Society of General Internal Medicine SGIM TO PROMOTE IMPROVED PATIENT CARE, RESEARCH, AND EDUCATION IN PRIMARY CARE AND FORUM GENERAL INTERNAL MEDICINE Volume 26 • Number 3 • March 2003

ANNUAL MEETING PRECOURSES OFFER EXCITING OPPORTUNITIES Eric Whitaker, MD his year’s precourses represent a and “The Immigrant Experience: Caring range of topics that we hope will fill for Patients New to this Country.” Each Tthe needs and interests of many new represents an example of how primary care and veteran SGIM members. Out of a physicians can be on the forefront of our record number of 55 submissions, 35 half- changing world of medicine. and full-day precourses were accepted for On the clinical front, precourses in presentation in Vancouver. The excep- this year’s program include “See One, Do tional quality of the submissions made this One, Teach One: A Practical Approach a challenging task for the committee. We to the Medical Orthopedic Exam for the are grateful to the efforts of all of those Academic Internist,” “Update on Anti- who submitted precourse proposals. The coagulation and Thromboembolism” or results are a remarkable range of content “Controversies in Chronic Pain Manage- and teaching approaches. ment” and “Sports Medicine.” We also thank the committee of ten For those interested in learning more Contents SGIM members, from a range of back- about certain research methods, courses grounds, who put in their time and ex- such as “HCUP: Data to Generate Evi- 1 Annual Meeting Precourses Offer pertise to review and select this year’s dence for Change,” “Meta-Analysis” and Exciting Opportunities precourses. Our strategy in selecting “QI Research: Where Reality Meets precourses was to include possibilities that Academia” are scheduled. 2 On Balance would appeal to the full range of interests We recognize that virtually all SGIM of SGIM members. To that end, we have members have formal or informal teach- included courses that emphasize clinical ing responsibilities in a variety of settings. 3 President’s Column topics, research methods, educational ap- Therefore, the precourses in education in- proaches, communication issues, and fi- clude ones targeted at students, residents 4 Let Your Voice for Peace Be Heard nally, advocacy and policy. All of the and attending physicians, such as “Teach- courses have large numbers of faculty— ing Evidence-Based Medicine to Resi- 4 Evidence Based Medicine Task Force meaning the opportunity for interactive dents—The PRIME Curriculum,” Report learning is high. “Teaching Effective Behavior Change In keeping with theme of this year’s Strategies to Medical Providers,” and “A 5 Research Funding Corner meeting, Generalist Physicians as Agents Curriculum for Medical Errors.” of Change, there are several courses in the Communication skills is another im- 5 UpToDate Goes Mobile policy and advocacy arena including: portant topic in many different settings “The Uninsured: Preparing Internists to and this year’s precourses reflect this. Ex- 6 ACGIM Column Contribute to Change,” “Effective Health amples of precourses that focus on com- Policy Advocacy for the General Inter- munication will include: “Informed De- 11 Classified Ads nist,” “Minority Generalist Career Devel- cision-Making and Controversial Preven- opment: Becoming an Agent for Change,” continued on page 8 SGIM FORUM

SOCIETY OF GENERAL INTERNAL MEDICINE ON BALANCE OFFICERS 2 PRESIDENT MD Martin F. Shapiro, MD, PhD • Los Angeles, CA [email protected] • (310) 794-2284 Hilit F. Mechaber, MD and Alex J. Mechaber, MD

PRESIDENT-ELECT JudyAnn Bigby, MD • Boston, MA Editor’s Note—This is the first article in set limits accordingly. Playing an active [email protected] • (617) 732-5759 our new regular column highlighting the role in raising our daughter has become

IMMEDIATE PAST-PRESIDENT challenges of balancing personal and our essential priority. When our Kurt Kroenke, MD • Indianapolis, IN professional lives. Submissions and daughter was born, we decided individu- [email protected] • (317) 630-7447 comments are welcome. ally and together that Hilit would cut back to working part-time in academia. TREASURER Eliseo Pérez-Stable, MD • San Francisco, CA t was the night before my last day of Hilit was fortunate to be able to [email protected] • (415) 476-5369 work prior to maternity leave. A day negotiate a job description that allowed I was quite looking forward to. her to continue the portions of her job SECRETARY I Winding down, bidding a temporary that were more structured and that were Ann B. Nattinger, MD, MPH • Milwaukee, WI [email protected] • (414) 456-6860 farewell to patients and staff, and the most rewarding, her clinical practice preparing to spend two weeks at home and teaching. She had to withdraw from SECRETARY-ELECT with our two-year-old daughter as her the responsibilities of our faculty William Branch, MD • Atlanta, GA [email protected] • (404) 616-6627 day care closed for the holidays. I had practice and the on-call responsibilities. 24 hours to go, but her symptoms Our decision to do this did not COUNCIL couldn’t tell time. She was cranky, tired, come easily. It meant a loss of income Christopher Callahan, MD • Indianapolis, IN had no appetite, and finally felt quite and benefits for Hilit and our already [email protected] • (317) 630-7200 warm. Sure enough, the thermometer heavy debt load became even worse. Kenneth Covinsky, MD, MPH • San Francisco, CA gave us the bad news. It seemed simple Hilit also had to relinquish her aca- [email protected] • (415) 221-4810 enough. She would have to stay home demic title when she assumed her part- Susana R. Morales, MD • New York, NY the next day to fight off a likely viral time position. However, we believed in [email protected] • (212) 746-2909 infection. Yet, for us, the solution was our hearts that children only grow up Eileen E. Reynolds, MD • Boston, MA far from easy. once, and having more time to witness [email protected] • (617) 667-3001 What gives? As two general this outweighed the financial and career Gary E. Rosenthal, MD • Iowa City, IA internists we were faced with only one sacrifices. We also trusted the words of [email protected] • (319) 356-4241 of the many challenges dual-physician our mentors that these loans would Harry P. Selker, MD, MSPH • Boston, MA families frequently encounter. Patients eventually be paid off. [email protected] • (617) 636-5009 rely on us to direct their health care, We have been challenged as a EX OFFICIO sometimes in life or death situations. couple, wanting to see both our careers Regional Coordinator While this type of reliance is one of the succeed. Over these past two years, Jane M. Geraci, MD, MPH • Houston, TX biggest privileges of doctoring, it can Alex has luckily had many opportuni- [email protected] • (713) 745-3084 simultaneously be viewed as a burden ties come his way to develop and grow Editor, Journal of General Internal Medicine that cannot always or easily be met. By as a clinician-educator. Though there Eric B. Bass, MD • Baltimore, MD placing our daughter’s health as our are times that Hilit has felt under [email protected] • (410) 955-9868 priority, how do we deal with the valued as a clinician-educator, she has Editor, SGIM Forum burden of guilt felt by canceling time set worked hard to keep herself visible and Melissa McNeil, MD, MPH • Pittsburgh, PA aside for our patients? Whose needs as involved as possible in our academic [email protected] • (412) 692-4886 become more important? Which of us community. The effort is quite worth- HEALTH POLICY CONSULTANT will stay at home? Though we have while. Hilit feels she made the right Robert E. Blaser • Washington, DC likely all chosen our profession at least choice in deciding to return to work [email protected] • (202) 261-4551 partially for altruistic reasons, this part-time. Her attitude towards her EXECUTIVE DIRECTOR constant conflict can easily test our work has improved by knowing that she David Karlson, PhD priorities. also has the time to be at home. She 2501 M Street, NW, Suite 575 Many of our biggest challenges can focus at work and feels like a better Washington, DC 20037 revolve around time and lack of doctor and teacher. She is also more [email protected] (800) 822-3060 flexibility. The delicate balancing of fulfilled both personally and profession- (202) 887-5150, 887-5405 FAX personal and professional time has ally, and only hopes that she will be able required us to evaluate our priorities and continued on page 8

2 PRESIDENT’S COLUMN

INVESTING IN OUR FUTURE Martin F. Shapiro, MD, PhD

GIM has taken some very exciting The Council challenge. We must find steps this year. We have created a has been very other ways to raise funds to Snew task force to address issues in excited and continue SGIM’s key career development, with the goals of activated by all of programs, launch new strengthening divisions of general these initiatives. ones, and respond to future internal medicine throughout the We do, however, needs of our members. Our country, and of helping individual have some funding situation is very faculty find the mentorship that they challenges that tight right now. We are need and the collaborators that they we face as an doing everything we can to need, even when they are not to be organization, if eliminate expenditures found in their own medical schools. we are to sustain that are not essential. At The task force has initiated a program all of these new programs. The essence the same time, we will need additional of site visits to medical schools to help is money. revenues. them improve their ability to achieve As our membership is well aware, The Society has five sources of their goals. They also have solicited SGIM made a decision after vigorous revenue: 1) member dues 2) royalties participants for a new long-distance debate, to limit the amount that we can from products and publications 3) mentoring program that will be accept from all external sources. This proceeds from the Annual Meeting and launched at the Vancouver meeting. will help the Society avoid becoming precourses 4) grants and contributions The Society also has created a task dependent upon funds from industry, or from the private sector, philanthropies force to address issues relating to the from any other, single source or pro- and the federal government and future of general internal medicine, in gram. This policy presents us with a continued on page 9 the domains of clinical practice, education and research. The task force’s report addresses issues that are central SGIM to our discipline. It appears likely that it will suggest some fundamental reforms in our field. It is not yet in final form, FORUM but will be sufficiently far along prior to the Vancouver meeting to allow it to be distributed to the membership at that EDITOR Mark Liebow, MD, MPH • Rochester, MN time. The Vancouver meeting includes Melissa McNeil, MD, MPH • Pittsburgh, PA [email protected] • (507) 284-1551 [email protected] • (412) 692-4886 a plenary session devoted to discussion P. Preston Reynolds, MD, PhD, FACP • Baltimore, MD [email protected] • (410) 939-7871 of the issues raised in the report. ASSOCIATE EDITORS The Council has been concerned James C. Byrd, MD, MPH • Greenville, NC Valerie Stone, MD, MPH • Boston, MA about the lack of venues for publication [email protected] • (252) 816-4633 [email protected] • (617) 726-7708 of educational scholarship by our Joseph Conigliaro, MD, MPH • Pittsburgh, PA Brent Williams, MD • Ann Arbor, MI membership and has embraced the idea [email protected] • (412) 688-6477 [email protected] • (734) 647-9688 of publishing a regular periodical. As Giselle Corbie-Smith, MD • Chapel Hill, NC Ellen F. Yee, MD, MPH • Albaquerque, NM has been communicated to you, this [email protected] • (919) 962-1136 [email protected] • (505) 265-1711 Ext. 4255 may well initially take the form of a David Lee, MD • Boise, ID twice-yearly supplement to JGIM. We [email protected] • (208) 422-1102 also have continued to be concerned about issues relating to disparities in Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine. health and health care and have a task SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists and those engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do not force involved with these issues. The represent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, and challenge readers’ opinions. task force already has announced a SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist the special issue of JGIM on disparities in author 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 health.

3 SGIM FORUM

Let Your Voice for Peace Be Heard P. Preston Reynolds, MD, PhD, FACP

ecember 2002 marks the fifth landmines are being laid. Administration. Recently, President anniversary of the signing of the The Clinton Administration had a Bush has requested again a thorough Dhistoric Mine Ban Treaty by 122 commitment to join the Mine Ban analysis of the US position on countries. This comprehensive treaty Treaty by 2006. Last year the Bush landmines with a recommendation that became effective on March 1, 1999, the Administration called for a reevaluation these weapons be integrated into our most rapid adoption of any interna- of that policy. The US Campaign to military arsenal. tional treaty. One hundred and forty- Ban Landmines along with delegates of Top ranking military leaders in this three countries have joined the Mine the ICBL lobbied extensively to avoid a country have called for a complete Ban Treaty and, thus, are required to reevaluation. Citizens from around the elimination of landmines from the US stop production, export, and use of country met with Congressmen and military arsenal. In 1996, 15 high landmines; destroy within four years Senators, attended workshops and ranking retired US military officers their stockpiles of landmines; and lectures, participated in rallies at the called upon the President to sign the within ten years clear their fields of White House, and attended universal Mine Ban Treaty. Again, in May 2001, landmines, and provide resources to worship services. Their efforts were eight officers wrote to President Bush, rehabilitate landmine victims. The successful in stalling the State Depart- stating landmines “are outmoded International Campaign to Ban Land- ment and the White House from rolling weapons that have, time and again, mines (ICBL), the recipient of the 1997 back gains made under the Clinton continued on page 10 Nobel Peace Prize, established “Land- mine Monitor,” an unprecedented effort to systematically document nations’ compliance with the Mine Ban Treaty. Evidence Based Medicine Task Force Report Beginning in 1999, the ICBL has Sharon E. Straus MD, MSc, FRCPC published the Landmine Monitor annually. The 2002 report gives clear n behalf of the SGIM EBM Task EBM have several available options. evidence of the enormous success of the OForce, I would like to take this McMaster University, New York ICBL in reducing the number of deaths opportunity to update you on the Academy of Medicine, Oxford Univer- due to landmine injuries from 26,000 to progress of our EBM Project. sity, and the University of Colorado 15,000–20,000 a year, eliminating The SGIM EBM Task Force has offer 3–5 day workshops on EBM. stockpiles of these deadly weapons, and developed several educational products. Based on the response of participants at creating a widespread commitment that The main educational product is the our practicing clinician workshops, we landmines should no longer be used in “EBM for the Practicing Clinician” have developed an abbreviated work- any conflict situation in any area of the workshop that was piloted in 2000 and shop for clinicians interested in teach- world. In fact, United Nations Resolu- has subsequently been revised and ing EBM. In May 2002, we successfully tion 56/24M calling for universalization completed at several workshops. We completed our first “Teaching EBM” of the Mine Ban Treaty was adopted on recently completed a series of 3 work- workshop at the SGIM Annual Meeting November 29, 2001, by a vote of 138 in shops for practicing clinicians that were and are planning a follow-up event for favor, none opposed and 19 abstentions. funded by a small conference grant from participants at this years’ Annual The United States has not signed the Agency for Health Research and Meeting as well as another ‘Teaching the Mine Ban Treaty. Only the US and Quality. We have also made available EBM’ workshop. Cuba among the nations of the Western the online Desktop that is used for these The Evaluation Cluster of the Task Hemisphere have not signed the treaty, workshops for participants to purchase Force has also been extremely active and soon the US will become the only and continue to use after the workshop and will be holding a retreat for re- member of NATO that has not joined is completed. searchers and teachers interested in the Mine Ban Treaty. With the threat of We have focused on developing rigorous evaluation of EBM activities. war against Iraq increasing daily, there is educational programs for practicing And, the Web cluster has developed growing concern that the US will pressure clinicians because few of these exist. materials for the SGIM EBM website its allies to allow it to use landmines or to Clinician-educators who wish more in that will be launched in June 2003. force them into situations where depth training in EBM and teaching continued on page 8

4 UpToDate Goes Mobile RESEARCH FUNDING CORNER Eric W. Vogel, MD, Jennifer Erskine MD Joseph Conigliaro, MD, MPH MSIS, Russell Maulitz, MD, PhD

his month’s Research Funding experience. Kirschstein-NRSA awards he highly popular clinical informa- Corner focuses on two training provide stipends for subsistence, tuition Ttion resource UpToDate (http:// Tawards. and fees and expenses such as research www.uptodate.com) has taken the next supplies, equipment, health insurance step in its evolution, with a new version Ruth L. Kirschstein National Re- and travel to scientific meetings. being released for handheld computers. search Service Award (F32) Additional funds may be requested by Although the hardware and software Release Date: February 6, 2003 the institution when the training requirements are a bit expensive for PA Number: PA-03-067 involves extraordinary costs for travel to someone without the right equipment The National Research Service Act sites remote from the sponsoring already, this product is a big leap (NRSA) Program, renamed the Ruth L. institution; or, accommodations for forward in delivering information—and Kirschstein National Research Service fellows who are disabled. The sponsor- authoritative answers to common Award Program, is a multi-agency award ing institution is allowed to provide patient-care questions—at the point of designed ensure that highly trained funds to the fellow in addition to the care. In this article, we will discuss our scientists will be available to carry out stipends paid by the NIH. As required experience in using UpToDate in the Nation’s biomedical and behavioral by the NIH, fellows incur a service general, the workings of the newest research agenda. Individuals with a obligation of 1 month for each month version of the program for handhelds, PhD., MD, DO, DC, DDS, DVM, OD, of support during the first 12 months of and its strengths and areas for improve- DPM, ScD, EngD, DrPH, DNS, ND, the support. The 13th and subsequent ment from the practicing clinician’s PharmD, DSW, PsyD, or equivalent months of support are acceptable standpoint. who agree to undertake a minimum of 2 postdoctoral payback service. Thus, Readers of the SGIM Forum are years of commitment must develop a individuals who continue under the probably familiar with UpToDate proposed postdoctoral training program award for 2 years will have paid off their already, but to review, UpToDate is a within the broad scope of biomedical, first year obligation by the end of the subscription-based clinical information behavioral, or clinical research and second year. Questions can be directed resource designed to provide physicians enhance the fellow’s understanding of at one of the many branches of NIH with concise, practical answers to the the health-related sciences that will that are participating in this announce- kind of questions they regularly encoun- lead to a productive research career. For ment. More details and a listing of each ter. Over 6,000 topics are presented in a those who have a health professional institute’s or center’s program contact textbook-style format, and the database degree, the proposed training may be information can be found on the also includes many illustrations, figures, used to satisfy a portion of the degree following web page: http:// videos, links to MEDLINE abstracts, a requirements for a master’s degree, a grants1.nih.gov/grants/guide/notice- complete drug information database, doctoral degree or any other advanced files/not98-027.html. and patient information handouts. research degree program. Fellowship UpToDate would technically not be awardees are required to pursue their Mid Career Investigator Award In considered an “evidence-based” re- research training on a full-time basis, Patient-Oriented Research (K24) source, as it currently lacks formal rules devoting at least 40 hours per week to Release Date: October 8, 1999 for data inclusion such as those used in the training program. Research clini- PA Number: PA-00-005 articles from the Cochrane Database of cians must devote full-time to their The Mid Career Investigator Award Systematic Reviews. Nonetheless, proposed research training and must in Patient-Oriented Research (K24) is a UpToDate is a well-regarded resource restrict clinical duties within their full- multi-agency award that provides up to known for content that is peer-re- time research training experience to five years (minimum three years) of viewed, well referenced and constantly activities that are directly related to the patient-oriented research support for updated based on newly published research training experience. clinicians to allow them protected time information, and the editors of These are institution-sponsored to devote to patient-oriented research UpToDate are considering a more awards so the applicant must identify a and to act as mentors for beginning explicit evidence-based format in the sponsoring institution and an individual clinical investigators. The target future. An annual personal subscription who will serve as a mentor and will candidates are outstanding clinical costs $495 for new subscribers ($395 for supervise the training and research continued on page 10 continued on page 7

5 SGIM FORUM ACGIM COLUMN ACGIM Management Institute: Improving Management Training and Leadership William P. Moran, MD

ach year the Association of Chiefs short work life survey upon which chiefs Medicine: Where is it’s Home in of General Internal Medicine can build interventions to improve Academic Medical Centers?” Dr. Esponsors the Management faculty satisfaction and enhance career Williams, Associate Director of the Institute, the goal of which is to development while reducing the Division General Internal Medicine, improve management training and occurrence of job stress and burn out. Emory Healthcare, will describe the leadership for faculty in General Financial losses in primary care plague reasons driving the expansion of Internal Medicine. This year the many chiefs of Sections of General inpatient physicians and identify the institute will be held on the afternoon Internal Medicine, yet all believe that range of potential roles for Hospitalists of April 30th, preceding the annual primary care is critical to the mission of in clinical care, teaching, administra- meeting of the Society of General Academic Medical Centers. Dr. Mary tion and research. Dr. Williams antici- Internal Medicine, with three presenta- Nettleman, Professor and Chief of pates future challenges facing inpatient tions focused on “Managing Demands General Internal Medicine at Virginia, physicians and will explore the develop- on Faculty and Chiefs.” In addition, a ment and future aca- special ACGIM-sponsored workshop demic home for the “Leadership that Fosters Health and Chiefs of GIM need to specialty of Hospital Balance in the Workplace” is scheduled Medicine. Finally, Dr. during the annual meeting. recognize predictable life Williams will also discuss Chiefs are increasingly faced with events as a staffing challenge, the role of the National staffing challenges, and Dr. Mark Linzer, Association of Inpatient Chief of General Internal Medicine at and work with their Chairs to Physicians (NAIP) in the University of Wisconsin Madison, promoting hospitalism as will lead off the Management Institute reduce the impact of these a career, and how the with a presentation entitled “Life events… NAIP may interact with Events (predictable and otherwise): other professional Staffing a Section of General Internal associations such as the Medicine.” Dr. Linzer is the Principal Commonwealth University feels that ACGIM and the SGIM. Investigator on the Physician Work Life the perception that primary care drains ACGIM is pleased to sponsor a Study and Physician Work Life Study II institutional resources is erroneous. In very special presentation during the and has studied predictable life events her presentation “Financing Primary SGIM meeting: “Leadership that Fosters as a cause of staffing shortages in Care and Academic Medicine,” Dr. Health and Balance in the Workplace.” sections of General Internal Medicine. Nettleman will explore ways to counter Drs. Penny Williamson and Tony These life events, such as pregnancy, this misperception with specific Suchman will lead this two part illness and part-time practice prior to attention to benchmarking and down- workshop for current and emerging retirement can reduce the available stream revenue analysis. Dr. Nettleman leaders in General Internal Medicine on work force in Sections of General will present suggestions for using these Friday May 2. They will provide Internal Medicine, precipitating faculty techniques, as well as other methods of attendees with an opportunity to dissatisfaction and stress. Dr. Linzer obtaining funding, to help chiefs and explore the principles of Relationship- presents the implications of this other leaders of General Internal Centered Administration, an approach challenge and suggests that chiefs can Medicine to achieve financial stability which parallels and supports their well anticipate and compensate for the work for their sections. known partnership-based clinical force consequences of predictable life The number of inpatient physicians approach, Relationship-Centered Care. events. Dr. Linzer believes that Chiefs (Hospitalists) has dramatically in- During this interactive workshop, of General Internal Medicine need to creased over the past decade, but the attendees will work in small groups and recognize predictable life events as a academic roots for inpatient physicians engage in an iterative process of staffing challenge, and work with their may not be clear at many institutions. practice and reflection to focus on four Chairs to reduce the impact of these Dr. Mark V. Williams, President of the core skills: being personally present, events on the remaining faculty in the National Association of Inpatient speaking authentically and listening to section. Dr. Linzer will also present a Physicians, will present “Hospital continued on page 10

6 UPTODATE continued from page 5 renewals, $195 for trainees), and ity of the installation process. sor loaded the various pages, it took less includes a new updated CD-ROM The Pocket PC version of UpTo- than two minutes to access the page version for a PC every four months, and Date delivers the same extensive with the information we were looking access to the Internet version of the database of textual information as the for. Searches on other topics were also database with a username and password. PC or Web versions, but there are a few easy to navigate and quickly led to the An exciting new addition to the differences. The handheld version does section with the answers we needed. UpToDate subscription package for 2003 not contain the photographs, videos, One problem we encountered with is the availability of access via Pocket and some of the full-text graphics that the program is the graphics. The figures PC handheld computer at no extra cost. the other versions have. Also, the and tables included were hard to Although handheld computers based on search interface and navigation work a visualize, and required scrolling to view the Palm platform are more widely in little differently in order to eliminate all their data. It appears that the figures use, the sheer size of the UpToDate the need for excessive scrolling through from the PC version were not reformat- database required the expandability and text that can be a problem with the ted for the small screen size on hand- graphics capability that is currently only small-sized screens in handheld devices. helds, so this is an area that could be available with handheld computers Our experience using the desktop improved in the future. As the capabili- using the Pocket PC operating system version of UpToDate indicates it is a ties of handheld computers improve in from Microsoft. The Pocket PC units useful resource that provides detailed, the future, UpToDate will also look to that have been confirmed to work with comprehensive answers to questions we add their photos and video to the UpToDate include the Toshiba e570 and have about patient care. We have mobile version. e740, the Hewlett-Packard/Compaq installed the database on desktop Overall, UpToDate for Pocket PC is iPAQ series (3600 and higher), the computers for our residents to use at a welcome addition to the UpToDate Hewlett-Packard Jornada 560 series, the Drexel University, and the residents family of products. For those who can Dell AXIM and the Casio Cassiopeia E- have also been quite happy with the afford the initial hardware investment, 200. Although the price of these units utility of the database in finding clinical this is one of the best mobile resources varies by features, the average new information to help them in their now available for helping physicians Pocket PC will run about $500. In patient care. find authoritative answers to questions addition, you will need to purchase a 1- The handheld version of UpToDate that arise from their daily patient gigabyte (GB) memory expansion has proved to be similarly useful. One encounters. It is also probably the first module to hold the UpToDate database, example of a search we did on the portable program of its type to become either as an IBM Microdrive (about handheld version concerned the utility available and hence offers a solution in $300) or a Compact Flash card (about of vena caval filters in preventing the here and now; competitors, such as $500), plus a storage reader (about $30) recurrent pulmonary embolism. After a handheld version of the American to connect the memory module directly opening the UpToDate program on the College of Physicians’ PIER Project to your desktop or laptop PC for Pocket PC, we were presented with a (http://pier.acponline.org/index.html) installation. Thus, users who start from screen to enter search terms. After will, as they emerge from beta testing, scratch and seek to get “to the bedside” entering “filter” in the search field, we also be worth a look. SGIM with subscription and all hardware may got a list of nine potential keyword face a stiff $1300-$1500 in initial matches, and chose “Filter, Inferior Editor’s Note—Eric W. Vogel, MD, is investment—the same as for some ultra- Vena Caval.” This led to another screen Director of the Internal Medicine Resi- light-weight computers. of nine potential articles, categorized dency Program at Drexel University The installation package for the into “Most Relevant Topics” and College of Medicine; Jennifer Erskine, Pocket PC comes as a 2-CD ROM set. “Related Topics,” and we chose the MD, MSIS, completed her fellowship in The process of adding the UpToDate “Inferior Vena Caval Filters” article. medical informatics at the Institute for software to your Pocket PC involves The chapter on this topic had 8 Healthcare Informatics, Drexel University, installing the database directly from a subtopics to choose from, and a figure Philadelphia; Russell Maulitz, MD, PhD, Windows-based PC to the 1 GB storage illustrating the various models available. is the Director of the Institute for module through the storage reader, and We learned that the effectiveness of Healthcare Informatics, Drexel University, then installing the UpToDate utilities to these filters had not been well studied Philadelphia. All are practicing primary the Pocket PC’s internal memory. The in carefully controlled trials. There was care physicians. Toshiba e740 unit we received for review a discussion of the results of the few came with UpToDate pre-installed on a trials that had been completed, along 1GB Compact Flash card, so we cannot with potential complications. Overall, comment on the actual ease and reliabil- with the slight delays while the proces-

7 SGIM FORUM

MD2 continued from page 2

that promotion and limit to our abilities to be in two places tenure are not the only at one time. We have an innate defining measures of At 2:00 AM she was still febrile, so understanding of the sacrifices success for an academic our hopes of still averting the dreaded physician. Because our clinic cancellation were doomed. We that we all make for our lives are more flexible, knew Hilit would be staying home. we have made time for Though her patients are no less impor- profession and our patients. things that we value. tant than any others, the setting in We both love medicine which she practices is structured to to continue in this capacity. and have found a way to continue allow a bit more flexibility. As we are We often wonder if the MD2 refers practicing and teaching it. We feel we frequently reminded, the “Mommy and more to our dual MD degrees or MD have succeeded in our own right. We Daddy” degrees were just as hard-earned plus Mommy and MD plus Daddy. have learned that at each moment we as the MD2. SGIM There are times that we flip-flop these are human and that there is a finite roles, and always feel they need to be juggled delicately. The patient with chest pain at 5:00 PM usually can’t wait EXCITING OPPORTUNITIES to be evaluated, even though the continued from page 1 carpool may be waiting. We have been tive Services: An Approach to Patient- Precourses have always been a way able to arrange work schedules so that Provider Communication” and “Learn- to further develop a current interest or one of us is almost always guaranteed a ing and Teaching An Evidence-Based to experiment with a new one. We finite starting and ending time to the Method for Patient-Centered Inter- encourage you to do both. Part of the day, not always patient-related, so that viewing.” design of having the choice of a full-day we are not stuck in such a quagmire. We hope this range of courses— course or two half-day courses is to Careful short and long-term planning from clinical topics to research to allow members to create their own track has been a necessity, and we have both education and advocacy—fulfills the through the precourses. One can see a worked hard to stay aware of each multiple interests, expertise and work topic in a little more depth with a full- others’ expectations. settings of SGIM members. The range day precourse or enroll in two different Sharing the same profession has of teaching approaches will be as varied types of courses with half-day courses. had many advantages and has allowed as the topics. We anticipate that you The precourses also offer a time to meet us to overcome many of the obstacles. will be able to learn both pieces of and visit with other members—either We can provide necessary support, content and techniques of teaching that old colleagues or new ones. In the guidance, and relevant feedback to each you can use in your own setting. As diversity of content and teaching other, much more objectively than any such we hope they will live up to the approaches, we think they reflect our colleague or mentor could. We have an title of one of the half-day offerings this membership and our goals as a innate understanding of the sacrifices year: “Balance, The Antidote to Society. SGIM that we all make for our profession and Burnout: A Professional Matter.” our patients. The key to success in our relationship has been a constant and open line of communication about all TASK FORCE REPORT matters. In this realm, honesty has been continued from page 4 of utmost importance, particularly at times when Hilit has felt less supported In addition, the Task Force has effective dissemination strategy within at work. We have also found a great developed relationships with the internal medicine. deal of support by networking with publishers of the four EBM databases we This has been an exciting year for other physician pairs through SGIM’s use in our workshops and with organiza- us and we look forward to the next year. annual Couples in Medicine “Meet the tions that will be key to the dissemina- Please look to our website to identify Professors” sessions, led by models Drs. tion of our products. We are in the opportunities for you to collaborate Robert and Suzanne Fletcher. process of identifying organizations with us. SGIM Grappling with our individual representing other specialties, such as definitions of “success” has been a the Alliance for Continuing Medical Editor’s Note—Dr. Straus serves as the challenge, but also a source of growth. Education, to assist us with dissemina- Chair of the Steering Committee, SGIM For Hilit, it has taken time to recognize tion once we have demonstrated an EBM Task Force.

8 OUR FUTURE continued from page 3

5) contributions from members. starting Wednesday at We don’t want to raise charges for noon on sports membership or for attending the annual medicine and meta- We have great loyalty among meeting to unreasonable levels. We are analysis, there are our members, a high doing all that we can to raise external sessions on profes- funds. We need our members to help us sional balance and proportion of whom come to out. Here is what you can do: teaching professional 1.Come to Vancouver. We have great values. The 15 half- the meeting every year. I hope loyalty among our members, a high day precourses on that you’ll be there this time. proportion of whom come to the Wednesday afternoon meeting every year. I hope that you’ll include such topics as be there this time. We are discussing intimate partner violence, evidence- meeting. You must have students, issues of great importance to the based patient interviewing, fellows or colleagues who have never future of our field. Submissions of precepting skills development, been to an SGIM meeting. Convince scientific abstracts, clinical vignettes chronicling competence during them to come. I am sure that you and other program components are residency, psychosocial aspects of remember the excitement of your first much higher than ever before. There bioterrorism, and using PDAs to Annual Meeting. Let them share that will be over 650 scientific abstracts improve care. If you can’t be there experience. presented at the meeting, along with Wednesday afternoon, you can take a 5. Make a contribution to the Society. over 250 clinical vignettes and record precourse the Thursday morning that Steve Schroeder, who just stepped numbers of sessions on innovations in the main meeting begins. There are down as President of the Robert medical education and practice 16 topics to choose from, including Wood Johnson Foundation, is leading management! There will be the usual long distance mentoring (tied into our annual fund-raising drive. Please wondrous array of workshops and the Society’s new initiative in that respond to this initiative. Your tax- interest groups. There will be clinical area), teaching faculty and residents free contribution can help us out a update sessions in clinical preventive how to code in the outpatient setting, lot. If you don’t have money to services, HIV care, geriatrics, managing your overweight and obese donate, we can accept airline miles women’s health, hospital medicine, patient, primary care genetics, (that will offset substantial expenses and general internal medicine. There teaching the resident to teach, incurred by the Society). You also can will be consultation sessions on training primary care physicians in print a contribution form from our implementing change at home. There smoking cessation interventions, and website or e-mail Bradley Houseton at will be structured opportunities to promoting professionalism through [email protected] for assistance in develop collaborative relationships self-reflection and meaning. This is making a contribution. and friendships with colleagues from an incredible menu. An impressive SGIM is activated to lead our field other institutions. The meeting array of resources, intellectual and in the tumultuous times ahead and to should be very stimulating, to say the fiscal, are put into these programs. By help our members have more successful least. Vancouver is fabulous. Opportu- my count, 219 faculty are participat- and fulfilling careers. To meet the many nities abound for gourmet dining, ing in these precourses. I’d like to challenges that we face, we urgently hiking in Stanley Park, sipping a take about 30 of them. Everyone need more resources. If you don’t want drink at an outdoor café on English could benefit from participating in us to follow the path of some other Bay, and taking trips to Whistler, one or two. organizations that are heavily depen- Vancouver Island and Alaska after 3.Help us find new members. Lots of dent upon industry support, then please the meeting. Don’t miss out! academic general internists belong to help us move with strength into the 2.Take a precourse. The precourses are the Society, but many others do not. future. Send your emails to me to a wonderful component of the Please help us recruit members of your [email protected]. SGIM meeting. Many of our members who division and others whom you believe attend the meeting take them, but could benefit from membership. If you not all do. This year, they cover an know anyone who once belonged but amazing array of topics, some of hasn’t renewed recently, we want ’em which are described in a separate back. Send them to www.sgim.org or article in this issue of the Forum. Here have them telephone 800-822-3060, are a few others that caught my eye. and we’ll sign them up. In addition to the full-day precourses, 4.Bring students and colleagues to the

9 SGIM FORUM

VOICE FOR PEACE continued from page 4

all fifty states wrote the you call and write the White House …landmines “are outmoded President adding their today asking President George W. Bush support for the Mine to sign the treaty and ban forever the weapons that have, time and Ban Treaty. use of landmines by American military The US has not forces. For information on the US again, proved to be a liability to used landmines in a campaign to ban landmines see: our own troops.” conflict situation since www.banmines the Gulf War in 1991, usa.org, for the ICBL, see has not exported them www.ICBL.org. proved to be a liability to our own since 1992, and has not produced them If you are interested in joining troops. We believe that the military, since 1997. It leads the world in SGIM’s human rights cluster, please diplomatic, and humanitarian advan- supporting mine clearance in other contact me at: pprestonreynolds@ tages of speedy US accession far nations. While the US is only one step comcast.net. SGIM outweigh the minimal military utility of away from embracing a ban on these weapons.” They closed their letter landmines, it is being pulled further and Editor’s Note—Dr. P. Preston Reynolds arguing they “would not be urging this further from its leadership role as the serves as the Chair, SGIM Human Rights course of action if we did not believe it Bush Administration threatens to make Cluster. She is a former member of the would enhance our combat mobility and this weapon available to US military Board of Directors of Physicians for effectiveness and, most importantly, commanders. The SGIM Health Policy Human Rights, 1987-2001, and founding protect our nation’s sons and daughters Committee has taken the position that member of the ICBL, Recipients of the when we send them into harm’s way.” In the United States should sign the Mine 1997 Nobel Peace Prize November 2001, 500 US veterans from Ban Treaty. We believe it is urgent that

RESEARCH FUNDING CORNER continued from page 5 scientists who are actively engaged in intended to further both the applicant’s computer time. Questions can be patient-oriented research and within 15 research and mentoring endeavors, to directed at one of the many branches of years of their specialty training. Candi- expand their potential contributions to NIH that are participating in this dates for this award must have a health- their field, and act as mentors for announcement. More details and a professional doctoral degree or its beginning clinician researchers. Awards listing of each institute’s or center’s equivalent and have a record of excel- can pay for 25–50 percent of salary, up program contact information can be lent patient-oriented research, experi- to $25,000 per year for research ex- found on the following web page: http:// ence in mentoring clinicians with little penses, such as supplies, equipment and grants1.nih.gov/grants/guide/pa-files/ or no research experience and have technical personnel for the principal PA-00-005.html. independent research support at the investigator and his/her mentored Please contact joseph.conigliaro@ time of the application. This support clinical investigators, travel to research med.va.gov for any comments, sugges- could include NIH awards or awards meetings or training, and statistical tions, or contributions to this from other sources. The award is services including personnel and column. SGIM

MANAGEMENT INSTITUTE continued from page 6 understand others, valuing differences provide an introductory exposure to Management Institute. ACGIM also and diversity, and trusting the process/ several organizational development encourages individuals who anticipate letting go of control. They will lead strategies including story telling, assuming leadership roles in sections to participants as they engage in inter- appreciative inquiry, world cafe and also consider attending the views and dialogue to discover core peer mentoring. institute. SGIM factors that promote personal balance ACGIM encourages Chiefs of and a healthy workplace. They will help Sections and Divisions of General Editor’s Note—Dr. Moran serves as the participants develop individual action Internal Medicine, other leaders from Program Chair, ACGIM Management plans to be implemented in their General Internal Medicine, managers Institute sections. This workshop will also and administrators to attend the

10 CLASSIFIED A DS

Whittle, MD, MPH; Director, Positions Available and Announcements Division of General and Geri- are $50 per 50 words for SGIM members and atric Medicine; Kansas Uni- $100 per 50 words for nonmembers. These versity Medical Center; 5026 U.S. Department of Health and Human Services fees cover one month’s appearance in the Wescoe; 3901 Rainbow Boule- Forum and appearance on the SGIM Web- vard; Kansas City, KS 66160. Food and Drug Administration site at http://www.sgim.org. Send your ad, Email [email protected]. along with the name of the SGIM member KUMC is an Equal Opportu- sponsor, to [email protected]. It is assumed nity/Affirmative Action em- MEDICAL OFFICERS that all ads are placed by equal opportunity ployer. Not a J-1 position. employers. The Food and Drug Administration, Center for Drug Evaluation and HOSPITALIST CLINICIAN Research, Office of New Drugs is recruiting physicians to serve as Review EDUCATORS. The Division of General and Geriatric Medi- Medical Officers in the dynamic, highly challenging and innovative ASSISTANT/ASSOCIATE PROFESSORS, PRE- cine at Kansas University atmosphere of drug development and research. Review Medical Officers VENTIVE MEDICINE. The University of Alabama Medical Center is recruiting provide scientific and regulatory guidance to sponsors through all phases at Birmingham, School of Medicine, Department outstanding clinician educa- of drug development, including the review of clinical trial designs, overall of Medicine, Division of Preventative Medicine is tors to join our academic seeking two doctoral scientists for faculty positions hospitalist group. The primary clinical drug development programs and evaluation of the results of these at the Assistant or Associate Professor level in the responsibility is supervision of clinical programs. The Office of New Drugs public health mission is to UAB Division of Preventive Medicine. Rank and patient care and education of protect and enhance the health of the public through the review and residents in inpatient and con- tenure status to be determined based on qualifica- evaluation of scientific data submitted by pharmaceutical manufactures in tions. Combination of medical degree with gradu- sultant roles. Successful candi- ate degree in a quantitative science preferred. Suc- dates will also participate in support of New Drug and Investigational New Drug applications cessful candidates should have a strong interest in innovative educational pro- (NDA/IND), and render an approval or disapproval for human use. health services research, teaching, and preventive grams for medical students. Medical Officers work with a multidisciplinary scientific team to provide medicine and physician candidates must be board Protected time for program certified in a pertinent specialty. Research experi- development or research is advice on clinical trial design and on approval of new drugs. A team ence and interest in quality of care, patient out- available. Contact Jeff approach facilitates interaction with a wide range of scientific disciplines comes, or clinical effectiveness are strongly pre- Whittle, MD; Director, Divi- and involves a working relationship with the pharmaceutical industry, sion of General and Geriatric ferred. Division research currently includes research individual investigators, academia and other government agencies. programs primarily related to clinical health ser- Medicine; KUMC; 5026 Wescoe; 3901 Rainbow Boule- vices research, clinical trials, and epidemiology with QUALIFICATIONS: Applicants must have a Doctor of Medicine or Doctor particular focus on underserved populations and vard; Kansas City, KS 66160. women. Current research programs include preven- Email: [email protected]. of Osteopathy degree from an accredited medical school. BC/BE in tion and outcomes of cancer, osteoporosis, cardio- KUMC is an Equal Opportu- oncology is highly desirable. Graduates of foreign medical schools must vascular disease, diabetes, and changing provider nity/Affirmative Action em- be certified by the Education Commission for Foreign Medical Graduates ployer. Not a J-1 position. practice patterns. The UAB Department of Medi- (ECFMG). Please submit a copy of your permanent ECFMG certification. cine consistently ranks in the top 10 Departments in NIH funding, with Preventive Medicine ac- PGY II. The Social Internal Candidates for Civil Service or U.S. Commissioned Corps must be U.S. counting for a large proportion of federal funding Medicine /Primary Care Pro- citizens. Permanent U.S. residents may apply for staff fellowship in the Department. The Division and Department grams at Montefiore/ Albert appointments. are expanding and provide a vibrant environment Einstein College in New York that stimulates professional growth and provides City (www.Medicine- CIVIL SERVICE SALARY: GS-14, $84,446 to $106,163 plus a Physician access to an outstanding infrastructure. Please send Residency.org) have an unex- CV to: Norman W. Weissman, Ph.D., Director, pected PGY II for July 2003. Comparability Allowance up to $30,000 (depending on years of UAB Center for Outcomes and Effectiveness Re- Applicants should be inter- experience) and an excellent benefits package. This is a term search and Education (COERE), 1717 11th Avenue ested in urban community ori- appointment (2 years), with the possibility of conversion to permanent ented care and clinical or aca- South, Suite 401, Birmingham, AL 35205-4785. employment. UAB is an Affirmative Action/Equal Opportunity demic generalist careers. Please contact: Gerald Paccione MD, Employer. Women and ethnic minorities are par- HOW TO APPLY: For more information, contact the Office of New ticularly encouraged to apply. Program Director. Email: [email protected]. Drugs/Program Management Team via e-mail at: CDER OND CHIEF MEDICAL RESIDENT. The University of EOE. [email protected]. Submit curriculum vitae with cover letter Louisville IM Training Program is currently seek- indicating you are applying to source code #103067 to: ing a CMR for 2003-2004. Faculty position. Duties PHYSICIAN-HEALTH SER- VICES RESEARCH INVES- include administrative, educational and clinical U.S. Food and Drug Administration Responsibilities. Works with another CMR to cover TIGATOR. The Houston both University and VA hospital systems. Faculty Center for Quality of Care and Center for Drug Evaluation and Research development in clinical teaching available. Inter- Utilization Studies, A Depart- Office of New Drugs ested candidates should fax or email CVs: ment of Veterans Affairs Attn: Program Management Team [email protected]; 502-852-0936. Health Services Research and 1451 Rockville Pike Development Center of Excel- WOCII, Room 3033, HFD-22 lence, and the Baylor College CLINICIAN SCIENTISTS. The Division of Gen- Rockville, MD 20852 eral and Geriatric Medicine at the Kansas Univer- of Medicine, Section for sity Medical Center is recruiting several clinician Health Services Research is scientists. Assistant professor positions provide 80% seeking a Board Certified Gen- THE FDA IS AN EQUAL OPPORTUNITY EMPLOYER WITH A SMOKE FREE ENVIRONMENT protected time and core support for the develop- eral Internist. Qualifications: ment of a coherent research agenda. Active areas Health Services Research of research include health and healthcare dispari- Training and Experience. ties, access to care, and quality of care. Qualified Proven track record in the fol- candidates at the associate professor level would also lowing areas: Advanced Re- have resources to recruit additional faculty. Inter- search Publications; Ability to acquire Grant Fund- ested candidates should submit a C.V. to Jeff ing; and Clinical experience. Job Description: Po- continued on next page

11 SGIM FORUM Society of General Internal Medicine 2501 M Street, NW Suite 575 Washington, DC 20037

CLASSIFIED A DS continued from previous page sition allows 50-75% Research Time. Clinical re- PHYSICIAN-INVESTIGATORS—MORE lege town lifestyle. Interested candidates should sponsibilities will be dedicated to General Internal THAN CORN GROWING IN IOWA. The Divi- send a letter expressing their interest in the posi- Medicine Practice (Hospital or Clinic) and Resi- sion of General Internal Medicine at the Univer- tion and a current CV to Gary E. Rosenthal, MD, dent Training. Highly competitive salary and ben- sity of Iowa seeks creative physician-investigators Director, Division of General Internal Medicine, efits package. Additional Requirements: Research with expertise in health services research, health University of Iowa Hospitals and Clinics SE618 interests should include treatment of opiate addic- policy, and chronic disease epidemiology at the GH, 200 Hawkins Drive, Iowa City, IA 52242. tion. Position is partly funded by a minority supple- Assistant or Associate Professor levels. Successful Email: [email protected]. The University ment grant that requires potential candidates to be: candidates will join a growing multi-disciplinary of Iowa is an Equal Opportunity/Affirmative Ac- (1) Of minority status as recognized by NIH guide- research group with substantial federal and non-fed- tion Employer. Women and minorities are strongly lines; and (2) Citizens or noncitizen nationals of eral funding and with expertise in a variety of quan- encouraged to apply. the United States.” Target Start Date: April 15th, titative and qualitative methods. Faculty will have 2003. Interested applicants should email or fax opportunities for joint appointments in the Center TRAINING IN FACULTY DEVELOPMENT. cover letter, Curriculum Vitae, and three (3) refer- for Health Services and Policy Research in the The Stanford Faculty Development Center is cur- ences to Tamara Lavin. Email: tlavin@ College of Public Health and the University of Iowa rently accepting applications for two month-long, bcm.tmc.edu Fax: 713-748-7359. Center for Qual- Public Policy Center, as well as eligibility for VA facilitator-training programs. The training prepares ity of Care and Utilization Studies, VAMC (152) HSR&D funding. Positions will include substan- faculty to conduct a faculty development course for Research, 2002 Holcombe Blvd., Houston, TX tial protected time for independent investigation faculty and residents at their home institutions. (1) 77030. Baylor College of Medicine is an Equal and will allow faculty to spend 25% of their effort The Clinical Teaching course introduces a 7-com- Opportunity, Affirmative Action and Equal Access in hospitalist or ambulatory-based clinical tracks. ponent framework for analyzing and improving Employer. Candidates at the Associate Professor level should teaching. (2) The Geriatrics in Primary Care course have 5 or more years of experience and an estab- enhances primary care physicians’ ability to care PHYSICIAN/INVESTIGATOR-GIM. Houston lished track record in obtaining extramural fund- for older patients and teach geriatrics. 2003 pro- Center for Quality of Care and Utilization Studies, ing. This is a tenure-track position; academic rank gram dates: Geriatrics in Primary Care (Septem- A Veterans Affairs Health Services Research and and tenure will depend on candidates’ qualifications ber 2-26) Clinical Teaching (September 29–Octo- Development Center of Excellence/Baylor College and expertise as is consistent with University policy. ber 24). Application deadline: June 1, 2003. For of Medicine, Section for Health Services Research The Division resides in the heart of the University information: visit http://sfdc.stanford.edu or con- is seeking a General Internal Medicine focused, of Iowa campus in Iowa City, which offers a re- tact Georgette Stratos, PhD at gstratos@ ABIM Certified Physician. Extensive Health Ser- nowned public school system and wonderful col- stanford.edu. vices Research Training and Experience is required. Responsibilities include obtaining funding/conduct- ing self-directed research and contributing to the BEHAVIORAL MEDICINE INTERVENTIONS SUMMER INSTITUTE: design and analysis of research projects being un- dertaken by other investigators in the Center and June 18–21, 2003, Pittsburgh, PA. Institute objectives are to: 1) provide a con- Baylor Section. We are seeking candidates at the ceptual framework for behavioral medicine interventions to promote the abil- Associate Professor/ Professor level. 50%-75% Pro- ity to understand and evaluate behavioral medicine intervention research; 2) tected Research Time. Clinical responsibilities will be dedicated to General Internal Medicine Prac- familiarize participants with behavioral medicine interventions and research in tice (Hospital or Clinic) and Resident Training. several content areas [i.e., diabetes, cardiovascular disease, and cancer] that The position offers a highly competitive salary and will serve as exemplars for behavioral medicine intervention research, in gen- benefits package. MUST be US Citizen. Target Start Date: 7/03. Candidates must provide evidence eral; and 3) provide participants with opportunities to discuss the development of research productivity, excellent quantitative of research ideas and initial studies in areas of interest. Lectures and workshops skills, and a desire to work in an interdisciplinary for individuals at postdoctoral fellow and faculty level with a limited background environment. Please email or fax cover letter, CV, and three references to Tamara Lavin. Email: in behavioral medicine. Travel stipend and CE available to those accepted to [email protected] Fax: 713-748-7359. Houston attend. Application due: April 28, 2003. For details, visit The Pittsburgh Mind- Center for Quality of Care and Utilization Studies, Body Center’s website: www.pghmbc.org or Email: [email protected]. VAMC (152) Research, 2002 Holcombe Blvd., Houston, TX 77030. EEO. (1.23.03)