A comparison of Australasian and United States emergency medicine training programmes

Abstract Training in emergency medicine differs from country to country. This article compares the emergency medicine training programmes of Australasia and the United States of America. The perceived advantages of programmes are highlighted, but no attempt is made to determine which is the better programme. The Australasian programme is significantly longer and places greater emphasis on the basic clinical sciences, physical examination skills and academic output. Australasian College for Emergency Medicine regulations are relatively flexible, and allow trainees to design their own programmes. Australasian trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part-time training may be acceptable. In the US, trainees rotate within and from one parent institution which provides a rigid teaching structure for a ‘critical mass’ of trainees, based upon a core curriculum. Rotations tend to be much shorter than in the Australasian programme but ensure exposure to a broader range of clinical experience. In the US programme, evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. In addition, trainees are under the close supervision of the teaching faculty at all times when working in an emergency department.     

The Development and Evaluation of a Geriatric Emergency Medicine Curriculum

Objective : To summarize the processes used to develop a curriculum and model of care for the emergency medical treatment of elder patients and to assess the efficacy of the teaching material in a pilot course.
Methods : A survey of emergency medicine (EM) residency directors and geriatric fellowship directors was used to identify key topics for inclusion in the didactic material. An interdisciplinary consensus process was used to develop didactic as well as teaching material in geriatric EM. Pretests and posttests were administered to 46 participants in the initial course to assess knowledge gain. Subjective course evaluations were also done.
Results : Test scores significantly increased from 54% correct on the pretest to 77% correct on the posttest (p < 0.001). Significant improvement in knowledge as judged by pretest and posttest results occurred in 6 of the 7 teaching modules. Subjective evaluations demonstrated good to excellent ratings for each module as well as the overall workshop.
Conclusions : The process of developing a curriculum for geriatric EM is described. The initial training of instructors was effective in improving participants' knowledge of geriatric issues in EM. Participants considered the training to be effective. The effect of the training on the emergency care of elder persons remains to be determined.     

Tobacco control interventions in the emergency department: a joint statement of emergency medicine organizations.

Smoking is the leading cause of preventable death and illness in the United States. National practice guidelines call for all health care providers to "ask" all patients about tobacco use, and to "advise, assess, assist, arrange" when smokers want to quit smoking (the "5 As"). Emergency departments (EDs) have not been an important locus of tobacco control efforts, although ED patients typically smoke at rates exceeding that of the general population, are interested in quitting, and often have limited access to primary care. To address the role of emergency medicine in tobacco control, the American College of Emergency Physicians convened a task force of representatives of major emergency medicine professional organizations. Funded by the Robert Wood Johnson Foundation, the group met in 2004 and 2005. This article represents a summary of the task force's recommendations for tobacco control practice, training, and research. We call on emergency care providers to routinely assess patients' smoking status, offer brief advice to quit, and refer patients to the national smokers' Quitline (800-QUIT-NOW) or a locally available program. Given the global burden of tobacco-related illness, the task force considers it essential for emergency physicians to conduct research into the efficacy of ED-based interventions and to place tobacco control into the training curriculum for emergency medicine residencies. Tobacco control fits within the traditions of other ED-based public health practices, such as injury control. ED-based tobacco control would allow the specialty to help fulfill the Healthy People 2010 mandate to reduce the prevalence of smoking among US citizens.     

A Model Longitudinal Observation Medicine Curriculum for an Emergency Medicine Residency

The role of observation services for emergency department patients has increased in recent years. Driven by changing health care practices and evolving payer policies, many hospitals in the United States currently have or are developing an observation unit (OU) and emergency physicians are most often expected to manage patients in this setting. Yet, few residency programs dedicate a portion of their clinical curriculum to observation medicine. This knowledge set should be integrated into the core training curriculum of emergency physicians. Presented here is a model observation medicine longitudinal training curriculum, which can be integrated into an emergency medicine (EM) residency. It was developed by a consensus of content experts representing the observation medicine interest group and observation medicine section, respectively, from EM's two major specialty societies: the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP). The curriculum consists of didactic, clinical, and self‐directed elements. It is longitudinal, with learning objectives for each year of training, focusing initially on the basic principles of observation medicine and appropriate observation patient selection; moving to the management of various observation appropriate conditions; and then incorporating further concepts of OU management, billing, and administration. This curriculum is flexible and designed to be used in both academic and community EM training programs within the United States. Additionally, scholarly opportunities, such as elective rotations and fellowship training, are explored.     

A comparison of Australasian and United States emergency medicine training programs.

Training programs in emergency medicine differ from country to country. This article compares the allopathic training programs of Australasia and the United States. The perceived advantages of these programs are highlighted, but no attempt is made to determine which is the better program. The Australasian program is significantly longer and places a greater emphasis on the basic clinical sciences, physical examination skills, and academic output. Australasian College for Emergency Medicine (ACEM) regulations are relatively flexible and allow trainees to design their own programs. Trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part-time training may be acceptable. In the United States, trainees rotate within and from one parent institution, which provides a rigid teaching structure for a "critical mass" of trainees, based on a "core" curriculum. Rotations tend to be much shorter but ensure exposure to a broader range of clinical experience. Evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. Trainees are under the close supervision of teaching faculty at all times when working in an ED.     

Development of a productive research culture in emergency medicine: Report of the outcomes of a research forum

In recent years, the Australasian College for Emergency Medicine (ACEM) has increasingly focused on the need for high‐quality research in emergency medicine (EM). One important initiative was the establishment of the ACEM Foundation, which among other responsibilities, is required to support clinical research through the provision of research funding and other measures. In February 2015, the Foundation held a Research Forum that was attended by the leading EM researchers from Australasia. The Forum aimed to determine how a productive research culture could be developed within the ACEM. Nine key objectives were determined including that research should be a core business of the ACEM and a core activity of the EM workforce, and that EM research should be sustainable and adequately supported. This report describes the background and conduct of the Forum, its recommendations and the way in which they could be implemented.     

急诊急救专科护士培训课程设置及管理实践探索

急诊急救专科护士培训在我国尚处于起步阶段,缺乏统一的培训规范和教材,要达到培养要求,课程设置是关键。针对临床及护理专业发展对急诊急救专科护士的要求,制订培养目标,进行课程设置,制订实施方案,并进行教学效果评价。学员们经过严格培训及考核后,在急救护理素养,急救护理知识、技能,护理管理,临床教学能力,护理科研能力等方面都有明显提高。     

Objectives to direct the training of emergency medicine residents on off-service rotation in cardiology,part 1

This article is the first of a two-part series outlining the objectives for emergency medicine residents on a cardiology rotation. Cardiology is offered as an off service rotation or an elective at some emergency medicine residency training programs. An organized core curriculum may provide a structured learning environment to help ensure that certain principles and objectives important to the practice of emergency medicine are learned. We have developed a written core curriculum containing a subject content list, learning objectives, and references for emergency medicine residents on cardiology services. This is the 28th in a series of objectives for off-service rotations for emergency medicine residents.     

Objectives to direct the training of emergency medicine residents on off-service rotation in cardiology,part 2

This article is the second of two parts outlining the objectives for a resident rotation in cardiology. Cardiology is offered as an off service rotation or an elective at some emergency medicine residency training programs. An organized core curriculum may provide a structured learning environment to help ensure that certain principles and objectives important to the practice of emergency medicine are learned. We have developed a written core curriculum containing a subject content list, learning objectives, and references for emergency medicine residents on cardiology services. This is a continuation of a series of objectives for off-service rotations for emergency medicine residents.     

Development of an emergency nursing training curriculum in Ghana

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: (a) an innovative, interdisciplinary, team-based clinical training model, (b) a unique and low-resource emergency nursing curriculum and (c) a comprehensive and sustainable training program to increase in-country retention of nurses.     

12 Highly Interactive Teaching: A "HIT" with Residents

Covering the core content of emergency medicine during residency training is both a time consuming and challenging endeavor. One of the more significant challenges in graduate medical education is to develop more interactive, less didactic teaching modalities. In an attempt to develop a more interactive educational curriculum, we interspersed weekly sessions titled "Highly Interactive Teaching" (HIT) with standard formal lecture didactics. A primary focus of many educators in emergency medicine is teaching residents how to manage the undifferentiated patient. To this end, we revised our curriculum to include 34 four-hour symptom/chief complaint-based sessions. The first hour is an introductory lecture on the general approach to a patient with the specified complaint. Residents then divide into small groups which rotate through specific case-based sections covering varied diagnoses which might present with the symptom complaint. These faculty-run small groups use a case-based approach, either high or low simulation-based or oral boards-based format. Each faculty then is required to sum up the salient points of their section. The final hour of the day is an evidenced-based review of supporting literature. Residents are required to read and critique selected articles for the audience so that the basis for diagnosis and management decisions can be discussed as a large group discussion. We believe this change in format will help residents not only to become more active learners, but also to become more astute clinicians.     

护理专业专科层次设置急救护理方向的实践

从改革背景、人才培养目标、课程体系、专业特色课程的教学管理、教学评价等方面,介绍了护理专业专科层次设置急救护理方向的教学实践.护理专业专科层次设置急救护理方向的优势有:课程设置突出了急救护理方向的专业特色,教学中强化了学生实践能力的培养,满足社会对急救护理服务的需求,为培养专科护士奠定基础.     

Augmenting the critical care data base of junior medical students with an emergency medicine lecture curriculum: a controlled study

A mandatory lecture course in emergency medicine, consisting of 13 lectures, was given to junior medical students over 3 years at Texas Tech University Regional Academic Health Center--El Paso. The performance of the students on a 25-question pretest and posttest was compared to a statistically similar group of their classmates on geographically separate campuses of Texas Tech University School of Medicine undergoing an otherwise comparable junior year clinical curriculum. Both groups exhibited improvement in posttest scores from pretest score values; additionally, students exposed to the lecture series at Texas Tech--El Paso performed significantly higher on the posttest, compared to the other campuses. We conclude that some emergency medicine material is successfully learned by junior medical students during their required third year clerkships; however, important learning objectives within the domain of emergency medicine can be most successfully taught if a mandatory junior year lecture course in emergency medicine is also incorporated into the third year curriculum.     

The structure,process and outcome of emergency medicine training

A study was conducted of 85 graduates of the Australasian College for Emergency Medicine to determine their perceptions of the quality of their graduate training and the status of their current practice. Participants were asked to use a scale of 1 to 5 (with 1 being a low or very poor rating, 5 being a high or very good rating) to rate their satisfaction with the structure of their training, the adequacy of the learning environment during training and the adequacy of their training relative to the emergency medicine curriculum. A response rate of 94% was achieved. Training in emergency departments (EDs) rated 4.0. Training in off-service rotations rated 3.6. The learning environment during training rated 3.8. The scope of educational experiences, access to teaching and research resources, and the quality and quantity of supervision by non-emergency physician specialists rated the lowest. The adequacy of their training relative to the curriculum rated 3.5, with a number of clinical areas including paediatrics, administrative aspects of emergency medicine and emergency medical systems, rated among the lowest. These perceptions in the context of the current practice of most graduates will help highlight the aspects of training that need further monitoring and improvement.     

Proceedings: Beyond Ultrasound First Forum on Improving the Quality of Ultrasound Imaging in Obstetrics and Gynecology

The Beyond Ultrasound First Forum was conceived to increase awareness that the quality of obstetric and gynecologic ultrasound can be improved, and is inconsistent throughout the country, likely due to multiple factors, including the lack of a standardized curriculum and competency assessment in ultrasound teaching. The forum brought together representatives from many professional associations; the imaging community including radiology, obstetrics and gynecology, and emergency medicine among others; in addition to government agencies, insurers, industry, and others with common interest in obstetric and gynecologic ultrasound. This group worked together in focus sessions aimed at developing solutions on how to standardize and improve ultrasound training at the resident level and beyond. A new curriculum and competency assessment program for teaching residents (obstetrics and gynecology, radiology, and any other specialty doing obstetrics and gynecology ultrasound) was presented, and performance measures of ultrasound quality in clinical practice were discussed. The aim of this forum was to increase and unify the quality of ultrasound examinations in obstetrics and gynecology with the ultimate goal of improving patient safety and quality of clinical care. This report describes the proceedings of this conference including possible approaches to resident teaching and means to improve the inconsistent quality of ultrasound examinations performed today.     

The Development of a National Emergency Medical Services Curriculum Framework for Physicians in Canada

Background. As the role of emergency medical services (EMS) continues to expand, EMS physicians andmedical directors require special skills andtraining to keep pace with the rapidly evolving subspecialty of EMS. In Canada, subspecialty training in EMS is still relatively new, anda standard national curriculum for physician EMS training does not exist. Objective. To develop a national EMS curriculum for emergency medicine (EM) residents andfellows andan abbreviated curriculum for non-EM trainees andcommunity physicians. Methods. The authors obtained EMS curricula andopportunities from Canadian EM andEMS training programs anda sample of U.S. programs to determine existing curricula, anddeveloped a framework for a national EMS curriculum using an expert working group of EMS medical directors andEMS leaders in Canada. Results. Canadian EM residency training programs included an EMS rotation, but their content anddepth of training were not uniform. The expert working group proposed a comprehensive set of training objectives, grouped into 16 categories, stratified by level of training. Conclusion. The proposed framework andobjectives are suitable for training medical students, family medicine trainees, community physicians, EM residents, andEMS fellows in Canada. The authors hope this article will serve as a guideline for residency andfellowship directors to develop their EMS training programs in a consistent manner, promote formal training for physicians involved in EMS, andhelp define the specific knowledge andexpertise required of physicians who provide EMS medical direction in Canada.