EmergencyPedia

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.

The practice of Emergency Medicine is different to the traditional teaching of history, examination and presentation skills. You may have minimal information on which to base your decisions, a lack of time, competing priorities and multiple patients at once…

Therefore, the primary roles of the emergency doctor or nurse are to:

1. Resuscitate
2. Risk stratify
3. Care coordinate
4. Educate

The ethics of our practice should follow the classic “benefit to patient”, “don’t harm” and “respect patient autonomy” principles but additionally with a utilitarian approach to all our patients being taking priority.

Out of sight (in the waiting room) should not be out of mind.

24 hours in Emergency

Training in Emergency Medicine

A Doctor Training in Emergency Medicine will expect to be a ‘jack of all trades’ but also an ‘expert’ in the first few hours of the presentation of any acute illness.   Terms completed in a (minimum) 7 year post-graduate training program may include the following:

• Emergency Medicine
• Internal Medicine
• Geriatric Medicine
• Pre-hospital and Retrieval Medicine (see videos below)
• Anaesthetics
• Intensive Care Medicine
• Obstetrics and Gynaecology
• Orthopaedics
• General Surgery
• Paediatrics
• General Practice
• Surgical Sub-specialties
• Toxicology
• Medical Administration
• Medical Education and Simulation
• Psychiatry

Emergency Medicine is one of the 3 ‘Critical Care’ Specialties along with Intensive Care and Anaesthetics. Compared with other specialities EM started recently.  It has evolved rapidly as a specialty over the last 30-40 years from small beginnings (a few pioneers in the North America and later in Australia).  In the last 10 years it has become one of the largest specialties in terms of numbers of enrolled trainees.  In the USA it is one of the most sought after training programs and in 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 will discuss below.

The Essence of Emergency Medicine 

Why do Emergency Medicine Training?

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.

Pros of EM Training

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.

In Australia and 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 so.  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?

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.

Original Blog Post

Click Here for our original post of EM training

Conclusions

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.