FORUM academic emergency
Attaining Academic Department Status for Emergency Medicine Within Medical Schools The specialty of emergency medicine has emerged as a separate academic department within medical schools. These academic departments were contacted and asked to submit information on the process they undertook to attain department status. The path taken by each department was unique and dependent on m a n y factors. Information about these departm e n t s is summarized, and ten broad recommendations for academic emergency physicians to consider when seeking department status are given. [Ling LJ: Attaining academic department status for emergency medicine within medical schools. Ann Emerg Med July 1990;I9:793-796.] INTRODUCTION As the specialty of emergency medicine continues to grow, academically affiliated emergency physicians increasingly feel the need to attain full department status - not only within hospitals but also within the medical schools where they hold appointments. Full department status has several advantages: It promotes stability, ensures a seat for the chairman on the executive committee and equal status, increases department stature within the political and social structures of the medical school, and allows the chairman to set credential criteria for the staff. Although status as a free-standing division or as a division within a supportive department may seem desirable, departments that have completed the final step of becoming fully autonomous agree that it is an even better situation than they had imagined. From 1988 through 1989, the American College of Emergency Physicians' (ACEP) Academic Affairs Committee conducted a telephone survey of Accreditation Council on Graduate Medical Education (ACGME)accredited emergency medicine residency programs to determine which were affiliated with autonomous departments of emergency medicine within medical schools (Figure). In addition, the Association of American Medical Colleges' education directory was reviewed to identify any medical school departments without emergency medicine residency programs. A contact person was then identified and queried for insight into the process undertaken at the medical school to attain department status. Because of the great diversity among situations and the uniqueness of each medical school and institution, information could not be collected on a standardized survey. Instead, the route taken to attain full department status for each individual situation and institution was summarized. On the basis of the subjective experience reported by the institutions surveyed, ten recommendations are made that academic emergency physicians should consider in the process of attaining full academic department status within their institutions.
Louis J Ling, MD, FACEP Dallas, Texas From the Academic Affairs Committee, American College of Emergency Physicians, DaNas, Texas. Received for publication July 20, 1989. Revision received November 20, 1989. Accepted for publication December 12, 1989. Address for reprints: American College of Emergency Physicians, PC Box 619911, Dallas, Texas 75261-9911.
GENERAL RECOMMENDATIONS The following actions were often recommended as either strategies in the quest to achieve full academic department status or prerequisites to pursue before applying for such status. Because values vary among medical schools, the importance of each recommendation varies as well; however, all should be considered.
19:7 July 1990
Annals of Emergency Medicine
793/103
DEPARTMENT STATUS Ling
Recommendation 1 Obtain support from the dean and the department chairmen. In every school, support from the dean, a chairman in the parent department, or some other influential individual was essential. Historically, these ind i v i d u a l s have been the d r i v i n g forces in recruiting interested and qualified emergency physicians to develop the emergency department. More recently, the impetus for department status has come from emergency physicians who find that deans must often be convinced that the change will be politically feasible and financially advantageous, or at least not cause a drain on the budget. If support is lacking from the sponsoring department or the dean, effort should be directed to develop such support before attempting to gain department stature.
Recommendation 2 A s k the hospital to support your case to the medical school. Influence on the medical school from the prim a r y teaching hospital has often been useful, especially when the hospital contributes significantly to the budget and policy of the medical school. If the hospital administration is not aware of the accomplishments and concerns of the emergency physicians, this situation should be rectified. Regular meetings should occur between appropriate hospital administrators and the hospital ED director for exchange of information. The director and faculty should be active on hospital committees and contribute to the medical staff. Frequently, when the department is a primary source of patients to the institution, the hospital has a greater interest than the medical school in the autonomous status of the ED and can be an influential ally in the establishment of full academic status, especially when the hospital administration can see the improved liability situation, better risk management position, and financial advantage attached to having a strong ED.
Recommendation 3 Show that the quality of medical care would be improved with full academic department status. The foundation of any emergency medicine practice is high-quality patient care. Without excellence in patient care, there is no credibility; without cred104/794
ibility, other accomplishments are not recognized. Many medical school administrations understand that full d e p a r t m e n t status facilitates improved quality of care through the consequent influx and retention of qualified faculty. In the past, this argument for improving the quality of care has been the most important single factor in the support for ED requests for academic department status. When emergency patient care has been in shambles, a would-be chairman has often argued that department status would be a means of attaining the resources necessary for i m p r o v i n g the quality of clinical care.
Recommendation 4 S h o w t h a t r e c r u i t m e n t of academic emergency physician staff is improved w i t h department status. The recruitment of qualified staff has been used as a rationale for department status. Medical school administrators realize that faculty physicians must be well trained, preferably in emergency medicine, and must accept the additional writing and research time necessary to produce an excellent academic program. Without a stable and c o m m i t t e d physician staff, a department cannot maintain a s t i m u l a t i n g professional environment. It may be necessary to recruit specialists with skills as clinical director, quality assurance director, education director, residency training director, emergency medical services (EMS) director, or research director. The director of the program must create an environment that encourages the staff to a u g m e n t t h e i r knowledge base and clinical skills; this obligation includes protected faculty time to read, to attend or teach didactic sessions, and to attend educational and professional meetings. Such faculty are rare and difficult to attract. The chairman with full academic department status provides stability and independence that allows for academic career development, which is attractive to potential faculty.
Recommendation 5 D e m o n s t r a t e teaching excellence at m e d i c a l s t u d e n t and graduate medical education levels. Offering a well-respected service w i t h i n the hospital lays the g r o u n d w o r k for teaching, the next step of department Annals of Emergency Medicine
development. Teaching medical students and residents is a visible and important way of demonstrating academic excellence. While teaching residents in other specialties may be appreciated, most academic departm e n t s have had an A C G M E - a p proved residency training program in emergency medicine. Although some medical schools have accepted department plans for a residency program, most have required that a program be actually under way or even fully approved before accepting that the department has the ability to train its own residents. Probably the most important factor in launching a successful program is institutional support, including the allocation of the necessary financial resources. The next factor is the residency director, who must possess excellent credentials and be recognized as a leader within the institution. The last critical point is that emergency medicine faculty must be respected as true specialists by the residents and faculty t h r o u g h o u t the institution. Didactic teaching in the medical school curriculum sel-ves as the other educational cornerstone. The didactic teaching has frequently evolved from teaching predeveloped courses (eg, advanced cardiac life support, advanced trauma life support) before progressing to protected lecture time in the medical student curriculum. In the early, preclinical years, lecture time often addresses first-responder skills. If possible, it is worthwhile to contribute to teaching in other areas of the curriculum, such as cardiov a s c u l a r or p u l m o n a r y s e c t i o n s , where emergency medicine faculty may have particular expertise. While most schools offer senior emergency medicine electives, few at this time require them of all students.
Recommendation 6 Demonstrate faculty achievements in research. A c h i e v e m e n t s by the faculty in research are the purest arg u m e n t for a c a d e m i c excellence. Publications and grant support are common measures of production. It is important to recognize that each medical school will place a different value on clinical research as compared with basic science research. The expectations for the quality and quantity of research should be defined early so faculty can invest their 19:7 July 1990
State California
Program
Charles Drew University Loma Linda University University of Southern California District of Columbia Georgetown University George Washington University Kentucky University of Kentucky University of Louisville Michigan Wayne State University Missouri University of Missouri-Kansas City School of Medicine New York Albany Medical College State University of New York at Buffalo State University of New York at Stonybrook North Carolina Bowman Gray School of Medicine at Wake Forest University East Carolina University Ohio Northeastern Ohio Universities College of Medicine Ohio State University University of Cincinnati Wright State University Pennsylvania Medical College of Pennsylvania Medical College of PennsylvaniaAllegheny Campus Four additional programs in the process of department application Arkansas University of Arkansas Kansas University of Kansas School of Medicine Oregon Oregon Health Sciences University Texas Texas Tech University time and resources wisely. Some EDs have successfully argued t h a t a c a d e m i c e x p e c t a t i o n s should parallel the time available for academic pursuits. The criteria for a c a d e m i c p r o d u c t i v i t y s h o u l d be modified for emergency medicine and other specialties (such as radiology and pathology) that have high demand for clinical service time. In the past, successful procurement of EMS grants has been a positive influence. However, some medical schools have a clinical emphasis and have not required research as a major requirement.
Recommendation 7 D e m o n s t r a t e financial stability and independence. Independent financial success is a double-edged sword - it gives emergency physicians leverage in negotiating and frees the dean from the fear that the new department will be a financial burden. It also allows emergency physicians to develop experience in
19:7 July 1990
handling a d e p a r t m e n t ' s finances. However, if the ED is perceived as a gold mine, more established departments may desire to keep or annex it. The ED must respond to competition and health legislation that affect ED and hospital economics. The director should be open to ways to optimize patient census and department finances.
Recommendation 8 Demonstrate to the medical school that the ED fits into its overall structure. It is important to consider the medical school's usual approach to department structure as well as the value it places on research versus clinical service. Some schools are structured at the division level and have very few independent departments; these are unlikely to ever have departments of emergency medicine. Some schools are very clinically oriented, appreciate the clinical contributions of emergency physicians, and are more likely to grant
Annals of Emergency Medicine
FIGURE. A c a d e m i c d e p a r t m e n t s surveyed. As of July 1989, the ACEP A c a d e m i c Affairs C o m m i t t e e h a d identified 20 medical schools with academic emergency medicine departments.
d e p a r t m e n t status based on these values. Active i n v o l v e m e n t w i t h i n the medical school committee and the faculty structure has been cited as demonstrating the department's abilities and commitment to the medical school. Working within the infrastructure of the medical school allows emergency physicians to learn about the value system and maintain p e r s o n a l r e l a t i o n s h i p s w i t h the power structure of the institution. Department priorities can then be adjusted to meet the expectations of the medical school.
Recommendation 9 Gain the support of the faculty. Usually, the final step in attaining department stature is an affirmative vote by the medical school faculty. This vote should be postponed until adequate faculty support is ensured. Some faculty will follow the lead of the d e p a r t m e n t c h a i r m e n or the dean, whereas others may be quite independent. Usually, the education of individual medical school faculty over a long period is a worthwhile investment that pays off when it is time for the final vote.
Recommendation 10 A c a d e m i c emergency physicians who are courted to direct university EDs should use the opportunity to explore the topic of department status. The recruitment of a new chairman is an opening to request department status as a condition for accepting the position or, at a minimum, provides an opportunity for the dean to define the minimum requirements for such. Identification of the necessary requirements may be open to negotiation and gives the incoming chair a realistic idea of its success. Likewise, it prepares the administration to expect an application in the future. When an administration discovers how difficult it is to recruit an experienced chairman, it m a y be quite willing to grant department status as a condition for the candidate's acceptance. Agreements should be
795/105
DEPARTMENT STATUS Ling
written in case of turnover in the administration or the dean's office.
OTHER CONSIDERATIONS Emergency medicine's unique body of knowledge may be cited as a reason for the ED to be independent, but this argument may not be effective. Opponents to this concept typically will have strong opinions to the contrary and may be unswayed by any arguments. Dwelling on this point may distract from the goal of attaining department status. In some medical schools where there is difficulty in attracting students (eg, high tuition), it has been suggested that full department status adds visibility to a specialty that has high appeal a m o n g i n c o m i n g students and so will aid medical student recruitment. Service in such spheres as prehospital care, poison center leadership, hyperbaric medicine, and community service has been cited by some emergency physicians as important.
106/796
Unless there is a more direct academic result, these services can not substitute for the more traditional areas of teaching and research. They are, however, probably helpful in establishing a positive reputation for the department within the community and among the faculty.
SUMMARY As the specialty of e m e r g e n c y medicine matures, a natural development is the establishment of academic d e p a r t m e n t s of emergency medicine w i t h i n medical schools. This process has been continuous since the first department was established in 1971. Initially, this process was highly dependent on individual effort and favorable local political circumstances. In m a n y ways, this remains the case; however, this process has become much more deliberate as emergency physicians realize the benefits of academic autonomy. The a t t a i n m e n t of academic department status has become m u c h
Annals of Emergency Medicine
more common, and there is no reason to believe that the trend will abate. In reviewing past experiences, e m e r g e n c y p h y s i c i a n s h a v e successfully attained academic department status in an effort to improve patient care, provide better education, and enhance scholarly achievement. This specialty must learn from the lessons of the past to be effective in continuing the advancement of emergency medicine. (An appendix giving information on individual departments is available from the author.) The author gratefully acknowledges Suzanne Shepherd, MD, and Glenn Hamilton, MD, of the Society for Academic Emergency Medicine for their valuable insight. John Moorhead, MD; Jo Ellen Linder, MD~ Gregg Pane, MD; Timothy Schaefer, MD; Keith Sivertson, MD; Gloria Thompson, MD; Richard Aghababian, MD; John McCabe, MD; and Michael Gallery, PhD, of the Academic Affairs Committee were helpful in their review of the manuscript.
19:7 July 1990
Attaining Academic Department Status for Emergency Medicine Within Medical Schools The specialty of emergency medicine has emerged as a separate academic department within medical schools. These academic departments were contacted and asked to submit information on the process they undertook to attain department status. The path taken by each department was unique and dependent on m a n y factors. Information about these departm e n t s is summarized, and ten broad recommendations for academic emergency physicians to consider when seeking department status are given. [Ling LJ: Attaining academic department status for emergency medicine within medical schools. Ann Emerg Med July 1990;I9:793-796.] INTRODUCTION As the specialty of emergency medicine continues to grow, academically affiliated emergency physicians increasingly feel the need to attain full department status - not only within hospitals but also within the medical schools where they hold appointments. Full department status has several advantages: It promotes stability, ensures a seat for the chairman on the executive committee and equal status, increases department stature within the political and social structures of the medical school, and allows the chairman to set credential criteria for the staff. Although status as a free-standing division or as a division within a supportive department may seem desirable, departments that have completed the final step of becoming fully autonomous agree that it is an even better situation than they had imagined. From 1988 through 1989, the American College of Emergency Physicians' (ACEP) Academic Affairs Committee conducted a telephone survey of Accreditation Council on Graduate Medical Education (ACGME)accredited emergency medicine residency programs to determine which were affiliated with autonomous departments of emergency medicine within medical schools (Figure). In addition, the Association of American Medical Colleges' education directory was reviewed to identify any medical school departments without emergency medicine residency programs. A contact person was then identified and queried for insight into the process undertaken at the medical school to attain department status. Because of the great diversity among situations and the uniqueness of each medical school and institution, information could not be collected on a standardized survey. Instead, the route taken to attain full department status for each individual situation and institution was summarized. On the basis of the subjective experience reported by the institutions surveyed, ten recommendations are made that academic emergency physicians should consider in the process of attaining full academic department status within their institutions.
Louis J Ling, MD, FACEP Dallas, Texas From the Academic Affairs Committee, American College of Emergency Physicians, DaNas, Texas. Received for publication July 20, 1989. Revision received November 20, 1989. Accepted for publication December 12, 1989. Address for reprints: American College of Emergency Physicians, PC Box 619911, Dallas, Texas 75261-9911.
GENERAL RECOMMENDATIONS The following actions were often recommended as either strategies in the quest to achieve full academic department status or prerequisites to pursue before applying for such status. Because values vary among medical schools, the importance of each recommendation varies as well; however, all should be considered.
19:7 July 1990
Annals of Emergency Medicine
793/103
DEPARTMENT STATUS Ling
Recommendation 1 Obtain support from the dean and the department chairmen. In every school, support from the dean, a chairman in the parent department, or some other influential individual was essential. Historically, these ind i v i d u a l s have been the d r i v i n g forces in recruiting interested and qualified emergency physicians to develop the emergency department. More recently, the impetus for department status has come from emergency physicians who find that deans must often be convinced that the change will be politically feasible and financially advantageous, or at least not cause a drain on the budget. If support is lacking from the sponsoring department or the dean, effort should be directed to develop such support before attempting to gain department stature.
Recommendation 2 A s k the hospital to support your case to the medical school. Influence on the medical school from the prim a r y teaching hospital has often been useful, especially when the hospital contributes significantly to the budget and policy of the medical school. If the hospital administration is not aware of the accomplishments and concerns of the emergency physicians, this situation should be rectified. Regular meetings should occur between appropriate hospital administrators and the hospital ED director for exchange of information. The director and faculty should be active on hospital committees and contribute to the medical staff. Frequently, when the department is a primary source of patients to the institution, the hospital has a greater interest than the medical school in the autonomous status of the ED and can be an influential ally in the establishment of full academic status, especially when the hospital administration can see the improved liability situation, better risk management position, and financial advantage attached to having a strong ED.
Recommendation 3 Show that the quality of medical care would be improved with full academic department status. The foundation of any emergency medicine practice is high-quality patient care. Without excellence in patient care, there is no credibility; without cred104/794
ibility, other accomplishments are not recognized. Many medical school administrations understand that full d e p a r t m e n t status facilitates improved quality of care through the consequent influx and retention of qualified faculty. In the past, this argument for improving the quality of care has been the most important single factor in the support for ED requests for academic department status. When emergency patient care has been in shambles, a would-be chairman has often argued that department status would be a means of attaining the resources necessary for i m p r o v i n g the quality of clinical care.
Recommendation 4 S h o w t h a t r e c r u i t m e n t of academic emergency physician staff is improved w i t h department status. The recruitment of qualified staff has been used as a rationale for department status. Medical school administrators realize that faculty physicians must be well trained, preferably in emergency medicine, and must accept the additional writing and research time necessary to produce an excellent academic program. Without a stable and c o m m i t t e d physician staff, a department cannot maintain a s t i m u l a t i n g professional environment. It may be necessary to recruit specialists with skills as clinical director, quality assurance director, education director, residency training director, emergency medical services (EMS) director, or research director. The director of the program must create an environment that encourages the staff to a u g m e n t t h e i r knowledge base and clinical skills; this obligation includes protected faculty time to read, to attend or teach didactic sessions, and to attend educational and professional meetings. Such faculty are rare and difficult to attract. The chairman with full academic department status provides stability and independence that allows for academic career development, which is attractive to potential faculty.
Recommendation 5 D e m o n s t r a t e teaching excellence at m e d i c a l s t u d e n t and graduate medical education levels. Offering a well-respected service w i t h i n the hospital lays the g r o u n d w o r k for teaching, the next step of department Annals of Emergency Medicine
development. Teaching medical students and residents is a visible and important way of demonstrating academic excellence. While teaching residents in other specialties may be appreciated, most academic departm e n t s have had an A C G M E - a p proved residency training program in emergency medicine. Although some medical schools have accepted department plans for a residency program, most have required that a program be actually under way or even fully approved before accepting that the department has the ability to train its own residents. Probably the most important factor in launching a successful program is institutional support, including the allocation of the necessary financial resources. The next factor is the residency director, who must possess excellent credentials and be recognized as a leader within the institution. The last critical point is that emergency medicine faculty must be respected as true specialists by the residents and faculty t h r o u g h o u t the institution. Didactic teaching in the medical school curriculum sel-ves as the other educational cornerstone. The didactic teaching has frequently evolved from teaching predeveloped courses (eg, advanced cardiac life support, advanced trauma life support) before progressing to protected lecture time in the medical student curriculum. In the early, preclinical years, lecture time often addresses first-responder skills. If possible, it is worthwhile to contribute to teaching in other areas of the curriculum, such as cardiov a s c u l a r or p u l m o n a r y s e c t i o n s , where emergency medicine faculty may have particular expertise. While most schools offer senior emergency medicine electives, few at this time require them of all students.
Recommendation 6 Demonstrate faculty achievements in research. A c h i e v e m e n t s by the faculty in research are the purest arg u m e n t for a c a d e m i c excellence. Publications and grant support are common measures of production. It is important to recognize that each medical school will place a different value on clinical research as compared with basic science research. The expectations for the quality and quantity of research should be defined early so faculty can invest their 19:7 July 1990
State California
Program
Charles Drew University Loma Linda University University of Southern California District of Columbia Georgetown University George Washington University Kentucky University of Kentucky University of Louisville Michigan Wayne State University Missouri University of Missouri-Kansas City School of Medicine New York Albany Medical College State University of New York at Buffalo State University of New York at Stonybrook North Carolina Bowman Gray School of Medicine at Wake Forest University East Carolina University Ohio Northeastern Ohio Universities College of Medicine Ohio State University University of Cincinnati Wright State University Pennsylvania Medical College of Pennsylvania Medical College of PennsylvaniaAllegheny Campus Four additional programs in the process of department application Arkansas University of Arkansas Kansas University of Kansas School of Medicine Oregon Oregon Health Sciences University Texas Texas Tech University time and resources wisely. Some EDs have successfully argued t h a t a c a d e m i c e x p e c t a t i o n s should parallel the time available for academic pursuits. The criteria for a c a d e m i c p r o d u c t i v i t y s h o u l d be modified for emergency medicine and other specialties (such as radiology and pathology) that have high demand for clinical service time. In the past, successful procurement of EMS grants has been a positive influence. However, some medical schools have a clinical emphasis and have not required research as a major requirement.
Recommendation 7 D e m o n s t r a t e financial stability and independence. Independent financial success is a double-edged sword - it gives emergency physicians leverage in negotiating and frees the dean from the fear that the new department will be a financial burden. It also allows emergency physicians to develop experience in
19:7 July 1990
handling a d e p a r t m e n t ' s finances. However, if the ED is perceived as a gold mine, more established departments may desire to keep or annex it. The ED must respond to competition and health legislation that affect ED and hospital economics. The director should be open to ways to optimize patient census and department finances.
Recommendation 8 Demonstrate to the medical school that the ED fits into its overall structure. It is important to consider the medical school's usual approach to department structure as well as the value it places on research versus clinical service. Some schools are structured at the division level and have very few independent departments; these are unlikely to ever have departments of emergency medicine. Some schools are very clinically oriented, appreciate the clinical contributions of emergency physicians, and are more likely to grant
Annals of Emergency Medicine
FIGURE. A c a d e m i c d e p a r t m e n t s surveyed. As of July 1989, the ACEP A c a d e m i c Affairs C o m m i t t e e h a d identified 20 medical schools with academic emergency medicine departments.
d e p a r t m e n t status based on these values. Active i n v o l v e m e n t w i t h i n the medical school committee and the faculty structure has been cited as demonstrating the department's abilities and commitment to the medical school. Working within the infrastructure of the medical school allows emergency physicians to learn about the value system and maintain p e r s o n a l r e l a t i o n s h i p s w i t h the power structure of the institution. Department priorities can then be adjusted to meet the expectations of the medical school.
Recommendation 9 Gain the support of the faculty. Usually, the final step in attaining department stature is an affirmative vote by the medical school faculty. This vote should be postponed until adequate faculty support is ensured. Some faculty will follow the lead of the d e p a r t m e n t c h a i r m e n or the dean, whereas others may be quite independent. Usually, the education of individual medical school faculty over a long period is a worthwhile investment that pays off when it is time for the final vote.
Recommendation 10 A c a d e m i c emergency physicians who are courted to direct university EDs should use the opportunity to explore the topic of department status. The recruitment of a new chairman is an opening to request department status as a condition for accepting the position or, at a minimum, provides an opportunity for the dean to define the minimum requirements for such. Identification of the necessary requirements may be open to negotiation and gives the incoming chair a realistic idea of its success. Likewise, it prepares the administration to expect an application in the future. When an administration discovers how difficult it is to recruit an experienced chairman, it m a y be quite willing to grant department status as a condition for the candidate's acceptance. Agreements should be
795/105
DEPARTMENT STATUS Ling
written in case of turnover in the administration or the dean's office.
OTHER CONSIDERATIONS Emergency medicine's unique body of knowledge may be cited as a reason for the ED to be independent, but this argument may not be effective. Opponents to this concept typically will have strong opinions to the contrary and may be unswayed by any arguments. Dwelling on this point may distract from the goal of attaining department status. In some medical schools where there is difficulty in attracting students (eg, high tuition), it has been suggested that full department status adds visibility to a specialty that has high appeal a m o n g i n c o m i n g students and so will aid medical student recruitment. Service in such spheres as prehospital care, poison center leadership, hyperbaric medicine, and community service has been cited by some emergency physicians as important.
106/796
Unless there is a more direct academic result, these services can not substitute for the more traditional areas of teaching and research. They are, however, probably helpful in establishing a positive reputation for the department within the community and among the faculty.
SUMMARY As the specialty of e m e r g e n c y medicine matures, a natural development is the establishment of academic d e p a r t m e n t s of emergency medicine w i t h i n medical schools. This process has been continuous since the first department was established in 1971. Initially, this process was highly dependent on individual effort and favorable local political circumstances. In m a n y ways, this remains the case; however, this process has become much more deliberate as emergency physicians realize the benefits of academic autonomy. The a t t a i n m e n t of academic department status has become m u c h
Annals of Emergency Medicine
more common, and there is no reason to believe that the trend will abate. In reviewing past experiences, e m e r g e n c y p h y s i c i a n s h a v e successfully attained academic department status in an effort to improve patient care, provide better education, and enhance scholarly achievement. This specialty must learn from the lessons of the past to be effective in continuing the advancement of emergency medicine. (An appendix giving information on individual departments is available from the author.) The author gratefully acknowledges Suzanne Shepherd, MD, and Glenn Hamilton, MD, of the Society for Academic Emergency Medicine for their valuable insight. John Moorhead, MD; Jo Ellen Linder, MD~ Gregg Pane, MD; Timothy Schaefer, MD; Keith Sivertson, MD; Gloria Thompson, MD; Richard Aghababian, MD; John McCabe, MD; and Michael Gallery, PhD, of the Academic Affairs Committee were helpful in their review of the manuscript.
19:7 July 1990
