EDITORIALS Is Emergency Medicine Research Viable? An active research program in an Emergency Medicine residency is an integral and essential c o m p o n e n t that broadens the potential of any future emergency physician in academia. However, Emergency Medicine research currently faces some major dilemmas. The majority of our residency programs are inadequately structured and do not provide the opportunity for good basic science research. The programs do not have faculty with strong backgrounds in research to provide the proper guidance to the residents. The high demand in community hospitals for emergency physicians and the short time each program devotes to research preclude the opportunity to provide an in-depth foundation in the intricacies of basic research. There is no single system or approach for providing research education and experience to residents that will work for all residency programs. Research programs develop through a combination of the needs and goals of the residency and the resources available. The resources currently available to emergency medicine residencies for developing effective basic science and clinical research (ie, research-trained emergency physicians, research dollars, laboratory space) are severely limited. One potential solution would be to divide residencies into academic and clinical. Academic programs would require one or more extra years and provide residents with a formal, structured research program that would enable them to conduct independent studies. These physicians would qualify for academic appointments (as they do in England and Australia). Many residencies in other specialties, such as surgery, require one to two years of formal research training and emphasize their training as specifically for an academic practice. Because most residents who train in emergency medicine practice in c o m m u n i t y hospitals, those programs emphasizing clinical skills would devote more time to developing the clinical knowledge base and administrative skills of their residents. Another approach to training emergency physicians for research-oriented academic careers is to place greater emphasis on emergency medicine research fellowships. Oneor two-year research or academically oriented fellowships should be seen as necessary for an academic appointment. We need to encourage more residency graduates to follow this course if they intend to pursue an academic career. All too often, physicians are hired immediately out of a residency, made assistant professors, and are given re-

search responsibilities. Program directors m u s t realize that this places unrealistic expectations on young faculty and does not give them time to obtain the basic skills necessary to advance. Furthermore, it leads to poorly designed and conducted research that may be seen by impressionable residents as how research should be done. It is better to have no research program than one where residents fail to learn a careful, methodical approach to answering clinical or basic science questions. If emergency medicine research is to be viable, the specialty must look outside its discipline to find individuals who can provide research expertise for the residents and faculty. Other specialties commonly employ nonclinical (ie, PhD) faculty to assist in resident training and to maintain m o m e n t u m in departmental research programs. A PhD with a proper track record of research can provide not only the knowledge and experience necessary to conduct laboratory research, but may also be a valuable resource for clinical study design. This provides young faculty with a research-oriented role model and a source for research education for residents. Of course, there are issues such as cost and finding a person who is interested in research and training residents. Several programs have solved these problems and currently have very successful research programs. Is emergency medicine research viable? No doubt the quantity of research from emergency medicine will continue to increase; it is the quality that is still in question. Until the standards for an academic and/or research appointment are raised and applicants are willing to extend their training for an academic position, emergency medicine research will continue to struggle.

John P Heggers, PhD Shriners Burn Institute Galveston, Texas Hubert S Mickel, MD Bethesda, Maryland James E Olson, PhD Wright State University School of Medicine, Cox Institute Kettering, Ohio William H Spivey, MD Department of Emergency Medicine The Medical College of Pennsylvania Philadelphia

Annals & Academic Respectability This editorial explores the issues of funding and publications from an investigator's viewpoint. While this opinion may not be entirely palatable to many clinicians or academic emergency physicians, it presents the realities of research and funding as I see them. 19:11 Novem be r 1990

The ultimate goal of research in medicine is better patient care, both now and in the future. The real battlefields, however, are not patient care, but money, power, prestige, and intellectual rigor, with m o n e y being the number one issue. The availability of tax-derived medical

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