What is Emergency Medicine (EM)?
Recently I’ve been asked by several Medical Students what I see in a career as an Emergency Physician and as a result I have tried to summarise some information on the speciality here…
Emergency Medicine is one of the 3 ‘Critical Care‘ Specialties along with Intensive Care and Anaesthetics.
EM started late in the day as a medical speciality. It has evolved rapidly as a specialty over the last 30-40 years from small and humble beginnings (a few pioneers in the United States) to one of the largest and most popular specialties.
Specifically, in North America it is one of the most sought after training programs. In many other countries it is becoming increasingly popular. Emergency Medicine is a widely recognised specialty and rapidly growing in a number of new countries because of a increasing worldwide recognition of the importance of timely Emergency Care at the front door of the hospital.
While there are a wide selection of options in a medical career for prospective trainees Emergency Medicine has a number of Pros which we discuss below…
The Essence of Emergency Medicine
Why do an Emergency Medicine Training Program?
In what job would you see all of the following cases in one day?:
A resuscitation of an arresting 50-year-old, reassurance of worried parents of a newborn after a thorough assessment, supervision of the reduction of a dislocated shoulder, recognise and treat malaria in a returned traveller and leadership of a trauma team. After a busy day you can return home on time with no extended periods of on call.
- A Collegiate and Challenging Speciality
- 4 day working week (in Australia at least)
- Comprehensive Training
- Multiple Niche Sub-specialties that are both recognised as a part of training and in post-graduate practice (including Ultrasound, Toxicology, Medical Education, Pre Hospital (Retrieval) Medicine, Administration, Management, Disaster, Mentorship, International Emergency Medicine, Public Health and Sports Medicine)
- Combined Training options with Paediatrics or Intensive Care
- Appropriate Remuneration
- Summary PDF – Click Here
What are the Cons of Training in Emergency Medicine?
- Night Shifts (and after hours work including weekends)
- Burn out
- High levels of acute stress and time pressure
- Government Targets (depending on local jurisdiction)
- Referring patients to busy collegues (can on occasion be challenging)
How long is the training program in Emergency Medicine?
This depends on the country you plan to train in.
Programs in the USA tend to be 3-4 years with optional fellowships in niche areas at the end of training. Consultants (attending senior doctors) do night shifts here which seems to be an issue to me from across the pond despite the fact I have always like night shift I can’t imaging doing it when I’m 64…
In Australia as well as in the UK consultants generally avoid the perils of night shifts as their career progresses (after they complete training) but often wait 7-8 years to do the same.
Canada has a 5-6 year training program with various options to combine training which are fairly flexible.
The Australasian (Australia and New Zealand) program is summarised as follows:
Click Here for the Australisian College Training Page
Click Here for the UK College Training Page
Click Here for the American College Training Page (note there is more than one college)
Click Here for the Canadian College Training Page
What is the assessment process in Australia and New Zealand?
Historically, there have been 5 main points of assessment:
- 2 exams (an entry exam based on basic sciences and a challenging exit exam based on clinical practice points that we dedicate much our site to help pass)
- On-going assessment in the work place by senior consultants
- Requirement of structured references to gain entry to the college (e.g. recommendation for training)
- A research component (known as the “4:10” which can be completed by study or research)
However, the ACEM college is currently undergoing a Curriculum Revision Project (CRP) which will significantly change the training program over the next 5 years
What is the assessment process in other countries?
- United States – an emphasis on continuous assessment and teaching and an exit “Board Exam“
- Canada – a challenging exit exam
- United Kingdom – an entry and exit exam which are both clinical with continuous assessment
Where to train?
Why not consider training with us at Westmead Hospital? Contact us here:
Are qualifications in Emergency Medicine recognised internationally?
Broadly, yes, but with notable exemptions and caveats. While there is a significant degree of reciprocal recognition local and international governance sometimes limits options in this regard.
The take home message is that Emergency Medicine is an increasingly attractive and exciting specialty that is is growing and changing quickly. It is an all encompassing specialty with a degree of flexibility to suit the choice of career interests as well as the balanced lifestyle that you seek as a doctor in training.