growing pains

412 COMMENTARIES Weber • GROWTH OF ANNUAL MEETING

Growing Pains

Perhaps you’ve seen the ad.In a small office, a group of

12 or so casually-dressed dot-com-ers huddle around a com-puter as their web site goes live.They see the total order fieldclick from zero to one. Theycheer. Three more clicks, thenfive, then 12; the orders are com-ing slowly enough that they canread each one as it is added tothe total score. The cheering con-tinues. But now the totalschange by 10s, no, by 100s, andas the orders skyrocket, thecheering dies down, the facesnow filled with consternation.How will they handle their suc-cess?

Academic emergency medi-cine (EM) has indeed been suc-cessful: in its recognition as aspecialty, in gaining departmentstatus in so many institutions, inhaving our studies published inmajor venues, influencing prac-tice and research beyond therealm of the emergency depart-ment, in encouraging moreyoung physicians to join ourranks.

And with that success hascome growth. As part of myhomework for this article, I re-read the messages of our lastthree program chairs and wasstruck, as they were, with thephenomenal growth of the Soci-ety for Academic EmergencyMedicine (SAEM) annual meet-ing in the past decade. I won’tbore you with statistics, but suf-fice it to say that the number andquality of the research abstracts,the variety and sophistication ofour didactic sessions, the exper-tise and experience of our speak-ers, not to mention our atten-dance, have all burgeoned sincethis society was founded as anorganization with a differentname.

But as in the commercial,

there can be a downside togrowth. It is not simply the com-plexity of putting on a meetingthat 1,500 people attend. Biggergroups require more schedulesand more rules. In our oral re-search sessions, the obligatorytime limits do not allow us tobuild in a true give and take—one question, one answer. Next!Larger groups intimidate someof us, so we don’t speak up, askquestions, or make commentsthat might be worth sharing.What if Ian Stiell is listening tomy dumb question about recur-sive partitioning, or Roger Lewishears me make a comment aboutthe sample size? So perhaps weare too careful. Others may betoo critical of the presentation,wanting to demonstrate theirknowledge to the Ians and Rog-ers or simply to their colleaguesand residents in the room. Andsome are really curious, or wantto help the presenter, but thedark room, the time limit, themicrophone, the size of the group,the formality all get in the way.Whichever way it goes, the com-mentary is awkward and limited.It is a natural reaction to the set-ting and the rules.

When sitting in these ses-sions, I’ve wondered how we canensure that as our meetinggrows, we do not lose sight of ourgoal: to foster quality research,improve our educational exper-tise, and expand the influence ofour specialty. How can the pre-senter gain really helpful insightinto improving her or his re-search? How can those who areinterested start to collaborate?How can we really get to knowand, even more importantly,trust each other so we can effectchange where it is needed?

At a time when the healthcare system is on its knees, fail-ing to meet the needs of patients,

short of nurses, inefficient, un-derfunded, unresponsive, anderror-prone, using antiquatedinformation systems and labor-intensive processes, it seems abit mundane to write an articleabout how we run the SAEM an-nual meeting. As emergency phy-sicians, we see daily the failuresof the health care system, notjust among the poor and unin-sured, but among the most afflu-ent, insured populations whocan’t get past the secretary to geta test result from their physi-cians, who wait weeks for an ap-pointment or a test, who—evenwith a primary care physician—are bounced from specialist tospecialist and test to test. We alsosee those who miss the three-hour window for the stroke pro-tocol, those who continue to die inalcohol-related car crashes. Wehave readjusted our work pat-terns to avoid the threat of Emer-gency Medical Treatment andActive Labor Act (EMTALA) vio-lations, a Health Care FinancingAdministration (HCFA) audit, ora lawsuit. There is only one wayI see us addressing both theknowledge and organizationalneeds of our health care non-sys-tem, and that is to do it together.

I passionately believe the an-nual meeting is more than aplace to report on our work orhear what others are doing,and then go back to our indi-vidual institutions, doing re-search in a single small depart-ment, or fighting lonely battleswith HCFA or the particularhealth maintenance organization(HMO) that is threatening todeny payments for a particularpatient. Be it research, educa-tional endeavors, or improvingthe delivery of health care, wemust come together, interact, or-ganize, collaborate, and create.The annual meeting is not just arepository of information andideas, but a time for newthoughts, inspiration, and plan-ning.

Thanks to Sue Stern, outgo-

ACADEMIC EMERGENCY MEDICINE • May 2001, Volume 8, Number 5 413

ing Program Chair, and her com-mittee, I know that many of youfeel the same way. Sue thoughtit was time we knew just whatmembers thought was good andbad about the annual meeting;she asked Robert Neumar tohead up a task force to surveythe membership. Members were,on the whole, quite satisfied withthe meeting, but the findingsalso included a strong message:the need for more time and op-portunities to talk, meet mem-bers, discuss our research (notjust present it), share ideas fornew projects, and move them for-ward.

That is the challenge for agrowing organization and agrowing meeting. In the past fewyears, several new and success-ful features were added to themeeting to respond to this chal-lenge: selected oral paper ses-sions were lengthened to allowfor audience discussion; the mod-erated poster sessions were re-placed by a combination of dis-cussion poster sessions, in whichgroups of like-minded research-ers present their projects anddiscuss next steps, and interac-tive poster sessions allowing one-on-one discussion between pre-senter and viewer.

This year we have moved fur-ther in this direction, with ourdidactics, research presenta-tions, speakers, and extracurric-ular activities. The banquet willbe held the first night of themeeting to allow many more

of us to attend. We’ve addedseveral late-afternoon recep-tions, and complimentary buffetlunches, where you can meet re-search presenters, catch up withfriends, and be introduced toother SAEM members. There’san ‘‘evening activity’’ where youcan learn more about your palmtop in an informal setting withdrinks and snacks. We are verypleased to have as our keynotespeaker Dr. William Foege, for-mer director of the Centers forDisease Control and Prevention(CDC) and a strong proponent ofEM. His speech is followed by areception where we can talk withDr. Foege and each other abouthis ideas. We’ve increased thenumber of state-of-the-art ses-sions and for many have broughtin speakers from outside EM tohelp foster collaboration in re-search. Experts on leadership,cultural and gender barriers,shiftwork, and government af-fairs will lead a number of ourfaculty development didactics, agood place to improve your skills,interact with colleagues, and ex-pand your horizons.

Of course we’ve continued thehighly successful discussion per-iods in selected oral paper pre-sentations, and the poster ses-sion formats that have been sowell received. And I’m personallyon a crusade to warm up therooms and put the lights on forquestions or discussion. Feel freeto stop me in the halls to let meknow if it isn’t happening . . . or

if you have other suggestions forimprovements.

We have a really excellentcrop of oral and poster presen-tations, a truly outstanding se-lection of didactic sessions, a newand ever-improving photographyexhibit and visual diagnosis con-test, medical student and chiefresidents forum—and a shorterbusiness meeting. The people tothank for this are Diane Gorgas,Chair of the Medical Student/Resident Subcommittee; DavidGuss, Didactic SubcommitteeChair; Bob Neumar, ScientificSubcommittee Chair (and alsothe leader of the needs assess-ment task force); Knox Todd, Re-gional Subcommittee Chair, anda very hard-working and enthu-siastic Program Committee. Spe-cial thanks to Art Kellermann forhis considerable assistance in ar-ranging speakers and introduc-ing us to his home town. Mostimportantly, thanks to all of youfor your thoughtful input on im-proving the annual meeting, andfor submitting so many excellentresearch abstracts and didacticproposals, which are the truemeasure of our continuedsuccess.—ELLEN WEBER, MD(weber@itsa.ucsf.edu), AssociateProfessor, Division of EmergencyMedicine, University of Califor-nia, San Francisco, San Fran-cisco, CA

Key words. Society for AcademicEmergency Medicine; annual meet-ing; growth.