the impression created by the growing number s of notices of available academic positions in academic emergency medicin e appearing in professional journals and inquiries being made by personnel search firms. A "bottom-line" observation that can be made from this survey as a whole is that of the 94 schools respondents, only ten (11%) r e p o r t e d no current inclination toward or any interest in academic emergency medicine. CONCLUSION
Significant gains have been made over the past two decades within US medical schools in establishing academic units of emergency medicine. The inconsistency of administrative status of currently existing units and the perception b y many deans of low academic productivity remain problematic. Continued concerted effort must be made to further expand the presence of emergency medicine in medical schools to influence the eventual manpower supply. In reality, if emergency medicine programs are to succeed within US medical schools, they must focus on the activities and missions traditional to academic disciplines. They have to be clinically strong, educationally committed, and willing to engage in serious research with the pursuit of extramural funding. REFERENCES 1. Gallery ME: Manoower needs in academic emergency medicine. Ann Emerg Med 1990;19:797-801. 2. SummaryReport of the Graduate Medical Education National Advisory Committeeto the Secretary, Department of Health and Human Services. Vol. I. Washington, DC, DHSS Publication, 1980,(HRA) 81-651.
3. Schropp MA: SurveyofAcademic Departments and Divisions. Lansing, Michigan, American Association of Academic Chairmen, 1991. 4. Chernow SM, Emerman CL, Langdorf M, et al: Academic EmergencyMedicine: A National Profile With and Without Emergency Medicine ResidencyPrograms. Lansing, Michigan, Education Committee, Society for Academic Emergency Medicine, 1989. 5. Allison EJ: Academic emergency medicine: Past, present, and future trends. Ann Emerg Med 1989:18:772-773. 6. Becker LB: Cellular resuscitation, basic science, and the future of emergency medicine. Ann Emerg Med 1989:18:896-897. 7. Schwab RA: The past and future of emergency medicine (letter). Ann EmergMed 1990:19:612. 8. Hamilton GC: Reorganizing academic emergency medicine: Who? Why? How? Am J Emerg Med 1988;6:416-423. 9. Lur~dbergT, Hedges JR: Academic aspirations of residents. Am J Emerg Med 1986:4:575-577. 10. Association of American Medical Colleges. 1985Medical Student Graduation Questionnaire: Subset report of respondents with emergency medicine as a definite specialty choice. Am J Emerg Med 1986;4:341-351.
Address for reprints: Alexander T Trott, MD, Department of Emergency Medicine, University Hospital, 234 Goodman Street, Cincinnati, Ohio 45267-0769.
955/81
academic emergency medicine
A
cademic Emergency Medicine in Uni ted
States Medical Schools
From the Department of
Alexander T Trott, MD
Emergency Medicine, University
Thomas H Blackwell, MD
of Cincinnati College of Medicine, Cincinnati, Ohio. Received for publication October 7, 1991. Revision received February 11, 1992. Accepted for phblication =March 2, 1992. Presented at the Society for Academic Emergency Medicine Annual Meeting in Washington, DC, May 1991.
Objective: Todetermine the current Standing of academic units of emergency medicine in allopathic medical schools and to measure the attitudes of medical school deans toward the specialty. Design: An investigator-blinded survey of the senior deans of 123 allopathic medical schools in the United States. [Results: Ninety-four of 123 (76%) survey instruments were completed. Fifty-six medical schools reported having academic units of emergency medicine (five divisions of the dean's office, 16 full departments, 35 divisions/sections of other departments}. Twenty-five of 56 units were reported to be academically less productive when compared with other specialty academic units of similar size. When overall mission (academic plus clinical/administrative} was considered, 46 of 56 units were reported as adequately fulfilling or exceeding mission expectations. Thirty-eight schools reported not having an academic unit of emergency medicine. 0nly ten of the 38 reported have no institutional support or plans for academic emergency medicine. Conclusion: Medical school deans are generally satisfied with the clinical/administrative performance of academic emergency medicine units but are less so with academic productivity. Despite the small numbers of full departments and disparate status of established units, it is noteworthy that only ten of the 94 respondents to this survey reported no support whatsoever for academic emergency medicine. [Trott AT, Blackwell TH: Academic emergency medicine in United States medical schools. Ann EmergMedAugust 1992;21:952-955.]
78/952
ANNALS OF EMERGENCY MEDICINE 2 1 : 8
AUGUST1992
ACADEMIC EMERGENCY
MEDICINE
Trott & B l a c k w e l l
INTRODUCTION The American College of Emergency Physicians has taken the position that there is a "severe shortage of a p p r o p r i a t e l y trained and certified emergency physicians" in the United States. ~ This position is supported by the G r a d u a t e Medical Education National Advisory Commission Report of 1980, which predicted that by 1990 emergency medicine would have a 6,000-physician shortfall. 2 Because medical schools play a central role in both u n d e r g r a d u a t e and graduate medical education, it is useful to periodically gauge the standing of academic emergency medicine in US medical schools. The purpose of the survey r e p o r t e d here was to determine not 0nly the administrative status of academic emergency medicine in US medical schools but also to measure attitudes of medical school deans toward the specialty. Information, such as reported here, can possibly assist efforts to eventually increase the number of training programs in emergency medicine in medical school environments.
school with an academic unit currently being established, school with unit in planning stages, school with institutional support present but no actual plans u n d e r consideration, or school with no support or plans for academic emergency medicine. The participants in this study included 123 senior deans of allopathic medical schools registered in 1990 with the American Association for Medical Colleges. Because of the sensitive nature of the information requested, the survey was blinded to the investigator. This measure was explained carefully in the cover letter accompanying the survey, and the survey instrument was designed to be free of potentially identifying information. Blinding of the responses was carried out in an attempt to maximize survey r e t u r n and to elicit accurate and true opinions from individuals completing instruments. F o r this reason, information about individual schools or geographic areas could not be derived. Statistical analysis for this study was carried out by applying the Mann-Whitney U method.
MATERIALS AND METHODS A survey instrumen t was designed to elicit both objective information and subjective observations regarding the position and status of academic emergency medicine within allopathic US medical schools. Schools with and without academic units of emergency medicine were surveyed. An academic unit in emergency medicine is defined as a clinical/educational/ research unit with duties and responsibilities comparable with other traditional academic units of a medical school. No attempt was made to distinguish between academic units with and without associated residency programs. Of medical schools with academic units, the following information was requested: administrative status of the academic program, availability of promotion and tenure to emergency medicine faculty, estimated academic productivity of the program, and fulfillment of overall mission of the academic program. Academic productivity was defined as research, scholarly output, and teaching effort. Overall mission was defined as clinical and administrative activities in addition to academic activities. When completing this survey, the deans were asked to make their assessments based on comparisons with other academic units of similar faculty size and budget strength. For schools without academic units, the deans were asked to categorize their school in one of four ways. These were
RESULTS Of 123 surveys sent, 94 were r e t u r n e d for a response rate of 76%. Fifty-six of those 94 (60%) schools r e p o r t e d having academic units of emergency medicine as defined above. Thirty-eight of the 94 (40%) schools r e p o r t e d not having academic units. The distribution of administrative status of schools with academic status was as follows: 16 full departments, five divisions of the dean's office, and 35 divisions or sections of other specialty departments. Forty-one (73%.) of the 56 schools with units reported tenure t r a c k eligibility for emergency medicine faculty. In schools with academic units, 25 of 56 deans (45%) believed that these units were less productive academically when compared with other specialty academic units with comparable budgets and faculty strengths. Twenty-six (46%) believed that they were equally productive, and five (9%) believed that they were more productive. However, 36 of 56 deans (64%) believed that academic units of emergency medicine were fulfilling their overall mission when administrative and clinical duties were considered along with academic output. Ten deans (18%) believed that academic units were exceeding expectations, and ten (18%) believed that they were not meeting expectations. Eighteen percent of the units were considered to be exceeding the dean's expectations for overall mission fulfillment.
Table1.
Table 2.
Comparison of deans" assessment of academic productivity between medical schools with full departments and those with divisions or sections of emergency medicine
Comparison of deans' expectations of overaU mission fulfillment between medical schools with full departments and those with divisions or sections of emergency medicine
Academic Productivity
Deans" Assessment of Mission Fulfillment
Full Departments
Divisions/Sections
(N=16)* (%)
(N=40)* (%)
Less productive Equally productive More productive
4 (25) 8 (50) 4 (25) Total 16 (100) * Differencebetween groups (as a whole) is significant at P < ,03.
AUGUST1992 21:8
ANNALS OF EMERGENCY MEDICINE
21 (52.5) 18(45.0) 1 (2.5) 40 (100)
Does not meet expectations Meets expectations Exceeds expectations
Full Departments (N=16)* (%)
2 (12.5) 10 (62.5) 4(25,0) Total 16 (100) * Difference between groups (as a whole) is significant at P< .32.
Divisions/Sections (N=40)* (%) 8 (20) 26 (65) 6 (15) 40 (100)
993/79
ACADEMIC Trott
EMERGENCY
MEDICINE
& Blackwell
Academic productivity and fulfillment of overall mission were further analyzed by comparing schools with academic departments (16) against the schools with divisions of the deans’ office or divisions and sections of existing departments (40). Tables 1 and 2 show the distribution of deans’ comparative responses for the two groups. A significant difference (P < .03) exists between groups for academic productivity. Deans of schools with academic departments are more likely to find academic units of emergency medicine more productive than schools with divisions and sections. When fulfilhnent of overall mission was assessed, there was no difference between groups (P < .41). When the two groups were compared for tenure eligibility, there was no significant difference (P < .32 ). In 11 of 15 schools with full departments, tenure was available to emergency medicine faculty. Of schools without full departments, 28 of 36 made tenure available. Five schools did not offer tenure to any clinical faculty for any specialty. For schools without academic units, an attempt was made to assess institutional support for and commitment to academic emergency medicine. The Figure summarizes that assessment from the 38 schools without academic programs. It is apparent that most of these schools have support for or demonstrated interest in academic emergency medicine. DISCUSSION Although it is widely recognized that data derived and conclusions made from surveys must be weighed against the imprecise nature of this investigational methodology, they can reveal types of information about the area or field being studied that are not otherwise measureable by rigid objective data collection. This survey was carried out with that understanding, and the results were interpreted accordingly. Of the respondents to the survey, only 60% of US medical schools have formal academic units of emergency medicine in place. Given the current shortfall and the prediction for continuing shortage of residency-trained emergency physicians, US medical schools are not close to training capacity. It is also evident that there is no consistent administrative Figure. Current existing
plans and supportfor academic units
7/38(18%)
academic
emergency
medicine
in schools without
Schools with units currently being established
4/38 (10%) / p;E$;$;;;“s
17/38 (40%) IO/38 (26%)
80/954
Institutional support present for academic emergency medicine but no current plans No institutional support or plans for academic emergency medicine
position for academic units of emergency medicine in medical schools. In this survey, only 16 units were identified as full departments. More up-to-date information indicates that as of July 1991, there were 21 full academic departments.3 Most units (35 in this survey) were identified as divisions or sections of other departments. A survey carried out in 1989 noted that most of these sections and divisions fall within departments of internal medicine and general surgery.4 It is probable that academic units were born of clinical necessity and were established in administrative and political environments peculiar to individual medical schools. Against considerable resistance, these units have largely survived and, in many cases, thrived. However, the fragmentation of administrative status, with only a relatively small number of full departments, remains problematic. Unlike for traditional departments, there are no clear and consistent lines of reporting within medical school hierarchies. This lack of consistency is a potential impediment, at the local as well as national level, to the growth and expansion of academic emergency medicine. To medical school decision makers, the specialty has yet to present itself as well defined and unified, at least at the administrative level. When asked to render an opinion regarding the academic productivity and fulfillment of overall mission of academic emergency medicine, an interesting dichotomy was noted. Clearly, significant negative opinion is held by many deans regarding the academic productivity of academic units of emergency medicine. However, the deans appeared to be generally satisfied with most units’ fulfillment of the overall mission when administrative and clinical are included in the assessment. When assessment of academic productivity is compared between schools with and without full departments, it is not surprising to find that deans of schools with full departments are generally more satisfied (Table 1). To be granted department status, academic productivity must be demonstrated. When fulfillment of overall mission was assessed, there was no difference between groups (Table 2). Again, emergency medicine has a strong tradition of clinical service, and that service may be the primary expectation of many deans. The negative impression held by many deans of academic productivity stems, in part, from the well-recognized difficulties in initiating and maintaining research programs in emergency medicine. There are still only a small number of full-time, experienced researchers in the field. An even smaller number receive significant extramural funding. Procurement of funding is certainly not aided by the apparent lack of research focus and fields of investigation that can be clearly identified as being unique to emergency medicine.5.7 Research productivity is also impeded because many emergency medicine faculty carry clinical loads that preclude meaningful and concentrated research.8 The numbers and quality of researchers are not likely to be augmented in light of surveys and observations that show a relatively small interest in
ANNALS
OF EMERGENCY MEDICINE
21:8
AUGUST
1992
ACADEMIC EMERGENCY M E D I C I N E
Trott& BlackweU
research careers by resident trainees and medical students entering training in emergency medicine. 8-10 Despite the well-recognized difficulties, it has been urged in various forums that emergency medicine must increase its efforts in academic endeavors familiar to traditional specialties.Z,8 Of the different academic endeavors, the training of investigators and building research programs currently require the most attention. A strategy that has potential to aid this process is collaboration with established investigators in other fields.8 With the growth in research, a greater number of truly academic positions, as opposed to clinical appointments, in medical schools will become available. 5 Fortunately, as this survey shows, eligibility of emergency faculty for tenure tracks is not an issue in most medical schools that currently have academic units. Therefore, access to academic positions is not artificially impeded. Although 60% of medical schools r e p o r t e d having academic units Of emergency medicine, not all are associated with residency training in the specialty. Our study was not able to identify the schools with residency programs, but according to the 1989-i990 Directory of Graduate Medical Education Programs, only 44 of 123 (36%) medical schools had established emergency medicine residencies. This difference might be explained in p a r t because schoolswith residency programs in emergency medicine might have been more inclined to return this survey than schools without programs. However, it also reflects that many emergency medicine programs gained footholds in academic centers strictly as clinical service units. Emerging residencies have followed as the units have grown beyond their service responsibilities. No doubt the granting of p r i m a r y b o a r d status has and will accelerate the growth of residency programs. In the 1991-1992 Directory, the number of residency programs in emergency medicine in US medical schools had increased to 52. The value of residency training programs to academic units of emergency medicine was clearly shown in a 1989 survey of all US medical schools carried out by the Society for Academic Emergency Medicine. 4 Several interesting and pertinent facts were revealed by that survey relevant to schools with and without residency programs. In schools with emergency medicine residency training programs, 80% of emergency medicine faculty were board-certified in emergency medicine as compared with 50% of emergency medicine faculty in schools without residencies. Twenty-four-hour-per-day coverage was provided by faculty in 96% of emergency medicine residency training program schools as compared with 73% in emergency medicine faculty in schools without residencies. One of the most telling findings of the survey was that 66% of all schools reported difficulty in recruiting new faculty. However, only 25% of emergency medicine residency training program schools reported that difficulty as compared with 75% of emergency medicine faculty in Schools without residencies. The problem of faculty recruiting is well recognized,5,8 but it appears that striving for and obtaining a residency program adds a clear advantage.
AUGUST1992
21:8 ANNALSOF EMERGENCY MEOICINE
In the arm of the survey that sampled schools without academic units Of emergency medicine, significant support for emergency medicine was revealed. Only ten of 38 schools without units indicated no plans or even institutional supp o r t for the establishment of a unit. This finding confirms the impression created by the growing number s of notices of available academic positions in academic emergency medicin e appearing in professional journals and inquiries being made by personnel search firms. A "bottom-line" observation that can be made from this survey as a whole is that of the 94 schools respondents, only ten (11%) r e p o r t e d no current inclination toward or any interest in academic emergency medicine. CONCLUSION
Significant gains have been made over the past two decades within US medical schools in establishing academic units of emergency medicine. The inconsistency of administrative status of currently existing units and the perception b y many deans of low academic productivity remain problematic. Continued concerted effort must be made to further expand the presence of emergency medicine in medical schools to influence the eventual manpower supply. In reality, if emergency medicine programs are to succeed within US medical schools, they must focus on the activities and missions traditional to academic disciplines. They have to be clinically strong, educationally committed, and willing to engage in serious research with the pursuit of extramural funding. REFERENCES 1. Gallery ME: Manoower needs in academic emergency medicine. Ann Emerg Med 1990;19:797-801. 2. SummaryReport of the Graduate Medical Education National Advisory Committeeto the Secretary, Department of Health and Human Services. Vol. I. Washington, DC, DHSS Publication, 1980,(HRA) 81-651.
3. Schropp MA: SurveyofAcademic Departments and Divisions. Lansing, Michigan, American Association of Academic Chairmen, 1991. 4. Chernow SM, Emerman CL, Langdorf M, et al: Academic EmergencyMedicine: A National Profile With and Without Emergency Medicine ResidencyPrograms. Lansing, Michigan, Education Committee, Society for Academic Emergency Medicine, 1989. 5. Allison EJ: Academic emergency medicine: Past, present, and future trends. Ann Emerg Med 1989:18:772-773. 6. Becker LB: Cellular resuscitation, basic science, and the future of emergency medicine. Ann Emerg Med 1989:18:896-897. 7. Schwab RA: The past and future of emergency medicine (letter). Ann EmergMed 1990:19:612. 8. Hamilton GC: Reorganizing academic emergency medicine: Who? Why? How? Am J Emerg Med 1988;6:416-423. 9. Lur~dbergT, Hedges JR: Academic aspirations of residents. Am J Emerg Med 1986:4:575-577. 10. Association of American Medical Colleges. 1985Medical Student Graduation Questionnaire: Subset report of respondents with emergency medicine as a definite specialty choice. Am J Emerg Med 1986;4:341-351.
Address for reprints: Alexander T Trott, MD, Department of Emergency Medicine, University Hospital, 234 Goodman Street, Cincinnati, Ohio 45267-0769.
955/81
