Introduction
The necessity of introducing emergency medicine (EM) into undergraduate medical education (here – medical school level) has been discussed, if not debated, for over four decades (1,2). More recently, two additional trends have become apparent. One speaks to the mutual co-integration and interdependence of all emergency care field components including EM (3). The other is the emergence of a keen interest in global health exhibited by both medical students and emergency medicine trainees alike (4-6).
Here we wish to present and describe a novel program for medical students that aims to address and integrate all of the three phenomena under one umbrella.
ACEP’s Global Emergency Medicine Student Leadership Program (GEMS LP) is now in its third year, with eighteen students from various medical schools learning about topics in global health through the guidance and shared experiences of internationally minded emergency physicians.
Background
The International Section of the American College of Emergency Physicians (ACEP) is one of ACEP’s largest, with over 2600 members currently (7). In 2013 the Section’s first annual ACEP International Ambassador Conference took place in Seattle. The meeting formalized and accentuated the common vision shared by those section members who had already been actively involved in global health and international EM development in their respective nation(s) of interest (8).
In 2017 members of Emergency Medicine Resident Association (EMRA) approached ACEP’s International Ambassador Program with the idea of mentorship for medical students interested in both EM and medical work globally.
Through a collaborative effort the Ambassador Mentorship Program (AMP) was born and welcomed its inaugural class of eight medical students in 2018 (9).
Focus
To better align our name with the program’s vision, AMP was renamed the Global Emergency Medicine Student Leadership Program (GEMS LP) in 2020. Currently GEMS LP is open to medical students at all levels of training (prior to graduation) who are members of EMRA.
The nine month curriculum consists of several integral components, including global health knowledge development, research, personal mentorship and networking.
Focus on global health (GH): GH has become a field that aims to transcend not only the borders among nations, cultures, governments and organizations, but also the distinction between what is narrowly medical and what is widely ethical and social – as in rooted in people’s daily living conditions (10). It has been a consensus among GEMS LP’s participants that efforts to improve development of EM and regional emergency care systems around the world cannot be studied or pursued outside of the global health context.
The program runs a structured journal club done via video platforms which includes review and discussions of textbooks and original literature pertinent to GH topics. Since 2020, journal clubs have also included a new component where students prepare local health improvement project proposals (based on their geographic or cultural area of interest or prior experience). These “mock” project proposals are then discussed by the journal club group at large as another way of learning.
Examples of monthly focus themes have included global health inequity, sustainability in global health, ethics of humanitarian work, need for EM expertise in low resource settings, language justice in healthcare and the future of global health.
We welcome all members of the ACEP International Section and current GEM fellows (ask us how to get involved at infoGEMSLP@gmail.com) – international voices add much to the discussion!
Focus on mentorship and networking: Through one-on-one guided phone calls with GEMS LP faculty and other International Section physician members, students are exposed to multiple examples of individual professional paths and are offered guidance in exploring their options for future training, careers and work/life balance. Student participants also have access to globally involved EM physicians across the entire Ambassador Program and the Section, both domestically and internationally. Mentors and guest speakers have also given presentations on career paths in global EM during journal club sessions to give mentees a variety of perspectives on the diverse training and career options available.
Focus on scholarship and research: Mentors involved in academic research have had mentees collaborate in groups of 2-5 on research projects. Examples have included: state of emergency care in the post-USSR zone – a literature review, Ugandan emergency mid-level training curriculum work, a review of pre-hospital medicine in resource-restrained areas within India and Sri Lanka, assisting with the ACEP Ambassador Program Country Reports, and others.
Group projects are a great way for mentees to network and build lasting working relationships, not only with the mentor leading the project, but also with their peers. While mentees are not traveling for program projects in light of the COVID-19 pandemic, the projects are still a way in which the program helps mentees build real world skills for future GH ground work.
Learning structure
During the course of the program each student will participate in all virtual journal clubs, and will be responsible for at least one presentation of a book chapter, an original research paper or a global health project proposal. Longitudinally, students are paired up with a faculty’s research project in small groups, and as mentioned, also participate in a minimum of three one-one-one mentorship phone or video calls with different mentors focusing on various aspects of career planning. Students may also be introduced to and connected with ACEP’s international section members based on mutual backgrounds, cultural and language skills or GH interests. Finally, students are invited to attend the annual ACEP Ambassador Conference (virtually during COVID restrictions) and are expected to attend the GEMS LP program orientation and close out sessions.
Future directions
Mentee retention: All mentees are invited to get involved with program leadership when they graduate the program, which is a constant source of energy and new ideas. This will ensure the program’s sustainability, as we build successive generations of program leadership from the trainees who themselves benefited from the program previously.
Expanding number of students and faculty mentors: As medical student interest in GEM opportunities and mentorship increases, we hope to continue expanding the program and recruit a diverse group of mentees, including international medical students. In order to facilitate this, additional faculty members will also be needed. The program hopes to continue recruiting diverse mentors, including those from international institutions (especially those from low- and middle-income countries), humanitarian organizations, community and academic emergency departments.
Expanding the research component and publications: Giving GEMS LP participants adequate exposure to academic global emergency medicine through participation in research projects and in peer-reviewed publications. Planned publications for the 2020-2021 year include: GEMS LP milestones study and a concept paper on the program. Currently mentees are interviewing the ACEP Ambassador team working in their country or region of interest on the state of emergency medicine development. We hope to publish an EM around the world country highlights article based on these interviews. Also, be on the lookout for an EM Resident piece in the April/May issue showcasing the projects that the 2019/2020 class completed.
Connecting with other organizations: GEMS LP is actively seeking to form mutually beneficial relationships with other organizations involved with EM, emergency care and global health domestically and internationally. Currently, we are working to expand collaboration with GEM fellows.
Please get in touch if your organization would be interested in collaborating at info.GEMSLP@gmail.com!
Information sharing: The program is interested in building an information repository to share research, advice and resources that accumulate within the program over the years that are useful for medical students interested in EM and global health around the world.
Impact evaluation: To formally evaluate the impact of the GEMS LP program on participant’s careers going forward, starting with the 2020-2021 class, students will be given pre- and post- program surveys using modified methodology described by Douglass et al. in “Development of a Global Health Milestones Tool for Learners in Emergency Medicine” (11). The milestones study is planned to track participants at 1, 2, 3, 5, 7 and 10 years post-graduation from the GEMS LP program to assess long-term impact on careers.
Relevance for the global EM-trainee community
GEMS LP’s current hybrid educational model has evolved to match the diversity of our mentees with their need to simultaneously gain knowledge in several interconnected areas: emergency medicine, international emergency care systems and global health and planning one’s future career as a medical student.
We hope that the GEMS LP program may serve as a potential model for others involved in global EM education such as medical schools, residency programs, or international colleges of emergency medicine to create opportunities and resources for their students to grow into thoughtful and successful leaders in the field of global EM.
In the current era of COVID-19, this virtual program may also serve to engage students and trainees in global EM work despite limitations on travel, as well as to expand access to formal mentorship opportunities for students who may not have these opportunities at their home institutions.
For more information on GEMS LP and how you can get involved as a mentor, mentee, or a journal club participant please visit the page below or email us!
https://www.emra.org/be-involved/committees/international-committee/amp-program-info/
The 2021/22 GEMS LP application will open for students this spring, with a deadline of June 30, 2021. We are always recruiting faculty mentors!
Cite this article as: Anthony Rodigin, Stephanie Garbern, Ashley Pickering, Alexandra Digenakis, Elizabeth DeVos, Jerry Oommen, “ACEP’s shiny new GEMS: the Who, What and Why that make this LP worth playing,” in International Emergency Medicine Education Project, February 21, 2021, https://iem-student.org/?p=17057, date accessed: February 21, 2021
References:
- Guidelines for Undergraduate Education in Emergency Medicine. Ann Emerg Med. 2016 Jul;68(1):150. doi: 10.1016/j.annemergmed.2016.04.049. PMID: 27343670.
- Beyene T, Tupesis JP, Azazh A. Attitude of interns towards implementation and contribution of undergraduate Emergency Medicine training: Experience of an Ethiopian Medical School. Afr J Emerg Med. 2017 Sep;7(3):108-112. doi: 10.1016/j.afjem.2017.04.008. Epub 2017 Apr 20. Erratum in: Afr J Emerg Med. 2017 Dec;7(4):189. PMID: 30456120; PMCID: PMC6234139.
- Carlson LC, Reynolds TA, Wallis LA, Calvello Hynes EJ. Reconceptualizing the role of emergency care in the context of global healthcare delivery. Health Policy Plan. 2019 Feb 1;34(1):78-82. doi: 10.1093/heapol/czy111. PMID: 30689851
- Havryliuk, Tatiana et al. Global Health Education in Emergency Medicine Residency Programs. Journal of Emergency Medicine, Volume 46, Issue 6, 847 – 852. March 7, 2014.
- Dey CC, Grabowski JG, Gebreyes K, et al. Influence of international emergency medicine opportunities on residency program selection. Acad Emerg Med 2002;9:679–83.
- Cox JT, Kironji AG, Edwardson J, Moran D, Aluri J, Carroll B, Warren N, Chen CCG. Global Health Career Interest among Medical and Nursing Students: Survey and Analysis. Ann Glob Health. 2017 May-Aug;83(3-4):588-595. doi: 10.1016/j.aogh.2017.07.002. Epub 2017 Aug 30. PMID: 29221533.
- http://www.acep.org; Search: “International Membership FAQs”. Accessed 1/16/21
- https://www.acep.org/globalassets/sites/intl/media/site-documents/1st-annual-acep-international-ambassador-conference-proceedings.pdf. Accessed 1/16/21.
- Patino, Andres. “GEMS LP – Global EM Student Leadership Program. The New AMP”. GEMS LP Program Orientation virtual meeting, PPT presentation. October, 2020.
- Cemma, Marija. “What’s the Difference? Global Health defined”. Global Health NOW. Sept. 26, 2017. https://www.globalhealthnow.org/2017-09/whats-difference-global-health-defined. Accessed 1/16/21.
- Douglass KA, Jacquet GA, Hayward AS, Dreifuss BA, Tupesis JP, Acerra J, Bloem C, Brenner J, DeVos E, Douglass K, Dreifuss B, Hayward AS, Hilbert SL, Jacquet GA, Lin J, Muck A, Nasser S, Oteng R, Powell NN, Rybarczyk MM, Schmidt J, Svenson J, Tupesis JP, Yoder K. Development of a Global Health Milestones Tool for Learners in Emergency Medicine: A Pilot Project. AEM Educ Train. 2017 Sep 11;1(4):269-279. doi: 10.1002/aet2.10046. PMID: 30051044; PMCID: PMC6001724.
