From the Chair: Thoughts from your Lame Duck
Critical Care Medicine Section
July 2007, Vol 8, #2
David T. Huang, MD, MPH
In my last newsletter article as your section chair, I would like to take this opportunity to reflect a bit on what we have accomplished in the last two years, and offer a few thoughts on how we can keep moving forward. As clichéd as it sounds, it honestly does not seem very long ago that I was a green junior emergency medicine (EM) resident attending my first American College of Emergency Physicians’ Section of Critical Care Medicine meeting and asking the chair at that time (Edward J. Kimball, MD,FACEP), "Gosh, is it possible for an EM resident to do a Critical Care Medicine (CCM) fellowship?"
Looking back over the last few years, I believe we’ve accomplished a good deal. Interest, and even to some degree, acceptance, of EM-CCM is growing; ACEP is an active part of the international Surviving Sepsis Campaign (SSC); the 2001 landmark publication of Early Goal Directed Therapy (EGDT) has triggered collaborative ED-Intensive Care Unit (ICU) quality improvement and research activity worldwide; and our own little Section has significantly grown in size.
Yet many challenges remain–CCM certification for EM physicians still remains an elusive goal, continued work will be needed to ensure continued ACEP and EM involvement as the SSC grows and changes, new ED-ICU clinical and academic collaborations will require ongoing leadership and intensive groundwork to maintain and grow these new alliances. It is not enough for our section to merely grow numerically in membership–it must also produce, in the form of focused, feasible, projects.
How to continue our momentum then and overcome these challenges? I certainly do not pretend to have all the answers, but permit your lame duck to wax poetic over a few principles I’ve come to strongly believe in:
First, politics is most definitely the art of the possible. Effecting real change requires a combination of both realpolitik and idealism; the former alone is morally bereft, while the latter, unguided and unchannelled, is typically ineffective. For small groups, like ours, collaboration over shared agendas with larger groups is essential. Half the battle truly is just showing up. This is not to encourage sloth and clock punching, but rather the opposite. That is, simply staying aware and engaged with current issues is half of the battle. If good clinicians and good researchers completely eschew politics, then the resulting political leaders will be the ones we deserve. Regarding the issue of CCM certification, I believe that it will be our collective, persistent, coordinated, steady, and firm influence that will ultimately achieve our goal.
Second, politics is also most definitely local. As I have written before, it is the daily, local, interactions we have with our medical colleagues that will slowly change minds, such that perhaps a decade from now EM-CCM will not be an oddity, but simply a normal, accepted part of the house of medicine. It will be the combination of national, organized activity and widespread, local, relationships that will ultimately effect change. Local, collaborative, EM-CCM training programs (such as the newly created program described in this newsletter), and ED-ICU quality improvement efforts are the focused, specific projects that are exactly the type of activities needed.
Third, good EM-CCM research is also necessary. Of the academic "triple-threat" of old (education, patient care, research), research efforts are arguably the most influential. The landmark EGDT publication changed the way all of medicine, including CCM, viewed EM. More such work is required. The clinical practice of EM is by its nature broad and quick-result oriented, and CCM is actually fairly similar. In contrast, good research requires exquisite attention to detail and results take months, if not years. And like any endeavor or field, research has its share of pain, cut, and squabbles. But the prize–a lasting contribution to science that raises the profile of EM-CCM – is well worth it. For those entering a fellowship, I encourage you to seek out a mentor, and at least try research on for size–you might like it!
Fourth, it is absolutely imperative that all new EM-CCM physicians dedicate themselves with a passion to their clinical, academic, and administrative work, as without our passion and energy, EM-CCM will not grow. For those EM residents about to enter a CCM fellowship, this is not merely another 1-2 years of "extra" residency, but rather a critically important point in your careers where you can learn and explore more than at any other time in your life. Make it your goal to be the best fellow in your class–providing the best clinical care, the best journal club presentations, and the best organizational skills. It will not only be you that is being judged, but like it or not, also your specialty of EM. To put it bluntly, if Internal Medicine (IM)-CCM fellow X screws up, it will only be that fellow who is criticized, not his/her specialty. But if EM-CCM fellow Y screws up, it will be both! Fortunately, the more positive converse also holds true. Of course this applies to new, young, EM-CCM faculty as well–one of the greatest "fringe benefits" of being section chair has been getting to meet, and sometimes work with, like-minded, young, EM-CCM faculty from across the country–it is these relationships, and productivity, that helps enrich academic and organized medicine, and sustains our energy. I hope that your membership in our section has also proved similarly fruitful–our listserv, newsletters, and annual meetings serve to enhance communication and collaboration–take an active part in them!
In conclusion, it has been my pleasure and honor to serve as your section chair for the last two years, and I hope our section’s efforts have proved useful to you. I wish the incoming chair, Todd Slesinger, MD, FACEP, good luck during his tenure, and the candidates for the new chair-elect (see elsewhere in the newsletter for how to run!) good luck in the election.
I hope to see many of you in Seattle!
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