Undergraduate Emergency Medicine Clerkship: Ethiopian Experience

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.

SMACC Sydney 2019: A Student Volunteer Experience

Lucas Oliveira J. e Silva Medical student at Universidade Federal do Rio Grande do Sul (UFRGS), Brazil. President of International Student Association of Emergency Medicine (ISAEM)
Lucas Oliveira J. e Silva: Medical student at Universidade Federal do Rio Grande do Sul (UFRGS), Brazil. President of International Student Association of Emergency Medicine (ISAEM)

I will never forget the first time I have heard about the concept of Free Open Access Medical Education (FOAMed). I was leading the organization of an Emergency Medicine (EM) student symposium in my city (Porto Alegre), and we decided to invite a student named Henrique Puls to give a lecture about his organization, the International Student Association of Emergency Medicine (ISAEM). 

At that point, he was an enthusiast about Emergency Medicine already, and he was the vice-president of ISAEM. He gave an excellent talk about ISAEM, but, most importantly, he introduced me to a “drug” that I would become addicted: the #FOAMed. After that lecture, we ended up becoming good friends and we started to work together. Our work has resulted in so many things that would never fit within this post. Throughout the time, one of the seeds that he has planted on me would blossom in the year 2019.

When I was introduced to the #FOAMed world, Henrique told me about a conference called SMACC – Social Media and Critical Care Conference. At that moment in my life, this conference didn’t make any sense to me: critical care experts giving TED-like talks and doing crazy simulations on stage. My thoughts were: Does this really exist? I kept watching SMACC lectures on YouTube, and year after year my interest would grow more and more. Then, Henrique and Daniel Schubert (another friend, current EM resident in Rio de Janeiro) were pioneers (as always) and participated as SMACC Junior volunteers in Berlin 2017. Every tweet and every post from them throughout the conference inspired me even more.

When SMACC organizers released that 2019 would be in Australia and it would be the last conference ever, I could not miss this opportunity. It would be my last chance to go. The application process was quite different and required a lot of creativity. I thought I would never pass. The email saying that I have been selected for the SMACC volunteer team made my heart start pounding really fast. 

Besides that, I have applied together with my girlfriend (Marianna Fischmann) and we ended up both being accepted. We would go to Sydney and we would be part of the SMACC Junior volunteer team.

The SMACC Junior team is made up of a committed and enthusiastic group of 25 medical/paramedic/nursing students who volunteer at the conference. SMACC 2019 was held in Sydney (Australia) from March 25 to March 29. We arrived in Sydney on March 23 (Saturday) after a very long journey: 36-hour travel, including airport and flight times. On Sunday, we had our first SMACC Junior meeting. At that point, I could feel the energy of the group. Students from eleven countries with totally different backgrounds, except for one similar interest: LEARN. 

First SMACC Junior meeting at the ICC Sydney Convention Center.

But what were the specific tasks we were supposed to do throughout the conference? What does a SMACC Junior volunteer mean?

Well, we were there to help on pretty much everything related to keeping the conference organized.

  1. Here a few of our specific tasks:
  2. Help with the registration of all attendees;
  3. Usher people throughout the conference to make sure they would be at the right place at the right time;
  4. Workshop support (eg. Manikin, time management, etc.);
  5. Help with backstage and on-stage activities;
  6. Represent the youth and inspired community of SMACC.
SMACC Junior material. We were supposed to be in blue T-shirts all the time, except when we were on Backstage (black T-shirts).

One small detail: we were supposed to be at the Convention Center every day at 06:00 AM and to leave it around 06:00 PM.

On Monday, the SMACC workshops started. As I am an Evidence-Based Medicine enthusiast and young researcher, I was allocated to the workshop called “Research Dark Arts.” It was focused on discussing the nuances and challenges behind the academic world. The faculty was mostly from the Australian and New Zealand Intensive Care Research Society (ANZICS) and included researchers like Paul Young, Steve Webb and John Myburgh. It was an amazing opportunity to somehow help these incredible researchers in their workshop. Besides that, I learned so much from them.

On Tuesday, I was allocated to one of the workshops I have always dreamt about: the SMACC Airway workshop. Emergency airway management has always been one of my main interests within the EM world. It was incredible to learn about the different techniques behind mastering the airway with people like Scott Weingart

Me and Scott Weingart after the SMACC Airway Workshop.

After a great day on Tuesday, we were rewarded with a dinner with all faculty members involved with the SMACC Workshops. The event was in a beachfront restaurant at the Cougee Beach. Besides the beauty of this place, this was a great opportunity for networking with people from all over the world.

Me and Marianna in the beachfront restaurant at Cougee Beach.

In the same evening, there was a party called GELFEST. This is a crazy party created by SMACC attendees. Medical education enthusiasts brought a lot of simulation entertainment to the party. The classic part is the famous SALAD simulator, created by James DuCanto. People were practicing his technique (Suction Assisted Laryngoscopy for Airway Decontamination) while drinking their Australian beer.

Marianna practicing SALAD with James DuCanto at the GELFEST party.

After two very intense days, the conference started on Wednesday morning. The anxiety was high because the volunteer group was responsible for registering almost 3000 people. We were very motivated and I think this was the reason why everything went so well.

SMACC Junior team ready to register the attendees.

It’s hard to write about the SMACC open ceremony. There is nothing similar to what happened. It’s even harder to believe that a medical conference could have done something like that. It’s also important to remember those who are reading my report that SMACC has a philosophy: there is only ONE THEATER for the main conference, and all the lectures and discussions happen there. There is no such thing as several rooms with several lectures happening at the same time. SMACC is not a classic conference.

SMACC Sydney Opening Ceremony

After a breathtaking open ceremony, the conference started. As volunteers, we had several tasks throughout the conference days, but almost always we were able to watch pretty much all the lectures. We just had to be aware of following our SMACC Junior Schedule. For example, I had to be at the SMACC Genius Bar during coffee breaks and lunchtime. SMACC Genius Bar was a booth to help attendees on getting into the #FOAMed world (e.g., Creating a Twitter account, etc.). Alyx, Claire and Xander were amazing SMACC Junior leaders, and they did a great job on keeping everyone on track.

Playing with simulation during the conference intervals.

Whenever there was free time, we often went to the simulation booths at the exhibition hall. Me and Floris (medical student from Belgium) had the chance of intubating a manikin inside a simulated crashed car. Quite fun.

On Thursday night, there was the SMACC Gala Party. And do you have any idea where that was? Inside one of the most famous amusement park in the world: Luna Park. Yes, the party was at Luna Park! Unbelievable. It was awesome — dancing, drinks and networking. Unique experience.

And here we go into the last day. On Friday, I had the opportunity of participating in one of the lectures on-stage. Ken Milne, the creator of the Canadian blog The Skeptics Guide to Emergency Medicine, asked for the SMACC Junior volunteers to cheer him up during his debate with Salim (REBEL-EM Blog) about several controversial EM topics. We suited up like Canadians and we had so much fun.

The SMACC Junior Team is cheering up on stage

Unfortunately, everything good comes to an end. But wait, was it really the last SMACC ever? Yes, it was. However, the SMACC leadership, Roger Harris and Oli Flower, had a surprise for the attendees at the end. They announced that the SMACC community would not come to an end, but it would start another journey, with another name and with a more ambitious plan. The name is CODA. They put together three giants of Medicine to create a forum geared toward tackling the main health issues around the world. These three are: SMACC community, New England Journal of Medicine and The George Institute.

Please check what the CODA is about: https://CODAchange.org

After this incredible journey, Marianna and I could explore the wonderful city of Sydney. It’s probably the most amazing city I have ever been to.

Surfing at Manly Beach after the end of the conference

I can’t deny, however, that I am little biased. Going to Sydney and having the chance of living every single moment throughout SMACC have changed my life. The people, the conversations, the lectures, every small piece of SMACC changed something on me. I am sure that this experience was life-changing for many people who attended it. We all left Australia with one common feeling: we are excited to be better versions of ourselves and, consequently, provide better care for our patients.

If I had to summarize what SMACC was, I would say four words: Emotion – Inspirational – Empathy – Humanity

Thank you SMACC for this incredible opportunity.

Oli Flower, Roger Harris and the whole SMACC Junior Team

Update on Countries Recognize EM As A Specialty

We currently published an article about countries recognize Emergency Medicine (EM) as a specialty. There is a huge interest from the international EM community. We received feedback from many FOAMed followers/enthusiasts. There were 70 countries on our list. After the new information and feedback, the countries reached 82. What an amazing help! And, What a fantastic specialty growing and spreading all around the globe.

70

82

If you have new information or update about countries please let us know!
We will be happy to update our list.

A 20-months-old head trauma: CT or Not CT?

by Stacey Chamberlain

A 20-month-old female was going up some wooden stairs, slipped, fell down four stairs, and hit the back of her head on the wooden landing at the bottom of the stairs. She did not lose consciousness and cried immediately. She was consolable after a couple of minutes and is acting normal per her parents. She has not vomited. On exam, she is well-appearing, alert, and has a normal neurologic exam. She is noted to have a left parietal hematoma measuring approximately 4×4 cm.

Should you get CT imaging of this child to rule out clinically significant head injury?

PECARN Pediatric Head Trauma Algorithm

Age < 2

Age ≥ 2

  • GCS < 15, palpable skull fracture, or signs of altered mental status
  • Occipital, parietal or temporal scalp hematoma; History of LOC≥5 sec; Not acting normally per parent or Severe Mechanism of Injury?
  • GCS < 15, palpable skull fracture, or signs of altered mental status
  • History of LOC or history of vomiting or Severe headache or Severe Mechanism of Injury?

The PECARN (Pediatric Emergency Care Applied Research Network) Pediatric Head Trauma Algorithm was developed as a CDR to minimize unnecessary radiation exposure to young children. The estimated risk of lethal malignancy from a single head CT in a 1-year-old is 1 in 1000-1500 and decreases to 1 in 5000 in a 10-year-old. Due to these risks, in addition to costs, length of stay and potential risks of procedural sedation, this CDR is widely employed given the frequency of pediatric head trauma ED visits. This CDR has the practitioner use a prediction tree to determine risk, but unlike some other risk stratification tools, the PECARN group does make recommendations based on what they consider acceptable levels of risk. In the less than 2-year-old group, the rule was found to be 100% sensitive with sensitivities ranging from 96.8%-100% sensitive in the greater than two-year-old group.

This algorithm does have some complexity and ambiguity. It requires the practitioner to know what were considered signs of altered mental status and what were considered severe mechanisms of injury. In addition, certain paths of the decision tree lead to intermediate risk zones. In these cases, the recommendation is “observation versus CT,” allowing for the ED physician to base his/her decision to image or not based on numerous contributory factors including physician experience, multiple versus isolated findings, and parental preference, among others.

Other pediatric head trauma CDRs rules have been derived and validated; however, in comparison trials, PECARN performed better than the other CDRs. Of note, in this study, physician practice (without the use of a specific CDR) performed as well as PECARN with only slightly lower specificity.

Case Discussion

For purposes of the case study, the patient falls into an intermediate risk zone of clinically important brain injury. However, a sub-analysis of patients less than two years old with isolated scalp hematomas suggests that patients were higher risk if they were < 3 months of age, had non-frontal scalp hematomas, large scalp hematomas (> 3cm), and severe mechanism of injury. Given the large hematoma in the case study patient and a severe mechanism of injury (a fall of > 3 feet in the under two age group), one might more strongly consider imaging due to these two additional higher risk factors.

Countries Recognize Emergency Medicine as a Specialty

As health care professionals working on Emergency medicine, our history is still being written. Let’s say you would like to learn which countries officially recognize Emergency Medicine (EM) as a specialty, and want to make a beautiful interactive infographic depicting these countries with their official EM recognition years (Because, why not?). It should be an easy task, right? WRONG.

What is your guess?

0
0
0
0

How many countries recognize Emergency Medicine as a specialty?

Even though it seems like a simple question which should have a clear answer, the answer is somewhat of a conundrum. There are a few difficulties for the answer. First of all, what is the definition of “recognition”? Could it be possible to consider having an EM residency program or the presence of EM specialists in a country as recognition? Probably not. Secondly, some of the countries recognize EM as a specialty but the exact year of recognition is unclear. Also, the answer may vary between articles and makes it hard to choose one. To make things clear, we have accepted the definition of “recognition” as a country’s official approvement of Emergency Medicine as a primary specialty. Countries recognizing EM as a supra-specialty (such as Switzerland) were also considered as a recognizing country in our list.

Anyway, we have rolled our sleeves up and dug deep. Many articles and tweets later, we had all the data available on this topic. To the best of our knowledge, this is the first time an article or blog post lists EM’s official dates of recognition for the entire world. We have also taken one step further and showed them on a neat interactive map.

So here we go: As of 05/2019, there are 82 countries in the world which recognize EM as a specialty. 13 countries from Africa, 27 countries from Asia, 13 countries from the America, 27 countries from Europe, and two countries from Oceania recognize EM.

As a well-known fact, the first two countries to recognize EM as a specialty are the United States and the U.K. Which are the latest? Germany and Denmark are the most recent of these countries, as both of them recognized EM in 2018. Perhaps, one year later, there will be new countries which welcome EM specialty. Who knows?

Shall we take a look at the current situation in an eye-pleasing way? Of course! You can view our interactive map right here. You can view maps with colors corresponding to the years of EM recognition for each country in the world (darker the color, earlier the date) in Figure 1. You can also view continental maps for Africa, Asia, Americas, Europe and Oceania in Figures 2, 3, 4, 5, 6, respectively.

Figure 1. Countries Recognize Emergency Medicine as a Specialty

WORLD

Figure 2. Countries Recognize Emergency Medicine as a Specialty

AFRICA

Figure 3. Countries Recognize Emergency Medicine as a Specialty

ASIA

Figure 4. Countries Recognize Emergency Medicine as a Specialty

AMERICA

Figure 5. Countries Recognize Emergency Medicine as a Specialty

EUROPE

Figure 6. Countries Recognize Emergency Medicine as a Specialty

OCEANIA

For the ones who believe nothing is better than a list, all countries are listed in alphabetical order in Table 1. Table 1. List of counties which recognize EM as a specialty (alphabetical order).

Table 1. List of counties which recognise EM as a specialty (alphabetical order).
Country Name Year of Recognition
Albania 2011
Argentina 2010
Australia 1993
Bahrain 2001 *
Belgium 2005
Bulgaria 1996
Botswana 2011
Brazil 2016
Canada 1979
Chile 2013
Colombia 2005
Costa Rica 1994
Croatia 2009
Cuba 2000 §
Czech Republic 2013
Denmark 2018
Dominican Republic 2000
Egypt 2003
Estonia 2015
Ethiopia 2010
Finland 2012
France 2015
Georgia 2015
Germany 2018 #
Ghana 2015
Greece 2017 #
Haiti 2014
Hong Kong 1997
Hungary 2003
Iceland 1992
India 2009
Iran 2002
Iraq 2013
Ireland 2003
Israel 2009
Italy 2008
Japan 2003
Jordan 2003
Kenya 2017
Laos 2017
Lebanon 2012
Libya 2013
Lithuania 2013
Malaysia 2002
Malawi 2010
Malta 2004
Mexico 1986
Morocco 2002
Myanmar 2012
Netherlands 1998
New Zealand 1995
Nicaragua 1993
Norway 2017
Oman 1999
Pakistan 2010
Peru 1999
Philippines 1988
Poland 1999
Qatar 2000
Romania 1999
Rwanda 2013
Saudi Arabia 2001
Serbia 1992
Singapore 1984
Slovakia 2003
Slovenia 2006
South Africa 2004
South Korea 1996
Sri Lanka 2011
Sudan 2011
Sweden 2015
Switzerland 2009 #
Taiwan 1998
Tanzania 2011
Thailand 2003
Tunisia 2005
Turkey 1993
United Arab Emirates 2004
United Kingdom 1993
United States 1972
Vietnam 2010
Yemen 2000

* Exact year of EM recognition in Bahrain is unknown and establishing of The Bahrain Emergentologist Association (BEMASSO) in 2004 accepted as the recognition year for this infographic.
§ Cuba has an EM/intensive care unit (ICU) training program which was begun in 2000.
# EM is considered as a supra-specialty in Germany, Greece, and Switzerland.

That is all for now! Please feel free to share it and comment on this list. Also, please tell us if we had any countries left behind or if there were any mistakes. EM family grows every day!

Together we are stronger!

References and Further Reading

  • Swanson RC, Soto NR, Villafuerte AG, Emergency medicine in Peru, J Emerg Med. 2005 Oct;29(3):353-6, DOI:10.1016/j.jemermed.2005.02.013
  • Garcia-Rosas C, Iserson KV, Emergency medicine in México, J Emerg Med. 2006 Nov;31(4):441-5, DOI:10.1016/j.jemermed.2006.05.024
  • Al-Azri NH, Emergency medicine in Oman: current status and future challenges,Int J Emerg Med. 2009 Dec 11;2(4):199-203. doi: 10.1007/s12245-009-0143-6.
  • Sakr M, Wardrope J, Casualty, accident and emergency, or emergency medicine, the evolution, J Accid Emerg Med. 2000 Sep;17(5):314-9.
  • Pek J.H., Lim S.H., Ho H.F., Emergency medicine as a specialty in Asia, Acute Med Surg. 2016 Apr; 3(2): 65–73, doi: 10.1002/ams2.154
  • Fleischmann T, Fulde G.,Emergency medicine in modern Europe, Emerg Med Australas. 2007 Aug;19(4):300-2.
  • Partridge R., Emergency medicine in Cuba: an update, Am J Emerg Med. 2005 Sep;23(5):705-6, DOI: 10.1016/j.ajem.2005.03.006.
  • MacFarlane C, van Loggerenberg C, Kloeck W.,International EMS systems in South Africa–past, present, and future,Resuscitation. 2005 Feb;64(2):145-8,DOI:10.1016/j.resuscitation.2004.11.003

How to find the right journal?

You completed your research, and now, it is time to find the most suitable peer-reviewed journals for your article. This step is frequently skipped by many researchers, and they immediately start writing their study with great enthusiasm. There are several downsides to this approach, and we will be covering some of them in this post.

Who is your target audience?

Knowing your target audience is one of the first things that you need to do. Do you want to reach only field experts? Is your paper includes very specific information or results on a topic? If your answer is “yes,” then you should look for more specific journals. If your answer is “no,” then you should search for more general journals. Is your manuscript about education-related more than emergency medicine? If your answer is “yes,” go for education journals first. If your answer is “no,” emergency medicine journals may be interested. So, decide which group of readers is more suitable for your manuscript. Do not forget; the journal is just a connection/bridge between your results/message and readers. And, you want to pass the correct bridge to reach them. Submitting the manuscript to an unsuitable journal is a common mistake and knowing your target audience is the first step to avoid this error. 

Emergency Medicine Journal List

You can find various sources listing current Emergency Medicine journals. For example, WikEM listed only 7 Emergency Medicine journals. Some of the popular ones such as the European Journal of Emergency Medicine is not listed here.

However, Scimago Journal & Country Rank website gives the full list of the Emergency Medicine related journals with a wide range. Currently, 78 journals are listed in Emergency Medicine category.

Which journal is right for your manuscript?

To decide, you should ask yourself some questions.

  • First, your readings: which articles did you read before you design your study? Which journals were those articles published? It is possible that the same journals may be interested more in your manuscript.
  • Second, look for the first and corresponding authors in similar articles. Did they publish similar topic frequently, and where?
  • Third, databases! There are many databases you can use to find your target journals. Google scholar probably has the most coverage of journals, publications. However, it provides a non-specific search. PubMed is one of the well-known databases mainly focuses on the medical field. So, it is a good starting point to find similar articles and their journals. The SCOPUS, however, has sections that help us to find possible journals. In addition to these search engines, a couple of other websites can help us. JANE: Journal Author Name Estimator (http://jane.biosemantics.org/) and JOURNAL GUIDE (https://www.journalguide.com/) are two of them.

SCOPUS provides multiple and easy to use filters to find journals. In the below example, I entered undergraduate, emergency medicine, medical school, medical student, curriculum, curricula keywords to SCOPUS and here are the results. On the left side, you see the filters.

One of the filters give you the journal list according to your keywords. These journals published most of the articles related to your search.

As you can see above, we found Academic Emergency Medicine, Western Journal of Emergency Medicine, Annals of Emergency Medicine,  Journal of Emergency Medicine and BMC Medical Education journals, and number of published articles related to our search terms.

You can also click the analyze search results button, and you can see visual diagrams summarizing the search.

This page gives you information about authors, institutions, countries, sponsors which may help you to define a suitable journal. It also helps for your future research and collaborations.

In JANE platform, you can add your title, keywords or your full abstract and search for relevant journals, articles or authors. 

As a example, I enter the same keywords to see the results.

As you see, JANE listed journals with the highest confidence and influence. Academic Emergency Medicine, Medical Teacher, and BMC Medical Education are the top three journals publishing manuscripts including our keywords. Let’s see the articles published in the first journal.

In 8 years, Academic Emergency Medicine published three articles. However, one of them may not be what we are looking for according to its’ title. And, one important point, Academic Emergency Medicine has a new journal called AEM Education and Training. So, they recently started to publish these type of articles in their second journal. Knowing this type of details can be impossible for all journals, but it is important when you try to find the correct journal.

Journal Guide also has similar interface.

I entered the same keywords to Journal Guide.

If you click the first journal (Annals of Emergency Medicine), you will see more details about the journal. There is a lot information on the page below such as publication speed which we will be discussing in the following section.

If you click matches link, then you will see those articles as a list.

In addition to SCOPUS, JANE, and Journal Guide, “find my journal” and “SJFinder” can be other options. 

So, you have multiple online options to search for the best suitable journal for your research area. I recommend you to look for all and evaluate each of them carefully to reach the desired result.

Evaluate The Journals

You have found potential journals, and now you should evaluate them. This step will help you to define suitable journals to submit.

Scope

In the evaluation process, the first thing you look for is “scope” of the journals in your list. Are the journals publishing articles similar to your topic or type? You have to know and particularly look for this because being out of the scope of the journal is the number one reason to be rejected. Luckily, many of the journals share the scope on their websites (see below). Scimago Journal & Country Rank also provides the information about scope.

If the journal’s scope is overlapping with yours, then you should look to the recent years about related articles. Searching for the last five years will be fine. However, do not forget that the recent is the better because journal scopes and type of the published articles (review, research, editorial, special issues, etc.) may change in time or when their editors change.

Indexing

Another important information is where these journals are indexed. Web of Science, SCOPUS, Medline, Pubmed are some of the prestigious indexes that you can trust. Publishing articles in journals indexed in these platforms increase the visibility, download, and citation of your article. You can find this information on the journal websites. I searched Web of Science, and found a 14 Emergency Medicine journals in this prestigious index. First ten journals are listed below.

Publication Model - Open Access or Not

After all these steps, you should also know the publication model of the journals. There is an increasing trend of open access journals. The advantage of these journals are authors keep the copyright of their paper, figure and table numbers are less limited, no registration required to reach or download the article which increases accessibility. One of the major downsides of these journals is the article-processing charge (APC). This price may range between 1000 – 2000 USD per article. Please do not forget that there are many journals called PREDATOR JOURNALS asking APC. Although some websites are listing these journals and updating their list regularly, being in prestigious indexes is considered as a safety belt because indexes are looking two to five years publication periods of these journals for many details. So, being in prestigious indexes is not easy. The journal has to provide transparent information for their quality on editorial, evaluation and publishing processes.

Please check the Scimago Journal & Country Rank website and look for this sign. 

Publication speed

Publication speed is another essential information about journals you should consider. This is basically from submission to first decision or publication time. The shorter is the better. Although time period is directly related to the quality of the submitted manuscript, average decision or publication times give handy information about the editorial and evaluation process of the journal. However, it is not easy to find this information. Some journals may show this information on their website but still locate them in hidden areas.

Impact Factor

If you realize that I have not mention about impact factor of the journal yet. Of course, when you complete the writing, you want to start from a high impact journal first. Acceptance in a high impact journal depends on how novel your finding is and its potential help to improve the field. If your manuscript is a repetition and has a relatively incremental effect on the field, high impact journals will probably reject your paper. It is changing field to field, but high impact journals have less than 10% acceptance rate.

Above table gives the impact factors of Emergency Medicine journals in 2014. 

Submission Strategy

After all these steps, now it is time to decide a submission strategy, defining first, second, and third journals. Choosing multiple journals with similar manuscript format and writing your manuscript according to their guidelines will shorten your reformatting time if your manuscript is rejected. When you write, it is better to keep manuscript under the word, figure, table, reference limits. 

Selected Journal Submission List

JournalsWord LimitAbstract Word LimitFigure/Table LimitReference Limit
Journal 14000350730
Journal 23500300425
Journal 35000250540
Journal 43500200630
Journal 54500300730

Above table includes 5 different journals. For your convenience in the reformatting process, it is better that you choose the minimum numbers to fit all. For example, if your target journals are those in the above table, your manuscript should have 3500 words, abstract: 200 words, figure and tables: 4, and references: 25. 

You should also keep some backup journals in case of rejection from all selected journals. New journals can be an option because they have a higher acceptance rate than old ones. However, they probably are not in prestigious indexes yet. In this point, it is better to learn whether this journal applied for those indexes. If the answer is yes, then it is worth submitting. There are also “mega journals” which publish a wide range of researches, and they have a wide range of readers. As a result, their impact factors are high. Some examples of these journals are PlusOne, Scientific Reports, Cureus, etc.

What is next?

If your manuscript is still rejected after all measures you consider above, do not think that this is a waste of time. Your research can always be valuable and available to others. This topic is discussed in “You have done everything, but your paper can still be rejected!” chapter.

References and Further Reading

  • Sarah Conte. Choosing the right journal for your research. Retrieved from: https://www.aje.com/arc/choosing-right-journal-your-research/ Date: May 4th, 2019.
  • Enado Academy. How to find the right journals to publish papers. Retrieved from: https://www.enago.com/academy/how-to-find-the-right-journal-to-publish-paper/ Date: May 4, 2019.

Tips To Writing Your Research: Introduction

Planning, implementing, and writing your research is a skill that you need to start learning at the beginning of the first year of medical school. Although many medical schools are good at medical research and publishing them, there are few examples out there aiming to teach proper research and writing skills to medical students. Therefore, students mainly gain such skills through interest and hard work.

Why is it important? Why should you know how to do research or write it? There are many good reasons, but I will mention one of them. When you graduate from medical school, you want to have a good CV representing your competencies. One of the components that many residency program directors looking for is research background and published articles if there is any. Having a research portfolio in CV is not only showing you are familiar to the basic concept of how to do research or writing it, but also indicates that you are a team member, collaborator, contributor. They evaluate you as “plus one” person to help the research activities in that department which is something they are always looking for. By the way, doing a scholar activity including research is “a must” for many structured EM residency programs around the globe. So, knowing how to write will give you a lot of comfort through your residency period too. 

Emergency Medicine is the most interesting 15 minutes of every other specialty.

Dan Sandberg

Emergency Medicine (EM) provides fantastic opportunities to medical students including medical research. If you know the basics, if you have a good and active team around you or if you are rotating in an academic center, you are in the gold mine to make an incredible contribution to EM literature.

Any fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage — to move in the opposite direction.

Albert Einstein

There are many aspects of research such as design, analysis, writing, presenting. Each of them has many details to discuss, but the end point is communication with the readers and making potential improvement in our field.

If we consider our research process from start to end is appropriately done, we will have excellent material to be written.

This series aims to give some useful tips to medical students regarding preparing your manuscript, writing and publishing it. Although we may use some examples related to EM in this series, the tips apply to any area of research

Have something to say, and say it as clearly as you can. That is the only secret of style.

Matthew Arnold

To start with, here is the topic list we are going to share. We will focus on each title separately. However, if you wish to add titles to this list, please write in comment section below. 

Topic List

  • How to find the right journal?

    You have to decide which journals you want to submit your research. This step is extremely important before you start writing your article.

  • Who is your reader and what they care about?

    Knowing your readers is important because it will help you to focus on what is important in your study.

  • Which section should you start writing?

    Most journals define research paper section similarly. These are: Title, Abstract, Introduction, Methods, Results, Discussion, and Conclusion. There are very useful recommendations that can facilitate your writing pace and save your time.

  • What is the logical flow in a manuscript?

    Because you want to share your findings with high clarity, the manuscript and its sections should be written coherently. This improves the understanding of your manuscript by reviewers, editors, and readers.

  • The Title

    The title is one of the important parts of your manuscript because it helps you to communicate with your readers directly. Having a good title not only helps to attract the editors, reviewers and your readers, it also helps to improve searchability, reachability of your research.

  • Introduction

    This section includes the core information about your research topic and clear explanation about your aim.

  • Methods

    The methods section should reflect your research details with full transparency. Quality of your research directly related to your method and how it has been written.

  • Results

    One of the most challenging parts of the manuscripts is result sections. Most of the readers are facing difficulty to understand this section because of the lack of knowledge of statistical analysis and their interpretation. Therefore, writing results section is critical to communicate with your readers.

  • Discussion

    This section summarizes your findings, and you compare/contrast them with up to date literature. This is the section that you highlights your core findings.

  • After your first draft, now what?

    Writing your first draft is a huge step. However, the manuscripts always need fine-tuning, especially for language and style.

  • Submission Phase

    You wrote your manuscript, and it is time to submit to the previously selected journal. In this phase, you need to think about what journal editors and reviewers want to see in your paper.

  • Importance of Cover Letter

    A cover letter is a tool that helps you to communicate and attract the editor. So, it should be written with care.

  • How to respond to reviewers?

    Responding to reviewers' comments is a critical task that you should take it seriously.

  • You have done everything, but your paper can still be rejected!

    Do not think that it is wasted time; this manuscript can be still valuable for your field.

I suggest to read this twitter feed too.

If you have topic recommendations, please write down.

Evidence-based Approach: Introduction

Acquiring solid history-taking and physical examination skills, the ability to use and interpret them in the right way are essential for physicians.

The literature shows the physical examination, in general, is considered in decline while the use of laboratory and imaging testing has markedly increased (1-3). Indeed, physicians tend to over-rely on the test results, instead of history and physical examination findings. A reason for this trend may be physicians’ lack of knowledge or confidence (4,5). However, not every institution has the optimal resources and even if they have, extensively testing every patient for every disease possible is not cost-effective or free of complications (5). Therefore, acquiring solid history-taking and physical examination skills, the ability to use and interpret them in the right way are still essential for physicians.

Learning and performing history-taking and physical examination techniques is one thing, applying the findings to reach a diagnosis is another (6). Early learners tend to focus on mastering the skills itself so much that often they may fail to notice how to utilize it, its strengths and weaknesses. iEM Education Project’s new series “Evidence-based Approach to History-taking and Physical Examination” aims to support this learning gap.

In a way, evidence-based history-taking and physical examination challenge traditional habits in an attempt to curate them; gives us the information needed to abandon the invalid techniques and nourish the beneficial ones. However, interpreting the findings relies on understanding the evidence. Therefore, before analyzing each disease from the perspective of evidence-based diagnostic skills, we need to review the biostatistical terms such as pre-test probability, sensitivity and specificity, positive and negative likelihood ratios (LR).

Below is a simple reminder about how to interpret these values. You may refer to the links provided to reach more information.

Pre-test Probability

Pre-test probability is the probability of the disease before implementing any results (7,8). In other words, it is how likely the physician thinks a patient with a chief complaint may have a specific condition. There are three main ways to estimate pretest probability; first, prevalence studies; second, validated clinical prediction rules; and third, physicians’ gestalt based on their own clinical experience (9).

Sensitivity

Sensitivity is a feature (symptom, sign or test) with a high sensitivity is positive more frequently in patients compared to healthy population and selects patients accurately when it is positive (positivity in disease) (7). Therefore, when a highly sensitive feature is absent, the probability of the disease decreases. (SnNout = a Sensitive test, when Negative, rules out disease) (7).

Specificity

Specificity is a feature (symptom, sign or test) with a high specificity is negative more frequently in the health population compared to patients and selects healthy people accurately when it is negative (negativity in health) (7). Therefore, when a highly specific test is positive, the probability of the disease increases. (SpPin = a Specific test, when Positive, rules in disease) (7).

Positive Likelihood Ratio (LR+)

LR+ describes how the probability of a disease changes when a feature (symptom, sign or test) is present (10).

      • If LR+ > 1, the presence of the feature, increases the probability of the disease. The bigger the LR+, the more strongly it favors the diagnosis.
      • If LR+ = 1, the presence of the feature does not change the probability. Therefore, it does not have diagnostic value. 
      • If LR+ = 0-1, the presence of the feature decreases the probability of the disease. The smaller the LR+, the more strongly it opposes the diagnosis (10).

Negative Likelihood Ratio (LR-)

LR- describes how the probability of a disease changes when a feature (symptom, sign or test) is absent (10).

      • If LR- > 1, the absence of the feature, increases the probability of the disease. The bigger the LR-, the more strongly it favors the diagnosis.
      • If LR- = 1, the absence of the feature does not change the probability. Therefore, it does not have diagnostic value.
      • If L- = 0-1, the absence of the feature decreases the probability of the disease. The smaller the LR-, the more strongly it opposes the diagnosis (10).

How to combine all?

In the traditional sense, the pretest probability is used to mean the prevalence of a disease before ordering a test (8). Basically, it is another way of saying physicians used to combine symptoms and signs intuitively, based on their experience to reach a pretest probability. However, evidence-based medicine encourages the physicians and the literature to reflect on the practice, break it into pieces and review the individual and collective value of each part. Accordingly, each individual feature from history or examination can be considered “tests.” (8)

You may think reviewing the value of each feature from the history and physical examination is mentally exhausting. Validated clinical prediction rules are here to help! Similar to the traditional sense, but in an evidence-based and standardized way, the validated clinical prediction rules combine some elements to reach a more straightforward calculation of pretest (9).

Overall, interpreting the findings is as important as performing the skill itself. Interpretation requires biostatistical knowledge as much as clinical ability. When applied analytically, history-taking and physical examination can safely accelerate the diagnostic process and limit overtesting (5).

References and Further Reading

  1. Smith-Bindman, R., Miglioretti, D. L., & Larson, E. B. (2008). Rising use of diagnostic medical imaging in a large integrated health system. Health Affairs, 27(6), 1491-1502.
  2. O’Sullivan, J. W., Stevens, S., Hobbs, F. R., Salisbury, C., Little, P., Goldacre, B., … & Heneghan, C. (2018). Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests. British Medical Journal, 363, k4666.
  3.  Bergl, P., Farnan, J. M., & Chan, E. (2015). Moving toward cost-effectiveness in physical examination. The American Journal of Medicine, 128(2), 109-110.
  4. Cook, C. (2010). The lost art of the clinical examination: an overemphasis on clinical special tests. The Journal of Manual & Manipulative Therapy, 18(1), 3.
  5. Greenberg, J., & Green, J. B. (2014). Over-testing: why more is not better. The American Journal of Medicine, 127(5), 362-363.
  6. Chi, J., Artandi, M., Kugler, J., Ozdalga, E., Hosamani, P., Koehler, E., … & Verghese, A. (2016). The five-minute moment. The American Journal of Medicine, 129(8), 792-795.
  7. McGee, S. (2018). Evidence-based Physical Diagnosis (4th Ed., Kindle Ed.). Philadelphia: Elsevier.
  8. Parikh, R., Parikh, S., Arun, E., & Thomas, R. (2009). Likelihood ratios: clinical application in day-to-day practice. Indian Journal of Ophthalmology, 57(3), 217.
  9. Shaneyfelt, T. (2012). Diagnostic Process. [Online Lecture]. Retrieved April 25, 2019 from https://www.youtube.com/watch?v=6qgnrXELoo4.
  10. McGee, S. (2002). Simplifying likelihood ratios. Journal of General Internal Medicine, 17(8), 647-650.

iEM Newsletter – April 2019

Welcome to the iEM Education Project Monthly Newsletter. We will share the achievements, information about top posts, chapters, activities and future plans of the project.

iEM Education Project

Meet The Blog Authors

We are starting to activate our blog and here are the current blog authors and it is counting. If you have something to share with medical students/interns in order to promote emergency medicine or improve undergraduate emergency medicine education, you are welcome! Contact us.

Elif Dilek Cakal

Elif Dilek Cakal

Turkey

Lucas Silva

Lucas Silva

Brazil

Kilalo Mjema

Kilalo Mjema

Tanzania

Temesgen Beyene

Temesgen Beyene

Ethiopia

Arif Alper Cevik

Arif Alper Cevik

UAE/Turkey

Helene Morakis

Helene Morakis

Canada

Henrique A. Puls

Henrique A. Puls

Brazil/USA

Jule Santos

Jule Santos

Brazil

Ibrahim Sarbay

Ibrahim Sarbay

Turkey

John A. Lee

John A. Lee

USA

Download Free EM Clerkship Book in pdf and iBook

Thank you for your interest in iEM’s free Emergency Medicine Clerkship book. We published its chapters on the website in May 2018. Pdf and iBook formats were announced to download last week and downloaded more than 2000 times in a week.

Blog Posts Published in April 2019

Top 5 Countries in April 2019

Mexico

12%

Thailand

12%

USA

11%

Turkey

Turkey

10%

Costa Rica

6%

We are hiring!

Thank you for your interest in iEM’s free Emergency Medicine Clerkship book. We published its chapters on the website in May 2018. Pdf and iBook formats were announced to download last week and downloaded more than 2000 times in a week.

We believe students/interns around the globe will be enjoying the content prepared by emergency medicine experts and enthusiasts from all levels. This is a great initiative of international emergency medicine community.

Today, we are inviting new contributors to iEM Education Project as a blog author, chapter author in 2021 book, as well as for many other contribution options.

If you would like to help medical students/interns by providing free emergency medicine education resources, please contact us by filling the form below.

iEM Weekly Feed 18

Sharing is caring!

With this feed, you will find all posts and news about iEM published during last week. Click the “title” or “read more” to open each page you interested in.

Posts from last week

In 3 days, more than 1000 downloads!

0
downloads

Thank You!

You can download now!

A Week Before!

Wellness Books For Medical Students

We recently asked FOAMed family! Dear #FOAMed family. Which books are you recommending for medical students for wellness, wellbeing, life-work balance? @umanamd @EM_Educator @amalmattu @srrezaie

Read More »

Wellness Cards

We share the wellness cards including ACEP Wellness Recommendations. Also Read! Wellness Week Dear students! This week is exceptional for all emergency medicine … iEM

Read More »

Wellness Week

Dear students! This week is exceptional for all emergency medicine professionals. EMERGENCY MEDICINE WELLNESS WEEK (EMWW). EMWW is created by ACEP to remind emergency physicians

Read More »

What Was Hot In March?

Download Now! – iEM Book (iBook and pdf)

Download all content written by world-renowned professionals, emergency medicine education enthusiasts. It is a fantastic collaboration of all stakeholders. iEM Clerkship Book includes 106 topics, 454 images/tables provided by 133 authors from 19 countries.

This book is a product of an international collaboration of emergency physicians and Emergency Medicine enthusiasts. It intends to show that we can produce a free book and resource if we work collaboratively.

iEM Book Cover

A Free Book for
Emergency Medicine
Clerkship Students

iEmergency Medicine for Medical Students and Interns – 2018

1st Edition, Version 1

Arif Alper Cevik, UAE

Lit Sin Quek, Singapore

Abdel Noureldin, USA

Elif Dilek Cakal, Turkey

Undergraduate Emergency Medicine Education (UEME) is an undervalued area in the development of Emergency Medicine around the globe. If you read the articles regarding Emergency Medicine clerkships or if you travel to different countries and discuss their undergraduate education with local leaders, you can easily recognize the gaps between countries. 

Today, there are few countries in the world that have appropriately designed UEME programs in their medical schools. The majority of the countries (even some developed ones) have no guidelines, curricula, or enough educational resources. In addition, there are limited resources (textbooks, websites) for medical students/interns which covers their educational needs based on current UEME recommendations. 

This book is a product of an international collaboration of emergency physicians and Emergency Medicine enthusiasts. It intends to show that we can produce a free book and resource if we work collaboratively. It is a product of endless hours of hard work of all Editors, authors, and contributors. We thank all of them for trusting us in this journey. 

This is just a start to build up better Emergency Medicine resources for medical students and interns, especially for developing countries. It is a continuous process, and there are a lot of areas that we need to improve in this book. Therefore, we are looking forward to your feedback and collaboration.

We also believe that international UEME will reach the minimum required standards in all countries based on the endless collaboration of emergency medicine professionals.

There is continuous work for the iEM book process. We applied multiple editing and reviewing steps. We continue this process for many chapters with the feedback from our readers and contributors.

We used original images, illustrations, diagrams provided by the Editors and authors as much as possible. However, there were chapters that we needed to use some copyright free material, Creative Commons licensed images, illustrations, and diagrams with attribution to the original owners. We are continuously searching for better images, illustrations, and diagrams. If you have copyright free clinical images, illustrations or diagrams, please share them with us. We would like to use them with your credentials in the book, online archive, and website.

“if you want to go fast go alone, if you want to go far go together”

African Proverb

Interview – Vicky Noble – US training in medical schools

We interviewed with world renowned emergency and critical care US expert “Vicky Noble” about US training in medical schools.

Read US Chapters and Posts

iEM Weekly Feed 17

Sharing is caring!

With this feed, you will find all posts and news about iEM published during last week. Click the “title” or “read more” to open each page you interested in.

Wellness Books For Medical Students

We recently asked FOAMed family! Dear #FOAMed family. Which books are you recommending for medical students for wellness, wellbeing, life-work balance? @umanamd @EM_Educator @amalmattu @srrezaie

Read More »

Wellness Cards

We share the wellness cards including ACEP Wellness Recommendations. Also Read! Wellness Week Dear students! This week is exceptional for all emergency medicine … iEM

Read More »

Wellness Week

Dear students! This week is exceptional for all emergency medicine professionals. EMERGENCY MEDICINE WELLNESS WEEK (EMWW). EMWW is created by ACEP to remind emergency physicians

Read More »

A Week Before!

iEM Flickr Image Archive

Our Flickr Image Archive Is Viewed More Than 150.000 times. Free Images and Short Videos Use them freely in your presentations, exams.

Read More »

Interview: Jesus Daniel Lopez Tapia

We interviewed with Dr. Jesus Daniel Lopez Tapia. He is the Dean of University Monterrey, College of Medicine and immediate past president of Mexican Society

Read More »

Video Interview – Rob Rogers – Part 3

Great messages for medical students, interns and new EM residents! Part 1 Part 2 Watch the part 3 here! You can listen full interview here!

Read More »

What Was Hot In March?

pdf and iBook are ready to download soon!

Wellness Books For Medical Students

We recently asked FOAMed family!

Thanks to all FOAMed leaders and enthusiasts for their answers. We received fantastic book recommendations for our students.

Although some of the books are not directly related to wellness, their content indirectly guides you to be more competent, mindful, grateful, happy in order to reach your life long wellbeing.

Here are amazing recommendations through twitter responses! (alphabetical order)

  • Being mortal
  • Daring greatly
  • Deep survival
  • Deep work
  • Designing your life
  • Enjoy every sandwich
  • Everything happens for a reason
  • Extreme ownership
  • Factfulness
  • Getting things done
  • Grit
  • How to win friends & influence people
  • How will you measure your life
  • Ikigai
  • In shock
  • Inclusion and diversity in workplace
  • Leaders eat last
  • Man’s search for meaning
  • Mindset
  • No ego
  • Peak
  • Rigor mortis
  • The 7 habits of highly effective people
  • The power of habit
  • The upside of stress
  • When breath becomes air
  • Why we sleep

You can find exact twitter messages including authors of the books below.

Here is the full list, again!

  1. Being mortal
  2. Daring greatly
  3. Deep survival
  4. Deep work
  5. Designing your life
  6. Enjoy every sandwich
  7. Everything happens for a reason
  8. Extreme ownership
  9. Factfulness
  10. Getting things done
  11. Grit
  12. How to win friends & influence people
  13. How will you measure your life
  14. Ikigai
  15. In shock
  16. Inclusion and diversity in workplace
  17. Leaders eat last
  18. Man’s search for meaning
  19. Mindset
  20. No ego
  21. Peak
  22. Rigor mortis
  23. The 7 habits of highly effective people
  24. The power of habit
  25. The upside of stress
  26. When breath becomes air
  27. Why we sleep

Also Read!