SGIM

FORUMSociety of GeneralInternal MedicineTO PROMOTEIMPROVED PATIENTCARE, RESEARCH,AND EDUCATION INPRIMARY CARE

Volume 23 • Number 3 • March 2000

FOLLOW YOUR HEART:THE HORN SCHOLARSPROGRAMCarole Warde, MD

continued on page 7

Eleven years ago, Mary Horn, a youngphysician and member of SGIM,was the master of balance. As a full-

time clinician–educator at a UCLA-affili-ated internal medicine residency program,she was a professional success on manyfronts. An astute clinician who listenedto her patients, colleagues, and studentswith an open mind, a compassionateheart, and a witty disposition, she was alsodedicated to serving indigent patients. Asan educator, it was crystal clear to her thatwe needed to change the way we wereteaching young physicians about ambu-latory care, and she set about doing it. Asa wife and mother of three young chil-dren, these same attributes enabled herto organize the household, be emotion-ally available for her family, and help themachieve their desired goals and fulfill theirnecessary responsibilities. Mary was agreat doctor, a great teacher, and a greatwife and mother. She was doing it all!

In 1990, then an Assistant ClinicalProfessor of Medicine, Dr. Mary Horndecided she could no longer balance herfamily responsibilities with the demandsof a full-time position in academic medi-cine and fulfill both roles as she wanted.She told her chief that she was going tohave to leave her position to find a half-time job, assuming that she would not beable to continue with the residency pro-gram if she worked only half time. But itwas clear to both her chief and assistantchief that the program needed Mary. Theycreated a split full-time position, some-

thing they had never done, something noother UCLA-affiliated hospital had done.They did it and they felt lucky to be ableto keep such a fine individual workingwith them. A few years later, her promo-tion to the rank of Associate Professor ofMedicine was without precedent; her aca-demic achievements spoke for themselves.

In early 1996, Mary began to experi-ence the initial signs of what later wasdiagnosed as amyotrophic lateral sclero-sis. As a physician, she was well aware ofwhat was happening to her. As a patient,she struggled with the diagnosis. From hersorrow and pain, she rose to fulfill her roleas teacher. This time, though, she had theimportant message of teaching her stu-dents what it was like to be a patient witha terminal illness. She continued to teachand see patients until only a few weeksbefore her death. Through her recent ar-ticle in the Annals of Internal Medicineabout patient–physician relationships, hermessage will continue to be heard (AnnIntern Med. 1999;130:940–1).

The end of the story is not tragic!Mary O’Flaherty Horn is the mentor weall need today. As a physician, she wasdedicated to general internal medicineand truly was a gifted clinician. Her in-tellect, intuition, straightforward style,and empathy made her one of the bestclinical teachers. However, Mary’s uniquerole as a mentor was the example she setin choosing her priorities and followingher heart. She was willing to give up the

Contents1 Follow Your Heart: The Horn Scholars

Program

2 News from the Regions

3 President’s Column

4 Innovation, Interest Groups, and theZlinkoff Foundation

4 Clinical Crossroads Comes to SGIM

5 Health Policy Review 1999

5 Vanessa N. Gamble to Lead AAMCCommunity and Minority Programs

6 Research Funding Corner

6 SUMSearch: A New Way to LocateMedical Evidence

7 New Members: California, MountainWest, and Northwest Regions

15 Classified Ads

2

SGIM FORUM

SOCIETY OF GENERAL INTERNAL MEDICINE

OFFICERS

PRESIDENT

C. Seth Landefeld, MD • San Francisco, CAsethL@medicine.ucsf.edu • (415) 750-6625

PRESIDENT-ELECT

Sankey V. Williams, MD • Philadelphia, PAsankey@wharton.upenn.edu • (215) 662-3795

IMMEDIATE PAST-PRESIDENT

Stephan D. Fihn, MD, MPH • Seattle, WAsfihn@u.washington.edu • (206) 764-2651

TREASURER

Kurt Kroenke, MD • Indianapolis, INKroenke_K@regenstrief.iupui.edu • (317) 630-7447

TREASURER-ELECT

Brent G. Petty, MD • Baltimore, MDbpetty@welchlink.welch.jhu.edu • (410) 955-8181

COUNCIL

Michael J. Barry, MD • Boston, MAmbarry@partners.org • (617) 726-4106

James C. Byrd, MD, MPH • Greenville, NCjbyrd@brody.med.ecu.edu • (919) 816-4633

Pamela Charney, MD, FACP • New York, NYcharney@aecom.yu.edu • (718) 918-7463

Martha Gerrity, MD, MPH, PhD • Portland, ORgerritym@ohsu.edu • (503) 494-6656

Catherine R. Lucey, MD • Washington, DCcrll@MHG.edu • (202) 877-6749

Valerie Stone, MD, MPH • Providence, RIValerie_Stone@mhri.org • (401) 729-2395

EX OFFICIORegional CoordinatorBruce A. Chernof • Woodland Hills, CAbruce.chernof@healthnet.com • (818) 823-4471

Editor, Journal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineEric B. Bass, MD • Baltimore, MDebass@jhmi.edu • (410) 955-9868

Editor, SGIM ForumSGIM ForumSGIM ForumSGIM ForumSGIM ForumDavid R. Calkins, MD, MPP • Boston, MAdavid_calkins@hms.harvard.edu • (617) 432-3666

HEALTH POLICY CONSULTANT

Robert E. Blaser • Washington, DCrblaser@mail.acponline.org • (202) 261-4551

EXECUTIVE DIRECTOR

David Karlson, PhD2501 M Street, NW, Suite 575Washington, DC 20037

KarlsonD@sgim.org(800) 822-3060(202) 887-5150, 887-5405 FAX

NEWS FROM THE REGIONS

Over 100 Members Participate inMidwest Regional MeetingGary Martin, MD

The Midwest Region had a verysuccessful meeting this past fall inChicago. Over 100 members

attended. Members participated in arecord number of abstract presentationsand in a diverse mix of workshops andpanel discussions. The keynote speechwas given by Carolyn Clancy, MD, on“New Directions in Evidence-BasedHealthcare: The View from AHCPR.”Ahsan Arozullah, MD, and MargaretBrunt, MD, received trainee awards forbest abstract presentations. KarynBaum, MD, received the junior facultyaward for best abstract presentation.

Marshall Chin, MD, will succeed GaryMartin, MD, as regional president.

The Midwest Regional Meeting washeld in conjunction with the MidwestAFMR and Central Society for ClinicalResearch. For the first time the meetingalso was coordinated with the IllinoisChapter of the American College ofPhysicians. The Illinois governor for theACP came to the meeting, and themeeting was highlighted in the IllinoisACP newsletter. Midwest SGIMmembers also helped coordinate theIllinois ACP meeting that occurred1 month later. SGIM

Genetics in Primary Care (GPC) is a new,federally funded faculty development initia-

tive to improve training in genetics for medical stu-dents and primary care residents. GPC will trainteams of 3–5 faculty from 8–10 medical schools and/or residency programs to implement faculty devel-opment activities at their home institutions/pro-grams. Two training sessions will be conducted ap-proximately 6 months apart with implementationback home occurring during the interim period.

Genetics inPrimary Care:A FacultyDevelopmentInitiative

The training sessions are currently slated to occur in late September/early October 2000and Spring 2001. Team membership must include at least three faculty members repre-senting family medicine, general internal medicine, and/or general pediatrics. A geneticsfaculty member is recommended. Other faculty members may participate.Selection of teams will be based on competitiveness of individual team applications ac-cording to review criteria specified in the RFP as well as on aggregate representationacross all teams of specialties and faculty responsibilities. A stipend will be provided toeach team to support team members’ participation in the two training sessions.The anticipated timeline for GPC is as follows:

Early April—Issuance of Request for ProposalsJune 1—Deadline for receipt of proposalsJuly 1—Notification of selectionJuly–September—Needs assessment activities undertaken by selected teamsLate September/early October 2000—1st training sessionSpring 2001—2nd training session

GPC is funded by the Health Resources and Services Administration with supportfrom the National Institutes of Health and the Agency for Healthcare Research andQuality. GPC is administered by the Society of Teachers of Family Medicine. Programinformation is available on the GPC Website (http://www.hrsa.gov/bhpr/dm/genpc.html).Potential applicants should contact Ardis Davis, MSW, GPC Project Manager, atardisd7283@aol.com.

3

PRESIDENT’S COLUMN

SGIM

FORUM

Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine.SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists andthose engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do notrepresent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, andchallenge readers’ opinions.SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist theauthor in directing a piece to the editor to whom its content is most appropriate.The SGIM World-Wide Website is located at http://www.sgim.org

EDITOR

David R. Calkins, MD, MPP • Boston, MAdavid_calkins@hms.harvard.edu • (617) 432-3666

EDITORIAL COORDINATOR

Stacy A. McGrath • Boston, MAstacy_mcgrath@hms.harvard.edu • (617) 432-3667(617) 432-3635 FAX

ASSOCIATE EDITORS

Jasjit S. Ahluwalia, MD, MPH, MS • Kansas City, KSjahluwal@kumc.edu • (913) 588-2774

James C. Byrd, MD, MPH • Greenville, NCjbyrd@brody.med.ecu.edu • (919) 816-4633

Giselle Corbie-Smith, MD • Atlanta, GAgcorbie@emory.edu • (404) 616-7490

David Lee, MD • Boise, IDlee.david@boise.va.gov • (208) 422-1102

Mark Liebow, MD, MPH • Rochester, MNmliebow@mayo.edu • (507) 284-1551

Jeannette M. Shorey, MD • Boston, MAJeannette_Shorey@harvardpilgrim.org • (617) 421-2625

Valerie Stone, MD, MPH • Providence, RIValerie_Stone@mhri.org • (401) 729-2395

Brent Williams, MD • Ann Arbor, MIbwilliam@umich.edu • (734) 936-5222

Ellen F. Yee, MD, MPH • Los Angeles, CAefyee@ucla.edu • (818) 891-7711 Ext. 5275

LIVING OUR DREAMSC. Seth Landefeld, MD

continued on page 8

Sunday night, February 13. Winterin northern California. Fiftydegrees, but intemperate in every

other way. Rain in inches and inches,wind like a tornado that won’t move on.Waiting for a window to blow in, as onedid at our neighbor’s. I won’t be able tosleep much, but at least I’m home.

I just returned from the SGIMCouncil’s winter retreat. We met at LaCosta Resort and Spa, a lush spot in themidst of 36 holes of golf in rolling hills30 miles north of San Diego. As I wrotea few months ago, I was ambivalentabout this setting—a personal melangeof concern about cost, memories of along, hot summer caddying but notplaying golf, and a wayward geneticpredisposition to the ascetic, to hairshirts over mud baths (in public, atleast!). In fact, La Costa forced me tosublimate that predisposition and toenjoy temperate southern California. Itall began at the airport, where ValerieStone, Steve Fihn, and I were met byone of those white stretch limos withalmost as much tinted glass as preten-sion. When we arrived Brent Pettygreeted us, delighted by the irony of mestepping from such an exotic set ofwheels; I only wished I had a cigar tooffer him. The accommodations weren’texactly humble-pie, but after the limo,they were nothing special. We allsurvived quite nicely; none of us fell inany of the fountains sprinkled around,and we didn’t have to rescue anyonefrom a mud bath, hot tub, or sand trap.In fact, Steve, Pam Charney, MarthaGerrity, and I even beat a retreat fromour landlocked paradise long enough toget to the beach a few miles away.

It was a great retreat. After mypiece on “Resort or Retreat?” some ofyou wrote, hoping that Council mighthave “time away, in retreat, from dailyconcerns and distractions, to allow themind to soar upward,” that we might

find “the rightkind of meetingplace for aproductivemeeting tooccur.” La Costawas all that, andmore.

At theretreat I sawSGIM in thecontext of Eleanor Roosevelt’s idea thatthose who live their dreams own thefuture. SGIM is living its dreams. Weare on our way to owning our future.I hope some of the highlights of theretreat will convince you of this, too.

A Memory, a Celebration, and aNew BeginningAfter we got in Wednesday evening, we

had dinner together andcelebrated SGIM’s firstendowed faculty develop-ment program: the MaryO’Flaherty Horn Scholarsin General InternalMedicine. This wonderfulprogram honors MaryHorn, a SGIM memberwho died recently. TheHorn Scholars Program

aims to support exemplars of thebalance of work and family life, SGIMmembers who, like Mary Horn, willpioneer new personal and professionalpaths to achieve this balance. Weshared the evening with the visionariesand benefactors who started theProgram: Louise O’Flaherty, Mary’smother; Darwin Horn, her husband;

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SGIM FORUM

Clinical Crossroads Comes to SGIMErin Hartman, MS

continued on page 10

Every day people face dilemmas withtheir health, their doctors, and the

medical care system. Often, patientscome to a point in their illness whenthey face a crossroads—several treat-ments are available, and they needguidance and information on which tochoose. Published monthly in JAMA fornearly 5 years, Clinical Crossroads is amodern-day CPC focusing on patientsand doctors who together face difficultclinical decisions. The patient andprimary care physician are interviewedon videotape, a portion of which isshown at the live conference, illustrat-ing both the patient’s and physician’sperspective. In the presentation, anexpert provides a critical review of thelatest treatment options for the patientand engages in a discussion with theaudience, all of which is included in thefinal Clinical Crossroads article inJAMA. Often, patients and familiesattend the conference and participate inthe discussion.

Traditionally, Clinical Crossroadsoriginates at different grand roundsconferences at Boston’s Beth IsraelDeaconess Medical Center (59 confer-

ences to date). This year, for the firsttime, the SGIM Annual Meeting willhost a live Clinical Crossroads confer-ence. Jennifer Daley, MD, will discuss“A Patient Dissatisfied with the Qualityof Her Care.” Drawing on the patient’sexperiences with the health care system,Dr. Daley will develop an evidence-based strategy for improving the qualityof care the patient encountered. Ageneral internist and one of the found-ing editors of Clinical Crossroads, Dr.Daley directs the Center for HealthSystem Design and Evaluation atMassachusetts General Hospital.

At Beth Israel Deaconess MedicalCenter and Harvard Medical School,general internists Tom Delbanco, MD,Richard Parker, MD, and Ann-MarieAudet, MD, along with ManagingEditor, Erin Hartman, MS, produce andedit the series. Margaret Winker, MD,Deputy Editor, JAMA, is their partnerin Chicago. The Robert Wood JohnsonFoundation funds Clinical Crossroads,which was initially conceived in part bythe Foundation’s President, StevenSchroeder, MD. SGIM

In the past year, the Zlinkoff Founda-tion has funded several SGIMinitiatives. The first was an Innova-

tions Retreat chaired by LisaRubenstein and Martha Gerrity inSeptember 1998. This retreat broughttogether a small group of SGIMmembers representing diverse stake-holder groups to develop strategies forinnovation within our Society. Theinitiative benefited from the extensiveinnovations experience of two profes-sional facilitators, Tom Gillette and HalSprague, who donated their time insupport of SGIM. Retreat participantsidentified three underlying innovationsgoals and a number of concrete initialstrategies. The goals were:◆ To foster the “bubbling up” of

innovation from the many diversesources to be found among the SGIMmembership;

◆ To turn the innovative ideas, prod-ucts, and values represented by ourAnnual Meeting and Journal intoyear-round development and outreachactivities that empower and showcasemembers; and

◆ To bring opportunities for innovationto members where they are throughcreative use of computer technology.

Some of the initial strategies wereimplemented at the 1999 AnnualMeeting in San Francisco this past May.Carolyn Clancy, Program Chair,discussed these innovations in aprevious Forum article summarizing the1999 Annual Meeting. A particularlysuccessful addition to the AnnualMeeting was the Innovations inMedical Education session.

Another proposed strategy was toidentify financial support for SGIM’sInterest Groups, which have an impres-sive track record of innovation. In thespring of 1999 the Zlinkoff Foundationgave SGIM a grant of $15,000 tosupport the activities of Interest Groups.

INNOVATION, INTEREST GROUPS, ANDTHE ZLINKOFF FOUNDATIONKurt Kroenke, MD, and Lisa V. Rubenstein, MD, MSPH

This support was timely. In less than 20years, SGIM has grown from a smallprofessional society of only a fewhundred members to its current size ofover 2800 members. For one member toknow most or even many of the othermembers is no longer feasible. Rather,small groups, each centered around aparticular interest, are essential for alarger organization to sustain its vitality,intimacy, and relevance for individualmembers. Small groups also foster amember’s connectedness to SGIM

during the 12 months between AnnualMeetings.

With the Zlinkoff funding as acatalyst, SGIM issued a call for InterestGroup proposals. Applications were duethis past June. The criteria for evaluat-ing proposals were that they be innova-tive, relevant to SGIM’s mission,achievable within 1 year, important tothe Interest Group’s development overtime, and sustainable after the start-upyear.

5

Health Policy Review 1999Mark Liebow, MD, MPH

continued on page 12continued on page 11

Vanessa N. Gamble toLead AAMCCommunity andMinority ProgramsGiselle Corbie-Smith, MD

Nineteen ninety-nine was not abad year for SGIM’s healthpolicy interests. Some threats

were averted, and we had some pleasantsurprises. It was not a big year fordefinitive legislative action, other thanappropriations, but several controversialideas were discussed publicly or evenvoted on in the House or Senate. Therewere some important resignations inhigh Federal health positions. The 2000campaign, a change in the WhiteHouse, and a possible change in thecontrol of the House of Representativesall loomed larger as the year ended. Thisarticle will review briefly what hap-pened in the health policy areas mostimportant to SGIMmembers.

Federal funding forhealth services researchincreased significantly.The Agency for HealthCare Policy and Re-search (AHCPR) got anew name and anadditional 25 milliondollars. The newname—Agency forHealthcare Research and Quality(AHRQ)—came as part of a reauthori-zation that passed toward the end of thelegislative session. AHCPR’s authoriza-tion from Congress had run out severalyears ago, and the Agency was socontroversial that it had not beenpossible to get a reauthorization billthrough until this year. While reautho-rization has not been a requirement forappropriations in recent years, reautho-rization is a vote of confidence byCongress in an agency and is helpfulwhen appropriations are being consid-ered. The reauthorization bill was oneof the pleasant surprises of the year. Fewof us would have predicted this wouldhave happened as late as September 1.There was a brief delay in the heat of

late session maneuvers getting Houseand Senate reauthorization billsreconciled while staff argued aboutwhether “Healthcare” would be oneword or two. Obviously, those in favorof one word won, which makes for abetter acronym.

The National Institutes of Health(NIH) officially got a 2 billion dollarincrease in its funding, but like manyagencies, a big chunk of its fundingcan’t be spent until the last 2 days ofthe fiscal year. This was done tomaintain the fiction that the 1997budget caps were being adhered to. It’snot clear how much this will affectNIH’s ability to fund grants this year.

The NIH Director has resigned and,while there are rumors about who mightreplace him, I’m not sure anyone fromoutside the NIH would want to take thejob in the last year of a presidency.

Title VII programs received aboutthe same funding for Fiscal Year 2000 asthey had for 1999, even though theAdministration’s budget had proposedto eliminate funding for them. TheAdvisory Committee on Primary CareTraining in Medicine and Dentistry wasformed and met last year. Generalinternists are underrepresented on theCommittee in terms of the percentageof programs we run or dollars we get.SGIM hopes to rectify this situationover time.

Nineteen ninety-nine was not abad year for SGIM’s healthpolicy interests. Some threatswere averted, and we had somepleasant surprises.

The Association of American MedicalColleges (AAMC) has announced

the appointment of Vanessa N. Gamble,MD, PhD, as Vice President, Commu-nity and Minority Programs. Dr.Gamble succeeds Herbert W. Nickens,MD, who died suddenly last spring. Dr.Gamble officially assumed her newposition in January 2000. Dr. Gamblehas a long personal and professionalinterest in the influence of race andracism on American medicine. In herfirst book, The Black CommunityHospital: Contemporary Dilemma inHistorical Perspective, she examined howthe issues of race and racism shaped thedevelopment of the American healthsystem. She went on to write GermsHave No Color Line: Blacks and Ameri-can Medicine, 1900–1945 and the awardwinning Making a Place for Ourselves:the Black Hospital Movement, 1920–1945.

Dr. Gamble completed her under-graduate work in Medical Sociology andHuman Biology at Hampshire Collegewith a senior thesis on the TuskegeeSyphilis Study. She completed her MDand a PhD in History and Sociology ofScience at the University of Pennsylva-nia and did family medicine residencytraining at the University of Massachu-setts. Her background in sociology,history, and medicine has allowed her tobring a broad perspective to theproblem of race and ethnic disparities inhealth.

Dr. Gamble comes to the AAMCfrom the University of Wisconsin,where she joined the faculty in 1989.While at the University of Wisconsin,she developed one of the first courses inthe country for undergraduates on thehistory of race, American medicine, andpublic health. As the first and onlyAfrican American woman tenured inthe School of Medicine, she was able to

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SGIM FORUM

Legislation passedby the onehundred sixth

U.S. Congress andsigned by the Presidentin December, 1999,amended Title IX of thePublic Health ServiceAct (42 U.S.C.299 etseq.) to mandate theestablishment withinthe new Agency forHealthcare Researchand Quality (AHRQ),formerly known as theAgency for Health CarePolicy and Research(AHCPR), a Center forPrimary Care Research (CPCR) to“serve as the principal source of fundingfor primary care practice research in theDepartment of Health and HumanServices.”

This month’s Research FundingCorner features a special interview withHelen Burstin, MD, MPH, the newDirector of the Center for Primary CareResearch. She comes to this positionfrom the Brigham and Women’sHospital where she was a health servicesresearcher, Director of Quality Measure-ment, and an active primary carephysician. Dr. Burstin also was AssistantProfessor of Medicine at HarvardMedical School. Dr. Burstin graduatedfrom the State University of New Yorkat Syracuse and the Harvard School ofPublic Health. After a primary careresidency in internal medicine atBoston City Hospital, she completed ageneral internal medicine fellowship atHarvard Medical School. Her researchhas focused on such primary care topicsas communication, access to care,quality, screening, and patient satisfac-tion.

Dr. Burstin has served as regionalco-chair for the Society of General

Internal Medicineand is currentlyPresident of the Boardof Directors of theAmerican MedicalStudent Association/Foundation. She isalso a former nationalpresident of AMSA.John M. Eisenberg,MD, Director,AHRQ, recruited Dr.Burstin and said, “Asa health servicesresearcher, educator,and practicingphysician, HelenBurstin will bring a

wealth of experience and knowledge tothe Center for Primary Care Research.We are very pleased that she is joiningAHRQ to further our goal to improvethe quality of primary care research andservices.”

As Director, CPCR, Dr. Burstin willlead the efforts to stimulate high qualityresearch in the primary care area,including evaluations of the quality,cost, and effectiveness of primary careservices, rural health services andsystems, and special populations. Shebegan this new position on January 3,2000.

The following is an interview withDr. Burstin (HRB) conducted by JasjitS. Ahluwalia (JSA) on January 31,2000.

JSA: Why did you decide to leave awonderful job in academics and athriving practice in Boston?

HRB: It was an opportunity to dosomething very different; to developand build something from the groundup. The Agency’s goals in primary careare improving access, quality, andefficacy of primary care. The opportu-nity to work with John Eisenberg was

RESEARCH FUNDING CORNER

AN INTERVIEW WITHHELEN BURSTIN, MD, MPHJasjit S. Ahluwalia, MD, MPH, MS

continued on page 12

Primary care physicians frequentlyhave questions about how to

manage their patients.1,2 Unfortunatelywe usually do not seek an answer, orwhen we do, we use convenientresources of uncertain reliability.1 Whyare we apparently guessing instead ofseeking answers? Physicians report thatone barrier is difficulty in usingMEDLINE.1 Observational studiesconfirm these complaints and show thatsearching MEDLINE is both time-consuming and frequently unsuccessful.3

Although the studies cited herewere done 10 years ago, the results areprobably still true. In a controlled trialwe recently found that teaching medicalclerks the use of innovations such asMEDLINE filters,4 the Database ofAbstracts of Reviews of Effectiveness(DARE), and the National GuidelineClearinghouse (NGC), did not increasethe likelihood that they would seekmedical information.5 We also observedthat we were repetitively giving thesame advice to students who neededhelp in searching. For example, wefrequently were reminding students oftips such as, “if you did not find whatyou wanted in DARE, search MED-LINE with the filter for systematicreviews” and “if you found too manyarticles in MEDLINE, restrict yoursearch to the Abridged Index Medicus(AIM).” These observations led us toconclude that searching for evidence isstill very hard and must be automated.

In order to ease the process oflocating medical evidence, we createdSUMSearch™ (http://SUMSearch.uthscsa.edu/sgim). SUMSearch usesmeta-searching and contingencysearching to automate searches formedical evidence on the Internet.Through meta-searching, SUMSearchsimultaneously searches multipleInternet sites and collates the results

SUMSearch: A NewWay to LocateMedical EvidenceRobert G. Badgett, MD

continued on page 14

7

FOLLOW YOUR HEARTcontinued from page 1

profession that she loved to be the wifeand mother she wanted to be. Becauseshe took the risk and because she hadastute and open-minded colleagues, shedid not have to give up her career as anacademic generalist. She had the rareadvantage of a split full-time position so

that she really could do what she choseand do it well.

Many physicians struggle with thesame tensions and choose various waysto balance medicine and family. MaryHorn’s career solution worked for herpatients, her students, the university,and her family. The academic positionthat allowed her to balance familyresponsibilities, social needs, and careerachievements should be an option forfuture academic physicians, but cur-rently exists in few settings.

Recognizing this need, Mary Horn’sfamily and colleagues approached SGIMwith the idea of creating the MaryO’Flaherty Horn Scholars Program in

General Internal Medicine. Their goalwas to enhance the opportunities forother outstanding general internists byreproducing Dr. Horn’s success inblending academic medicine and familylife in academic institutions across thecountry.

When fully funded,the Mary O’FlahertyHorn Scholars Programin General InternalMedicine will provide a3-year stipend for aphysician who choosesto practice academicgeneral internal medi-

cine half time and spend “the otherhalf” caring for dependent familymembers. The recipient must bededicated to promoting creativity andscholarship in the balance of work andfamily and to serving the indigent. Anygeneral internist who meets the require-ments and who is sponsored by anacademic medical center in the UnitedStates may apply to the program. Theprogram is intended to provide onequarter of a full-time stipend; theacademic institution sponsoring therecipient will match the other quarter.The sponsoring institution must providean optimal environment for therecipient’s academic development and

Mary’s unique role as a mentorwas the example she set inchoosing her priorities andfollowing her heart.

promotion, both during and subsequentto the award.

The Horn Scholars Program is animportant step toward shaping ourfutures in academic general internalmedicine. SGIM believes that thisprogram will meet the needs of currentand future members. The Society has setup a special fund for this program andwill administer it. To sustain an awardevery third year, at least $750,000 isneeded; a yearly award would require atleast $2.25 million. Dr. Horn’s family,friends, and colleagues have generouslycontributed the seed money (over$300,000 to date!); SGIM will matchevery $250,000 of contributions to theProgram with a contribution of $25,000from the Society’s reserves, up to a totalSGIM contribution of $100,000. Therewill be a reception to celebrate theHorn Scholars Program at the AnnualMeeting. We hope to make our firstaward by May 2001.

Work is beginning to raise theremainder of the funds needed and willbe orchestrated by the DevelopmentCommittee, chaired by Barbara Turner.Your ideas, energy, and contributionswould be greatly appreciated. Pleasesend correspondence to Carole Warde,MD (carole.m.warde@kp.org). SGIM

SGIM welcomes the following newmembers in the California, MountainWest, and Northwest Regions:

ArizonaLisanne Burkholder, MD, MPHBrian N. Sabowitz, MDCaliforniaEva M. Aagaard, MDLisa Backus, MD, PhDGregory M. Bugaj, MDCindy Caffrey, MDSaima Chaudhry, MDMary-Margaret Chren, MDDavid L. Conant, MDDebra D. Craig, MD, MA

Anne M. Cummings, MDStephanie FeinMelissa Fischer, MDChiquita R. Flowers, MDCaroline L. Goldzweig, MD, MSAdrienne Green, MDAmita Gupta, MDBrooke Herndon, MDMark E. Higgins, MDChristine S. Ho, MDSusan Huang, MDClaudia M. Husni, MDJeff S. Ilfeld, MDArmen Isaiants, MDDenise Jackson Townsend, MDBrad Jacobs, MD

Ashish K. JhaAnne Kastor, MDJoel Katz, MDAmy KilbourneKazuo Kukita, MDT. James LawrenceSonia R. Levingston, MDPamela Ling, MDPaula J. Lum, MD, MPHElizabeth Malcolm, MDPaul L. Nadler, MDTung Thanh Nguyen, MDTimothy P. Ong, MDNeil M. Paige, MDBraj B. Pandey, MD

New Members: California, Mountain West, and Northwest Regions

continued on page 14

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SGIM FORUM

LIVING OUR DREAMScontinued from page 3

Carole Warde, her work-sharing partnerand former President of SGIM’s Califor-nia Region; and Jonathan Blitzer,Carole’s husband. The Program is still“under construction,” as this Webwimphas learned to say—$300,000 has beenraised, more is needed—and is describedfully in Carole Warde’s article in thisissue of Forum.

Creating the Future NowWe started the business end of theretreat Thursday morning with a reviewof “Where We Are, Where We AreGoing, and How We Get There” in thecontext of the strategic initiativesCouncil defined last June. We foundthat SGIM has accomplished a lot inthe last 6 months, in addition to theHorn Scholars Program and our year-in-year-out winners: JGIM, SGIM Forum,and the upcoming Annual Meeting. Avery incomplete list of the new high-lights includes:◆ The 1st All-Member Survey, thanks

to Allan Prochazka, Jim Byrd, and theMembership Committee, and toExecutive Director David Karlson andthe SGIM staff.

◆ The UpToDate peer review program,headed by Bob Badgett, who hasinvolved 36 SGIM peer reviewers andis looking for even more (if inter-ested, contact Bob at Badgett@uthscsa.edu).

◆ An initiative in qualitative researchand research in the humanities,thanks to Amy Justice and theResearch Committee, and to GaryRosenthal, Carol Bates, and theProgram Committee.

◆ A movement initiated by Council topromote diversity at every organiza-tional level of SGIM, beginning withan effort to consider diversity inselecting nominees to run for officeand Council and in appointingcommittee members.

◆ An initial proposal from the TaskForce on the Chiefs of GeneralInternal Medicine (headed by WendyLevinson and Bob Centor), whichwas formed to recommend ideas to

Council on how to meet the needs ofdivision and section chiefs.

◆ Grants to five SGIM interest groupsfor projects of innovation andexcellence, funded by the ZlinkoffFoundation and led by LisaRubenstein and Martha Gerrity.

◆ A grant to the Geriatrics InterestGroup, headed by GlendaWestmoreland, to support expansionof the SGIM Website to give physi-cian–teachers better tools to teachabout caring for our aging patients,funded by the Hartford Foundation.

◆ Formation of the Task Force on theRegions (led by Bruce Chernoff andJohn Noble) to report to Council inMay on the health of our sevenregions and how SGIM can servethem better.

◆ An annual award for the best paperby a young SGIM investigator.

◆ A Research Mentorship Program,started through the efforts of HarrySelker, Preston Reynolds, and theDevelopment and Research Commit-tees.

◆ A revitalized Education Committee,now headed by Gordon Noel, withnew members and a 2-day retreat,which led to proposals for a smallgrants program in Education Researchand for a national conference onfunding for graduate medical educa-tion and the support of clinicalteaching.

◆ Website enhancements includingonline abstract submission and the“What’s New” section.

◆ Listserves for roughly 50 interestgroups and committees.

◆ A revised Policy on Acceptance ofExternal Funds, thanks to KurtKroenke, Steve Fihn, and the EthicsCommittee.

◆ A new 5-year contract to publishJGIM and SGIM Forum, which willbe completed soon, thanks to BillTierney, Eric Bass, David Karlson, andmembers of the CommunicationsCommittee.

◆ Negotiation of a new contract forhealth policy staffing and representa-

tion, orchestrated by Mark Liebow,Steve Fihn, and the Health PolicyCommittee.

◆ New policies on acceptance ofexternal funds for research andeducational projects to assure fairaccess to opportunities for all mem-bers, drafted by Barbara Turner,JudyAnn Bigby, and the DevelopmentCommittee in consultation with theResearch and Education Committees.

We also learned from things thatwent well and from things that did not.Several themes were common tosuccessful committees: committedleadership, usually on the part of acommittee chair with time and energy;a focused agenda shared by the commit-tee and Council; a close relationshipbetween the committee chair andCouncil, usually facilitated by a Councilmember liaison to the committee (listedon www.sgim.org) and by the chair’sparticipation in the Summer Retreat;dedicated SGIM staffing of the commit-tee; and SGIM support of committeecommunications by E-mail and tele-phone, and by meeting in person. Thesethemes are hardly surprising! Nonethe-less, they reflect our Society’s evolutionover the last several years and indicatekeys to achieving our goals in thefuture.

Supporting the Chiefs of GeneralInternal MedicineWendy Levinson and Bob Centor, co-chairs of the SGIM Task Force onChiefs of General Internal Medicine,joined Council Thursday afternoon andFriday morning to discuss the TaskForce’s exciting and provocativeproposal. Growing out of an InterestGroup/Workshop led by Bob, Wendy,and Council member Jim Byrd, the TaskForce was charged by Council to addressthe needs of division and section chiefsfor professional development and ourneed as general internists to increasetheir impact (as our leaders) in aca-demic departments and health careenterprises. In addition to Bob, Jim, and

continued on next page

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LIVING OUR DREAMScontinued from previous page

Wendy, the Task Force included SankeyWilliams (SGIM President-elect) andseveral other GIM division chiefs (oneof whom represented those chiefs whoare not SGIM members).

The Task Force huddled for a 2-dayDecember meeting in Chicago, designeda Precourse for the Annual Meeting,and proposed to Council that aninitiative be undertaken with four goals:◆ To provide professional development

through leadership and managementtraining.

◆ To provide a forum for the exchangeof information and the developmentof collaborative efforts.

◆ To provide personal development andnetworking for Chiefs.

◆ To influence and educate institutionalleaders about issues relevant toacademic general internal medicine.

All of us who are or have beendivision chiefs resonate to these goals:learning to lead in medicine is one ofthose lacunes in training where to “seeone” is woeful preparation to “do one,teach one.” Council, members to whomCouncil members talked, and theleadership of many of our sister profes-sional organizations universally en-dorsed these goals.

To give Council something substan-tial to work with, the Task Force reportproposed creation of a new, indepen-dent organization, the Association ofChiefs of General Internal Medicine,that would pursue the four goals whilemaintaining a strong alliance andformal communications with SGIM.Uneasy with the idea of a separateorganization, the Task Force recognizedthat our Bylaws didn’t provide asolution; they provide for regions withreasonable autonomy and with exofficio Council representation, but notfor another structure with similarindependence. The Task Force alsosuggested that the influence of divisionchiefs on chairs might be enhanced by anew structure.

The Task Force proposal gave usplenty to explore and talk about! Woulda separate organization divide the house

of general internal medicine, or would itgive us a double-barreled weapon to winthe shoot-outs at the OK Corrals ofHealth Care 2000? We all endorsed thefour goals, and we were hamstrung bythe lack of an appropriate structure inSGIM. Yet none wished to causeunintended harms to SGIM or academicgeneral internal medicine, and manyhad some level of concern that creationof a separate organization could havesuch unintended consequences.

I was reminded of a story in ArabianNights in which Prince Ahmed andPeriebanou, a fairy princess, enjoy thelove affair of the last millennium. Theproblem was that the Prince’s father, theSultan, grew jealous of his son andimposed escalating and unreasonablerequests, one of which was for a tentthat might be carried in a man’s handand which would extend over his wholearmy. The request was trifling forPeriebanou, who gave Ahmed a tentwith the needed property: it became“larger or smaller, according to theextent of the army it has to cover,without applying any hands to it.” Iwondered, might not SGIM be such atent, at least for us in academic generalinternal medicine?

With all those around the tablesharing the goals articulated by the TaskForce, Council members contributedelements of a design that might expandSGIM’s tent appropriately: explorationof a new structure that would fit thegoals and could be created and definedin SGIM’s Bylaws; a period to try andevaluate the structure; and support ofthe new enterprise by SGIM. WendyLevinson, Bob Centor, Jim Byrd, andSankey Williams will now work withthese and other ideas to craft a second-stage proposal so that Council and theTask Force can move ahead rapidly overthe spring and summer.

Promoting Diversity at EveryLevel in SGIMCouncil also spent several hoursThursday and Friday talking aboutSGIM’s commitment to promoting

diversity at every level of the organiza-tion so that all of us feel both welcomeand engaged to the degree we wish.How can we achieve this goal? Thisyear, Council took some first steps.Every committee was asked to promotea diverse membership, consideringseveral characteristics including gender,ethnic and cultural background,geography, and personal and profes-sional roles. Nominations for office,Council, and representation of SGIM toother organizations were reviewed topromote diversity. Next steps mightinclude Council and staff workingsystematically with the MembershipCommittee, the Minorities in MedicineInterest Group, and other interestgroups to identify volunteers who wouldexpand our committees and representa-tion. But clearly these are only firststeps. I would love to hear your ideasabout how SGIM can best welcome andengage all our members in ways theywish.

SGIM is living its dreams, ourdreams. We are creating the future. TheAnnual Meeting in Boston is aroundthe corner now. We can share ourdreams and take a next step togetherthere. SGIM

Calendar of Events

Annual Meeting Dates23rd Annual Meeting

May 4–6, 2000Sheraton Boston Hoteland TowersBoston, MA

24th Annual MeetingMay 3–5, 2001Sheraton San Diego Hoteland MarinaSan Diego, CA

25th Annual MeetingMay 2–4, 2002Hyatt Regency HotelAtlanta, GA

26th Annual MeetingMay 1–3, 2003Vancouver, BC, Canada

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ZLINKOFF FOUNDATIONcontinued from page 4

The response exceeded theCouncil’s expectations. Despite themodest funding and short time torespond, nine Interest Groups submittedproposals. Prompted by thisgroundswell, the Council decided topartially match the Zlinkoff funds sothat three rather than two InterestGroup proposals could be supported,each with a grant of $7500.

The Clinician–Educator InterestGroup will develop a Web-based, peer-reviewed clearinghouse for educationalproducts and ideas. The goals of thisclearinghouse are to develop anddisseminate standards for the qualityreview of educational products, toprovide a site for dissemination of highquality educational materials, and tolink members electronically so thateducational expertise can be shared in atimely fashion. Representative materialsinclude syllabi, curricula, cases forteaching, assessment instruments,studies of educational interventions,and standards for peer review ofteaching quality.

The Health Policy Interest Groupwill develop a Website with hyperlinksto other sources of information abouthealth policy/social responsibility issues.This Website will allow SGIM to pollmembers on critical health policy issuesand to develop a grassroots advocacyprogram.

The Physicians Against ViolenceInterest Group will produce a videotapeabout the detection and treatment ofchildhood, adult, and elder abuse for useby health care professionals in primarycare offices. Use of this videotape willfulfill JCAHO requirements for trainingabout violence. The Interest Group willconduct a study to determine if viewingthe videotape changes provider behav-ior. They will submit both a scientificabstract and workshop proposal for the2000 Annual Meeting.

Excellent initiatives which couldnot be funded in the first cycle includedproposals from the Geriatrics, MedicalStudent, Junior Faculty, InternationalHealth, Clinical Examination, and

Teaching Physical Diagnosis InterestGroups. However, the Council wentback to the Zlinkoff Foundation againin October and is happy to report thatthe Foundation has provided another$15,000 to fund two more InterestGroup initiatives. Second, since manyof the Interest Groups included aWebsite as a prominent objective intheir proposals, the Council approved amajor investment from reserve funds toaccelerate Website development in the1999–2000 fiscal year. Besides fosteringInterest Group communication, thisstate-of-the-art Website will facilitateSGIM committee activities, electronicabstract submissions, on-line registra-tion for the Annual Meeting, andnumerous other mem-bership services.

Interest groups arethe grassroots of ourorganization. Theyshould be viewed not asspecial interests but asstakeholders. Some years ago at anAnnual Meeting, a colleague, uponobserving the diversity of interestsrepresented at a poster session, reflectedthat SGIM may be more a confedera-tion than a union. We hope not. Wewant to see diverse interests supportedand valued as they focus on particularaspects of SGIM’s mission of improvingpatient care, research, and teaching inprimary care and general internalmedicine. We do not wish to see abalkanization of our generalist societyinto competing interests nor a splinter-ing off of subgroups into separatemeetings. By coalescing around aparticular passion and remaining leanenough to act efficiently, an interestgroup can inspire, advocate, galvanize,and execute changes that noticeablyadvance an area of excellence withinSGIM.

However, an interest group also canencounter stumbling blocks. Its mem-bers are geographically dispersed, busyat their respective institutions, andtypically meet face-to-face but once ayear. Participation is an unfunded,

volunteer activity, and regular commu-nication has been challenging. Hope-fully, seed money, Websites, and othertypes of support will nurture thespontaneous but sometimes fragilenature of SGIM’s various interestgroups.

SGIM intends to continue todiscover ways to support and market theinnovative activities of its members. Butconsider this final word about innova-tion: for every successful experiment,there is likely to be one that falls shortof expectations. This amalgamation ofpositive and negative trials should notsurprise the investigator side of ournature. As scientists, we pose hypoth-eses, design a study, gather data, and

analyze the results. Certainly, we preferpositive results to a negative study. Wewould rather have each innovation be“significant” (p < .05, compared tobaseline), making a recognizabledifference either for our members ortheir constituents—patients, learners,the public. Obviously this is not thecase. Indeed, unless the number of ourdisappointing ventures approximatesthe number of our victories, we areprobably being unduly conservative.Innovation requires stepping across theline. It also means contemplation,evaluation, perseverance, and responseto feedback. Investigators work a coupleyears to get a project funded—respond-ing to pink sheets, seeking alternativefunding, or trying a different grant.Educators and administrators experiencesimilar turbulence in fostering curricularand organizational change. As SGIMenters the 21st century in an innovativespirit, it must be willing to embrace therisks as well as rewards that are inextri-cably part of the innovationsethos. SGIM

Interest groups are thegrassroots of our organization.

11

Recent amendments to the 1997Balanced Budget Act stopped thedecline in Medicare’s support ofgraduate medical education for now.However, there are still decreasesscheduled in the future, which will putfurther pressure on academic medicalcenters struggling to stay solvent. Otherlegislation changed the way direct

graduate medical education funding ispaid out, trying to narrow the gap in theamount paid per resident in varioushospitals. Differences in per-residentfunding are largely an artifact of mid-1980s accounting practices, but thosegetting high per-resident payments wereunderstandably reluctant to give themup. MEDPAC, which advises theCongress on Medicare payment issues,floated the idea of dropping any explicitsupport for graduate medical educationby Medicare and replacing the GMEpayments with payments for “enhancedpatient care.” While this isn’t likely tohappen in the short run, because oftechnical as well as political problems,many view this proposal as a threat. Ifadopted, it would mean that no na-tional payer would be responsible forfunding graduate medical education.SGIM will watch this issue closely.

Long-term reforms for Medicarewere discussed extensively in connec-tion with a national commission thatwas to consider the future of Medicare.The requirement that 11 of thecommission’s 17 members agree on arecommendation kept the commissionfrom making any formal recommenda-tions. However, a majority of commis-sion members came out in favor of a“premium support” model for Medicare.Under such a model a variety of privateplans would compete for Medicare

beneficiaries, and the Federal govern-ment would give a fixed subsidy to eachbeneficiary to help her/him purchasethe plan of choice. This is similar to theway Federal employees choose healthinsurance plans. This would be adramatic change in Medicare and hasbeen very controversial. The Adminis-tration and some legislators have

proposed adding aprescription drug benefitto Medicare. The HealthSystem Reform cluster ofthe Health PolicyCommittee is looking atthese and other propos-als for big changes in thesystem.

The Department of Veteran Affairsgot 5 million dollars or about 1.6%more for medical research as well asincreased funding for clinical care ofveterans. Kenneth Kizer, MD, theUndersecretary for Health, was forcedout of office when the Administrationcouldn’t muster enough support for hisreconfirmation in the Senate. Hisdeputy, filling Dr. Kizer’s position fornow, implemented a controversial latedecision by Dr. Kizer to change the wayresearch funds were distributed in theVA system to make it more likely thefunds would be available for research.

There was no major legislation toimprove insurance coverage, but theAdministration continued its efforts tosee that more uninsured children gothealth insurance coverage through theState Children’s Health InsuranceProgram (SCHIP). A number ofmedical organizations banded togetherto lead a drive asking candidates forpublic office in 2000 to support plansfor universal health insurance coveragein the United States. SGIM endorsedthis effort.

Managed care became a politicalwhipping boy in 1999. The Senatepassed a weak “Patient Bill of Rights” inmid-year on a close vote. In the fall theHouse of Representatives passed a muchmore anti-managed care bill by asurprisingly large margin over the

opposition of the House leadership. TheHouse leadership was able to stall theconference committee until the springand appointed as conferees mostlypeople who didn’t support the Housebill. It’s not clear whether there will bea bill emerging from the conferencecommittee that can pass both houses orwhether the parties would prefer acampaign issue to legislation. TheAdministration took regulatory actionto implement some of the Patient Bill ofRights concepts in Medicare andMedicaid managed care plans.

Congress missed its self-imposeddeadline to enact legislation on theprivacy of medical records. As a result,the Administration was required toissue a set of regulations on the han-dling of electronic medical records.These regulations would have a substan-tial effect on the use of records forresearch. The comment period for theseregulations was still open at year end.There was much talk but little actionon potential misuse of genetic informa-tion by insurers or employers. This willbe an even more important topic in2000.

The early prediction for healthpolicy in 2000 is that there will be manywords but little action. However, thelast Presidential election year broughtsome surprises as the two parties workedtogether to establish a legislative recordgoing into the election. Annualappropriations will need to be com-pleted, and there may be marginalchanges in Medicare if the 1999changes in the Balanced Budget Act donot seem adequate to keep many largeinstitutions off the road to bankruptcy.The new program with the best shot atbeing enacted is a prescription drugbenefit for Medicare beneficiaries.However, a short legislative session andother formidable barriers may preventeven this proposal from becominglaw. SGIM

POLICY REVIEWcontinued from page 5

The early prediction for healthpolicy in 2000 is that there willbe many words but little action.

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SGIM FORUM

raise the awareness at theinstitutional level of the impactof race and culture on medicine.She went on to create anddirect the Center for the Studyof Race and Ethnicity inMedicine. The center focuseson the “role of race andethnicity in shaping theexpectations, beliefs, andattitudes of physicians andpatients; disparities in theeffects of many diseases andconditions on racial and ethnic groups;and inequities in health care delivery.”Prior to joining the faculty at theUniversity of Wisconsin, Dr. Gambletaught at the Harvard School of PublicHealth, the University of Massachu-setts, and Hampshire College, where shealso served on the Board of Trustees.

Dr. Gamble has successfullycombined scholarship and activism inher work. In addition to her researchand teaching, she has served on numer-ous national committees charged withimproving the health of underservedpopulations. Notably, Dr. Gamblechaired the Tuskegee Syphilis StudyLegacy Committee and was an instru-mental force in securing a presidentialapology for the study participants andtheir families.

The AAMC is well recognized forits efforts to achieve racial and ethnicparity in the physician workforce. Injoining the leadership of the AAMC,Dr. Gamble sees an opportunity tocontinue to advocate for these issues ona national scale. Project 3000 by 2000,created under the leadership of Dr.Nickens, was an effort to increase thenumbers of underrepresented minoritiesat all levels in the academic pipeline tocareers in the health professions. Otherongoing AAMC efforts to improve thenumbers of underrepresented minoritiesin the health professions include theHealth Professions Partnership Initia-tive, the Minority Medical EducationProgram, and the Health Professions forDiversity coalition. In addition toencouraging minorities to pursue careers

GAMBLE TO LEAD PROGRAMScontinued from page 5

in medicine, the AAMC is alsocommitted to the retention anddevelopment of minority facultymembers. Programs like theAAMC Health Services ResearchInstitute for Minority Faculty(http://www.aamc.org/meded/minority/hsri/start.htm) and theMinority Faculty Career Develop-ment Seminar (http://www.aamc.org/meded/minority/minfac/start.htm) address the trainingand support of junior minority

faculty at academic institutions. At atime when affirmative action is underattack, Dr. Gamble sees the need tocontinue to build incrementally onexisting programs. The importance ofcultural competence in physiciantraining is now being recognized, andprogress has been made toward requiringcurricula in cross-cultural issues foraccreditation by the LCME.

In addition to leading the Divisionof Community and Minority Programs,Dr. Gamble also plans to continue herown research. She is currently writing abook documenting the history of blackwomen physicians and a series of essayson race, racism, and Americanmedicine. SGIM

In addition to encouragingminorities to pursue careers inmedicine, the AAMC is alsocommitted to the retentionand development of minorityfaculty members.

certainly a large draw.JSA: Who was the previous

director of CPCR?HRB: It was previously run by

Carolyn M. Clancy, MD, anotherwonderful general internist, before shemoved on to be the Director of theCenter for Outcomes and EffectivenessResearch. The Center has had an actingdirector for the last year.

JSA: Is the Center a small unit orone of the larger units within theAgency?

HRB: It is a smaller but growingcenter. I actually have five open health

services researcher positions, and we aretrying to build capacity in primary careresearch.

JSA: How many doctoral levelpositions, besides yourself, are in theCenter?

HRB: The current staff includesthree primary care physicians, aneconomist, a social scientist, and asenior scholar from the AmericanNursing Association.

JSA: The five potential doctorallevel positions that you are recruitingfor, are you looking for physicians ornon-physicians?

HRB: We are expecting at leastthree out of the five to be physicianhealth services researchers, who will beinvolved in intramural research atAHRQ, but who also will work with ourfunded researchers.

JSA: Besides the obviously wonder-ful opportunity to work with you, whywould someone want to come and joinyour center?

HRB: I think there are excitingopportunities at a national center. TheCPCR was the only center specificallynamed within the AHRQ reauthoriza-

INTERVIEWcontinued from page 6

continued on next page

13

tion. So it’s clearly a high priority forthe federal government. Interestingly,we are the largest provider of researchfunding in primary care research withinthe Department of Health and Human

Services. There is clearly great interestin primary care at the federal level andworking here seems like a real opportu-nity to make a difference.

JSA: How about people like me,people outside; are there opportunitiesfor extramural funding? Will your centerissue RFAs or have standing programannouncements?

HRB: Yes to both. Currently, our

center portfolio has the largest numberof research grants within the agency.We will continue to put out new RFAs.Our most recent RFA is to developPrimary Care Practice-based Research

Networks (PBRNs).Though PBRNs havebeen used extensively infamily practice andpediatrics, it has notbeen something used bygeneral internists. Weare also excited about

getting general internists involved inthe PBRN initiative. This RFA wasreleased on January 21, 2000. The letterof intent is due March 10th, and theapplication is due April 27, 2000.

JSA: Are there other areas inwhich you think the Center will beissuing RFAs in the next year or two, ifyou are able to tell us?

HRB: We will clearly continue our

INTERVIEWcontinued from previous page

Our most recent RFA is todevelop Primary Care Practice-based Research Networks.

interest in access to care and quality ofcare. Patient safety and medicalinformatics are newer interest areas.Patient safety is an initiative followingthe recent IOM report. We are alsointerested in understanding howinformatics can change primary carepractice, such as getting information topatients and organizing care betterbetween patients, providers, andspecialists. SGIM

In addition to Drs. Eisenberg,Burstin, and Clancy, other SGIM membersserving at AHRQ include David Atkins,MD, MPH, Arlene S. Bierman, MD, MS,Gregg S. Meyer, MD, Claudia Steiner,MD, MPH, and David Stryer, MD. Drs.Eisenberg and Burstin will be presenting aworkshop at the SGIM Annual Meeting inBoston entitled, “Future Directions inPrimary Care Research.”

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SGIM FORUM

SUMSEARCHcontinued from page 6

into one page. If SUMSearch finds toomany “hits” on an Internet site, it usescontingency searching to requery thesite until it identifies an optimalnumber of hits. On the other hand, ifSUMSearch finds too few hits on anInternet site, it may search another site.For example, if DARE provides only afew systematic reviews, SUMSearch willsearch MEDLINE for additionalsystematic reviews. SUMSearch allowsthe clinician to enter a query one time.It then selects the best Internet sites tosearch, formats the query for each site,executes contingency searches, andreturns a single document to theclinician. Most of the burdens ofInternet searches are eliminated.

After searching, SUMSearchorganizes the list of links to documentsby breadth of discussion. First, there arelinks to resources that provide broaddiscussion: relevant textbooks, tradi-tional review articles, and practiceguidelines. Next, there are links toresources that provide narrow discus-sions: systematic reviews and originalresearch. Thus, a clinician conducting asearch on a topic with which they arenot familiar will find links easy to readwith broad discussions at the top of thelist. A clinician with a specific questionabout a topic with which they areotherwise familiar will find links tosystematic reviews and original researchin the second half of the results.

The rationale for organizing theresults by breadth is as follows. Ideally,clinicians always answer medicalquestions by reading original researchand systematic reviews of originalresearch. However, this is not alwayspractical, especially for broad clinicalquestions. For example, consider aclinician confronted by a patient insepsis. This clinician has no recentexperience with the disease. Theclinician may ask: “Tell me all aboutsepsis and how I should establish adiagnosis, prognosis, and treatment planfor my patient.” This clinician does nothave the time to seek original studiesaddressing each facet of his question

and thus may benefit most from thebroad discussions provided bySUMSearch. On the other hand, amore experienced clinician confrontedby the same patient may ask: “Inpatients with septic shock, does the useof steroids reduce mortality and, if so, byhow much?” This clinician has a specificquestion and may need original studiesand systematic reviews to get the mostcurrent answer to a specific problem.

In summary, SUMSearch is anInternet site that may benefit manySGIM members. Our goal is to providean easy-to-use site to quickly search theInternet for valid medical evidence.Please send comments and suggestionsabout SUMSearch to Bob Badgett(Badgett@UTHSCSA.edu). SGIM

References1. Williamson JW, German PS, Weiss R,Skinner EA, Bowes F 3d. Health scienceinformation management and continuingeducation of physicians. A survey of U.S.primary care practitioners and theiropinion leaders. Ann Intern Med.

1989;110:151–60.2. Covell DG, Uman GC, Manning PR.Information needs in office practice: Arethey being met? Ann Intern Med.1985;103:596–9.3. Hersh WR, Hickman DH. How welldo physicians use electronic informationretrieval systems? A framework forinvestigation and systematic review.JAMA. 1998;280(15):1347–52.4. Haynes RB, Wilczynski N, McKibbonKA, Walker CJ, Sinclair JC. Developingoptimal search strategies for detectingclinically sound studies in MEDLINE. JAm Med Inform Assoc. 1994;1:447–58.5. Badgett RG, Kosub K. How well do weteach medical students to find medicalevidence. Clerkship Directors in InternalMedicine: Denver, 1998.

Parts of this article were publishedpreviously in He@lth Information on theInternet (http://www.wellcome.ac.uk). They are reproduced here withpermission of the Wellcome Trust and theRoyal Society of Medicine.

John D. Piette, PhDSamantha Pitt, MDTamara M. Shankel, MDMichael Shlipak, MD, MPHVictor Silvestre, MDMyles Spar, MDMichael Steinman, MDHitoshi Tomizawa, MDAdriana Valdovinos-Campa, MDDorothea von Goeler, MDMaria A. Wamsley, MDDavid S. Zingmond, MDDaniella ZipkinColoradoMarcia BlakeAnna CosyleonRocio GiananiChristopher Hicks, MDSteven Kolpak, MDRicardo Padilla, MDLisa Scatena

John M. Westfall, MDJoel Witter, MDOregonDiana Antoniucci, MDJonathan D. Darer, MDLisa ElsBenjamin J. Geiman, MDRobert P. Irwin, MDMichelle Kar, MDBenjamin H. LeBlanc, MDErin S. LeBlanc, MDJody Pettit, MDGwen J. Reeve, MDBrian S. Sallay, MDWashingtonAllen W. ClaybornClaudia Finkelstein, MDBrian P. Mulhall, MDLael G. Paul, MDKenichiro Taneda, MDAlvin J. Thompson, MD, MACP

MEW MEMBERScontinued from page 7

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CLASSIFIED ADS

Positions Available and Announcementsare $50 per 50 words for SGIM members and$100 per 50 words for nonmembers. Thesefees cover one month’s appearance in theForum and 2 month’s appearance on theSGIM Website at http://www.sgim.org. Sendyour ad, along with the name of the SGIMmember sponsor, to SGIM Forum, Admin-istrative Office, 2501 M Street, NW, Suite575, Washington, DC 20037. It is assumedthat all ads are placed by equal opportunityemployers.

PRIMARY CARE FELLOWSHIP. The Universityof Kansas Medical Center invites applications for a2-year research-oriented fellowship to begin July 1,

2001. The fellowship is open to applicants in In-ternal Medicine, Pediatrics, or Family Medicine.Fellows complete an MPH degree, receive mentoredresearch training, and receive faculty developmenttraining to prepare for a career in academic medi-cine. The fellowship provides mentorship and col-laborative opportunities with established faculty inareas including health services research, quality ofcare, aging, ethics, behavioral medicine, and can-cer control. In addition, fellows will gain experi-ence in teaching activities and provide clinical care2 half days a week. Excellent resources for careerdevelopment, such as funding for conference travel,research expenses, and MPH tuition are available.Please send a detailed cover letter highlighting in-terests and career goals, a CV, and three letters ofrecommendation to: Jasjit S. Ahluwalia, MD, MPH,MS, University of Kansas Medical Center, Depart-ment of Preventive Medicine, 3901 Rainbow Blvd.,

Kansas City, KS 66160-7313. Telephone (913) 588-2772. AA/EOE

DIRECTOR OF CLINICAL RESEARCH. TheDepartment of General Internal Medicine of theCleveland Clinic Foundation seeks interested ap-plicants for Director of Clinical Research. This per-son will oversee research activities for clinical ar-eas which include primary care, geriatrics, women’shealth, and preventive medicine out-patient sec-tions; hospitalist program; subacute unit; medicalconsultation and pre-operative assessment units;and general internal medicine fellowship program.Interested applicants should send CV to RichardS. Lang, MD, Chairman, Department of GeneralInternal Medicine, Cleveland Clinic Foundation,Desk A-11, 9500 Euclid Avenue, Cleveland, OH44195. Telephone (216) 444-6842.

The Agency for Healthcare Research and Quality (AHRQ)announces the immediate availability of medical officer po-sitions in the Center for Primary Care Research (CPCR).

The AHRQ sponsors and conducts research that enhances the qual-ity, appropriateness, access, and effectiveness of health care services.The Center for Primary Care Research serves as the major Federalsource of funding for primary care research and accomplishes itsmission through research that seeks to improve access to and theeffectiveness, quality, and cost of primary health care services. Otherareas of study for CPCR include access to care, vulnerable popula-tions, patient–provider communication, health-related behavioralchange, medical informatics, and geriatrics.

The duties and responsibilities will include conducting intramuralresearch, as well as stimulating and managing extramural researchin the organization, practice, and outcomes of primary care. Indi-viduals must possess extensive experience and training in researchmethods (e.g., epidemiology, health services research, or statistics)as well as a background designing and planning studies, performinganalyses and interpreting results, manipulating large secondary da-tabases, and presenting findings through oral presentations and pub-

lished manuscripts. Additionally, experience in the study of thestructure, performance, and policy concerns of the health care sys-tem, especially related to primary care, is highly desirable.

The applicant should be a board certified physician and possessclinical experience in primary care, or experience in performingpolicy analyses related to primary care. The researcher will be al-lowed one-half day per week for clinical practice in primary care.Temporary and permanent positions may be available. The AHRQis located in Rockville, Maryland (a suburb of Washington, DC).

Please visit our web site at www.ahrq.gov to view specific em-ployment opportunities. Full text vacancy announcements specifyqualification requirements for individual positions, desirable quali-fications that must be addressed individually through a personalnarrative, as well as other administrative requirements. Questionsabout these openings may be directed to Dr. Helen Burstin, Direc-tor, Center for Primary Care Research by phone at (301) 594-4028 or via E-mail hburstin@ahrq.gov.

AHRQ IS AN EQUAL OPPORTUNITY EMPLOYER

Agency for Healthcare Research and Quality(formerly known as the Agency for Health Care Policy and Research)

U.S. Department of Health and Human Services

Society of General Internal Medicine2501 M Street, NWSuite 575Washington, DC 20037

SGIM

FORUM

The University of Minnesotaseeks a senior academic gen-eral internist to assume lead-

ership of the Division of GeneralMedicine and the Clinical Out-comes Research Center. Withinthe Division of General Medicine, the Director is respon-sible for overseeing and developing the clinical and educa-tional activities of a large group of clinician–educators. Theseinclude educational programs, a large integrated facultyprimary care practice, three general medicine inpatientfirms, and general medical consultation. As head of theOutcomes Research Center, which is funded by the Aca-demic Health Center and currently includes five MD andthree PhD investigators, the candidate will lead an inter-disciplinary research program, recruit and mentor researchfaculty, develop research collaborations and establish edu-cational programs across the University, and establish his/her own research program.

DirectorUniversity of Minnesota(Tenured Associate Professor or Professor)

Applicants must be board certi-fied in internal medicine; havea strong record of academicachievement, as evidenced bypublications, peer-reviewedgrants, and national recognition

in outcomes research or related field; and be eligible for ap-pointment as a tenured Associate Professor or Professor. Ad-ministrative experience in a large clinical, educational, orresearch program highly desirable. Eligibility for a Minne-sota license required. Applications will be reviewed imme-diately and accepted until position is filled. Send a coverletter, CV, and the names and contact information for threereferences to:Dr. Hanna Rubins (1110), VAMC, One Veterans Drive,Minneapolis, MN 55417.

The University of Minnesota is an Equal OpportunityEducator and Employer