International EM Archives

The Global Emergency Medicine Literature Review Group

The Global Emergency Medicine Literature Review Group (https://gemlrgroup.wixsite.com/mysite) is a team of students and physicians from around the world that work together each year to review and highlight the published literature related the practice of emergency medicine in resource-constrained settings. The Global Emergency Medicine Literature Review (GEMLR) started in 2005 and has been published annually (you can review past editions of the GEMLR: here, https://www.ncbi.nlm.nih.gov/pubmed/?term=gemlr).

Annual Systematic Review

The review group completes their annual systematic review of scholarly work around international emergency medicine, which screens for and then reviews relevant peer-reviewed and gray literature. The authors of this years review note that the term international emergency medicine is quite subjective, but the research of interest is generally related to “the practice and development of emergency medicine in settings without the robust or mature systems commonly seen in resource-rich western countries.”

The 2018 Review

The 2018 review was just recently published online in Academic Emergency Medicine (https://www.ncbi.nlm.nih.gov/pubmed/31313411), and this edition was put together by a team of 7 editors, 5 editorial board members, and 27 reviewers (of note, I was one of the reviewers for 2018). Interestingly, a number of reviewers are tasked with reviewing literature in other languages with which that reviewer is fluent in order to include any relevant studies from around the world. Articles are screened for appropriateness and then grouped into three main categories: the development of emergency medicine, disaster and humanitarian response, and emergency care in resource-limited settings.

The GEMLR group screened over 19,000 articles for the 2018 review, and of these 517 were found to be of appropriate quality and content for a full review. Each screened article is then obtained in full-text format and both categorized and scored by two independent reviewers. This edition of the GEMLR found the screened articles fell into each category as follows: 15% in the development of emergency medicine, 25% in disaster and humanitarian response, and 60% in emergency care in resource-limited settings. After scoring, a total of 25 articles (approximately 5% of all of the scored literature is selected for a full summary and critique. This year’s publication included the full summary and the critical appraisal of each of the highest-scoring articles in Supplement 7.

The 2018 GEMLR authors found that this year’s edition included “studies and reviews focusing on pediatric infections, several new and traditionally under-represented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.”

The body of published work around international emergency medicine continues to grow; 7.3% more studies were identified as compared to 2017. I would encourage you to looking through the most recently published GEMLR reviews to find content areas that are currently gaps in the peer-reviewed literature and consider finding ways to help prepare and publish relevant work. The great news is that the body of work in international emergency medicine is expanding.

Ongoing Scholar Work Around International Emergency Medicine

This and other recent GEMLR publications are a great resource and can be a really helpful starting point in looking at ongoing scholarly work around international EM. This is also a great resource to consider as content to be used in your next journal club. I strongly recommend you take a look at this year’s publication and then go look at a few of the articles; there is a lot of great work being done and published!

Although applications to be a reviewer for the 2019 review have just recently closed, keep your eyes on the GEMLR team (@gemlrgroup) for the latest in IEM research, and for the opportunity to join the GEMLR team for next year.

Applications open: become a Global Emergency Medicine Literature Group reviewer! Seeking diverse applicants from around the world with talent for writing\editing & global health research or practical experience. Applications due August 1 – please share. https://t.co/NgKp2AhTLg
— GEMLR (@gemlrgroup) June 30, 2019

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Emergency Medicine (EM) is about timely intervention and management of acute and life-threatening conditions (1). Every medical school graduate should learn and practice basic, yet important interventions for critically ill patients.

There are increased efforts in incorporating EM training into undergraduate curriculum worldwide (2, 3). However, the specialty of EM itself is yet not fully developed in low resource settings (4). South Africa is the first country starting to develop an EM system in Africa (5).

The modern medical education for both undergraduates and postgraduates level started in Ethiopia, at Addis Ababa University, in 1964. However, EM training as a specialty begun in the year 2010 (See infographic below). It was initially fragmented into different departments.

EM was also a 7-week separate elective rotation for undergraduates in the revised curriculum of 2008. It was successfully launched as training in 2013 with 300 4th year medical students (75 students in 4 groups). Students rotate in Adult EM (3 weeks), Pediatric EM (2 weeks) and Anesthesiology (2 weeks). Department of Emergency Medicine is the primary department controlling and managing these rotation areas in the clerkship. Our teaching program is primarily covered by EM, Pediatric EM, and Anesthesiology faculty. It includes practical demonstrations and simulation learning through our EM residents.

Topics covered by EM clerkship include:

Adult EM rotation

Introduction to EM
Basic Life Support (BLS)
Advanced Cardiac Support(ACLS)
Advanced Trauma Life Support(ATLS)
Approach to chest pain
Basic ECG and common arrhythmias
Approach to respiratory emergencies
Electrolyte emergencies
Approach to acute confusional state and neurological emergencies
Endocrine emergencies
Hypertensive emergencies
Approach to the poisoned patient and common toxicological emergencies

Anesthesiology rotation

Basic airway management devices
Oxygen therapy
General and regional anesthesia with class discussions and practical demonstrations

Pediatric EM rotation

Pediatric assessment triangle
Pediatric advanced life support (PALS)
Newborn resuscitation
Common pediatric emergencies

Teaching methods are classroom didactics, case discussions, low fidelity simulations for basic airway management and ATLS demonstrations as well as case-based role plays for scenarios like Acute Myocardial Infarction, and so on.

Thus, in delivering such an innovative form of undergraduate rotation, our department has been selected as the best teaching department for the past 4 years consecutively by graduating medical students.

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