In some parts of the world, Internships consist of rotating in different departments of a hospital over a period of one or two years depending on the location. In others, interns are first-year Emergency Medicine residents. Whichever country you practice in, an emergency rotation may be mandatory to get the most exposure, and often the most hands-on.
Often, junior doctors (including myself) find ourselves confused and lost as to what is expected of us, and how we can learn and work efficiently in a fast-paced environment such as the ER. It can be overwhelming as you may be expected to know and do a lot of things such as taking a short yet precise history, doing a quick but essential physical exam and performing practical procedures.
I’ve gathered some tips from fellow interns and myself, from what we experienced, what we did right, what we could’ve done better and what we wish we knew before starting.
These tips may have some points specific to your Emergency Medicine Rotation, but overall can be applied in any department you work in.
First things first – Always try to be on time. Try to reach your work a couple of minutes before your shift starts, so you have enough time to wear your PPE and feel comfortable before starting your shift.
Know your patients! Unlike other departments, ER does not always have rounds, and you do not know any of the patients beforehand, but it always helps to get a handover from the previous shift, and know if any of the patients have any results, treatment plans or discharges pending, to prevent chaos later on!
Always be around, inform your supervising doctor when you want to go for a break, and always volunteer to do more than what you’re asked for. The best way to learn is to make yourself known, ask the nurses to allow you to practice IV Cannulation, Intramuscular injections, anything and everything that goes around the department, remember the ER is the best place to learn.
Admit when you feel uncomfortable doing something, or if you’ve done a mistake. This makes you appear trustworthy and everyone respects someone who can own up to their mistake and keeps their patients first.
Breath sounds and pulses need to be checked in every patient!
Address pain before anything else, if their pain is in control, the patient will be able to answer your questions better.
Never think any work is below you, and this is one thing which I admired about ED physicians, you do not need someone to bring the Ultrasound machine to you, you do not need someone to plug in the machine, you do not need someone to place the blood pressure cuff if you can do it yourself. Time is essential, and if you’re the first person seeing the patient, do all that you can to make their care as efficient as possible.
Care for patients because you want to, and not for show. Often junior doctors get caught up in the fact that they are being evaluated and try to “look” like the best version of themselves. While it may be true, remember this is the year where you are shaping yourself for the future, and starting off by placing your patients first, doing things for their benefit will not only make it a habit, the right people will always notice and will know when you do things to provide patient-focused care, or when you do them to show that you are providing patient-focused care.
Teamwork will help you grow. Not everything in life has to be a competition, try to work with your colleagues, share knowledge, take chances on doing things, learn together, trying to win against everyone else only makes an easier task even more stressful and can endanger lives.
Learn the names of the people you work with! In the ER, you may across different people on each and every shift and it may be difficult to remember everyone’s names, but it’s always nice to try, and addressing people by their names instantly makes you more likable and pleasant to work with!
Keep track of your patients and make a logbook of all the cases you see and all the procedures you observe/assist in/perform. This not only helps in building your portfolio, but also in going back and reading about the vast variety of cases you must have seen.
Always ask yourself what could the differential diagnosis be? How would you treat the patient?
Ask questions! No question is worth not asking, clear your doubts. Remember to not ask too much just for the sake of looking interested, but never shy away from asking, you’d be surprised to see how many doctors would be willing to answer your queries.
Don’t make up facts and information. If you forgot to ask something in history, admit the mistake, and it’s never too late, you can almost always go back and ask. It’s quite normal to forget when you’re trying to gather a lot of information in a short span of time.
Check up on the patients from time to time. The first consultation till the time you hand them the discharge papers or refer them to a specialty shouldn’t be the only time you see the patient. Go in between whenever you get a chance, ask them if they feel better, if they need something. Sometimes just by having someone asking their health and mental wellbeing is just what they need.
Take breaks, drink water and know your limits. Do not overwork yourself. Stretching yourself till you break is not a sign of strength.
Sleep! Sleep well before every shift. Your sleep cycles will be affected, but sleeping when you can is the best advice you can get.
Practice as many practical skills as you can. The ER teaches you more than a book can, and instead of looking at pictures, you can actually learn on the job. Practice ultrasound techniques, suturing, ECG interpretation, see as many radiology images as you can, learn to distinguish between what’s normal and what’s not.
Last but most important, Enjoy! The ER rotation is usually amongst the best rotations an intern goes through, one where you actually feel like you are a doctor and have an impact on someone’s life! So make the best of it.
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.
At a GEMS journal club, 2020
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!
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.
Patino, Andres. “GEMS LP – Global EM Student Leadership Program. The New AMP”. GEMS LP Program Orientation virtual meeting, PPT presentation. October, 2020.
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.
Are you ready to meet the genuine people behind the professional?
iEM team proudly presents the ICON360 interviews. In this series, world-renowned experts will share their habits, give advice on life, wellness and the profession.
Stephanie Kayden
Stephanie Kayden, MD, MPH, is Vice Chair of the Department of Emergency Medicine at Brigham and Women’s Hospital and Harvard University. She has a focus on international humanitarian response and leadership. She serves on the faculty of the Humanitarian Studies, Ethics, and Human Rights cluster in the Department of Global Health and Population. As Director of the Lavine Family Humanitarian Studies Initiative at the Humanitarian Academy at Harvard, Dr. Kayden trains students and professionals in global health and humanitarian work.
Are you ready to meet the genuine people behind the professional?
iEM team proudly presents the ICON360 interviews. In this series, world-renowned experts will share their habits, give advice on life, wellness and the profession.
Stephanie Kayden
Stephanie Kayden, MD, MPH, is Vice Chair of the Department of Emergency Medicine at Brigham and Women’s Hospital and Harvard University. She has a focus on international humanitarian response and leadership. She serves on the faculty of the Humanitarian Studies, Ethics, and Human Rights cluster in the Department of Global Health and Population. As Director of the Lavine Family Humanitarian Studies Initiative at the Humanitarian Academy at Harvard, Dr. Kayden trains students and professionals in global health and humanitarian work.
The 10th Asian Conference on Emergency Medicine was successfully completed in New Delhi, India, during the last couple of days. The conference hosted around 1700 attendees around the globe, mainly Asia. There were approximately 300 speakers from all continents. Dr. Tamorish Kole and Dr. Sirinath Kumar were the two Emergency Medicine professionals who behind the success of this conference. Both experts are also a member of the board of directors of the Asian Society for Emergency Medicine (ASEM). At the end of the conference, Dr. Kole took over the presidency from Prof.Dr. Yildiray Cete (Turkey) who served to ASEM for two years.
Asian Society for Emergency Medicine, Board of Directors
Vice-President of India, Venkaiah Naidu, opened the conference with promising support to the improvement of Emergency Medicine care in India as well as highlighting the implementation of Emergency Medicine into the undergraduate curriculum. As many countries in Asia, Indian medical graduates are working in acute care settings after graduation. Therefore, focusing on undergraduate education can help many countries in the same context.
Venkaiah Naidu, Vice-President of India
This topic one of the items discussed in the ASEM Board of Directors meeting. Creating a widely acceptable undergraduate curriculum is a necessity for Asian countries, especially those in the development stage of Emergency Medicine. ASEM board formed a sub-committee to work on this highly significant problem. Dr. Mohan Tiru (Singapore) and I will be leading board members to continue and finalize the process. Because the International Federation for Emergency Medicine (IFEM) currently working on a comprehensive update process for its’ undergraduate curriculum, there is no need to reinvent the wheel for ASEM. Taking the updated version of the IFEM undergraduate curriculum as the main framework and working on it to create a precise Asian undergraduate curriculum will be enough and probably the fastest way. However, there is a need to understand the current situation and needs in Asian countries. Therefore, the sub-committee of ASEM will work on learning needs assessment and current situation analysis until the IFEM undergraduate curriculum finalized. The expected time for the new updated version of the IFEM undergraduate curriculum is April-May 2020. Completing learning needs assessment and current situation analysis of Asia by March-April 2020 will give the Asian board a chance to move forward with updated IFEM undergraduate curriculum. Probably, developing the Asian curriculum will be possible in a short period of time until the end of 2020.
Asian Society for Emergency Medicine, Board of Directors Meeting
While ACEM2019 continues, I was able to meet a couple of contributors to the International Emergency Medicine Education Project. I visited Rob Rogers’ well-known course, Medutopia, which aims to increase the quality of the teaching skills of educators. According to Dr. Rogers, this is the most enthusiastic and knowledgable group since the Medutopia journey has begun. Dr. Andy Little and Dr. Mike Giosondi were other two experts who gave the course with Dr. Rogers. You can read and listen to Dr. Rogers’ contributions to the International Emergency Medicine Education Project here.
I also came across to Dr. Simon Carley from Manchester, who is well-known for ST.EMLYN’s blog. He gave a couple of amazing talks during the conference, including one plenary presentation.
Simon Carley, plenary session
Arif Alper Cevik and Simon Carley
One of the surprising things was meeting with one of our blog authors Dr. Kaushila Thilakasiri (Sri Lanka) and her team. This energetic group was not only coming for ASEM to attend meetings, but they also came to compete in SimWars. And of course, they won the first prize.
Kaushila Thilakasiri and Sri Lanka team
Two days of workshops and three days of the busy scientific program passed like lightning. In addition to scientific activities, ACEM 2019 team prepared many social events for participants. I think, socially and scientifically, ACEM 2019 was a very busy conference. This created many networking opportunities.
One of the final event was graduation ceremony of 2018-2019 class of Emergency Medicine residents. Around 120 new graduated were appreciated with a nicely setted up ceremony with attendence of leaders of Emergency Medicine such as Prof. Lee Wallis (Past President of IFEM), Dr. Taj Hassan (Pas President of Royal College of Emergency Medicine) and Prof. James Ducharme (President of IFEM) as well as local leaders of Emergency Medicine of India.
2018-2019 Indian Emergency Medicine Graduates
As a summary, ACEM2019 was a successful gathering for international Emergency Medicine experts and Asian emergency physicians, residents and medical students.
ACEM 2021 will be in Hong Kong. ASEM board of directors decided to give ACEM2023 to Manila, Phillipines and ACEM2025 to Dubai, United Arab Emirates. We hope to see you all in these upcoming events.
Starting the Emergency Medicine (EM) Clerkship is one of the most exciting times of any medical student’s life, regardless of whichever specialty they plan on specializing in because EM has something for everyone. It is like solving all those questions that begin with ‘A patient presents to the Emergency Department with…’ but in reality, at a faster pace and with more tricky situations. This can make students feel overwhelmed, as they find themselves juggling between books and resources as to which one to follow or which topics to learn, and I am here for just that! To share the approach that helps many students get the hang of EM and make the most of their time in one of the best learning environments of any hospital.
Prepare a list of common conditions
The basic approach would be first to jot down all the problems you can think of.
There are problems that you may be heard a lot such as Chest Pain, Heart Failure, Shock (and it’s types), Acute Coronary Syndrome, Sepsis, Pulmonary edema, Respiratory Failure, Coma, Stroke, Hypoglycemia, Subarachnoid Hemorrhage, Fractures, Head Trauma, Status Epilepticus, Diabetic Ketoacidosis, and Anaphylaxis.
As every doctor you meet will always say, common is common, so always focus on things that you have heard and seen most about, read about them, make notes on their clinical features, differentials, investigations and management. Most importantly, do not forget to read about the ABCDE approach in every critically ill and trauma patient.
Brush up on your history taking and examination skills
Know what to ask and when to ask. Patients in the ED are not in their most comfortable composure, so try to practice and frame questions that provide you with just enough information to make a diagnosis in the least possible time. The same goes for examination, never forget the basics of examination and their importance. Practice examination as much as you can and you will automatically see it come to you naturally at a faster pace. Also, do not forget focused history and physical examination is a cornerstone of EM practice and saves a lot of time. Where investigations can help you exclude a differential, 80% of your diagnosis will be built from what you ask, what you see and what you feel. Keep in mind that if you are not thinking or looking for something, you will not see and find it. So, be suspicious of life, organ and limb-threatening problems.
Read about common ED procedures
ABG, Intubation, Central Lines, FAST Scan, Suturing, Catheter and Cannula placement are some of them. As a medical student, you will probably not be required to perform any, but it is good to have an idea about the procedures when you see them. If you can practice, then that is even better, ask a resident or intern to show you how and you can have a go yourself under their supervision! Remember, “see one, do one, teach one.”
Watch videos on examination, interpreting X-rays, & procedural skills
Youtube is an asset when it comes to medical education, make good use of it. There are also plenty of videos on the iEM website that you can watch and learn from.
Interpretation of ECG & X-rays
Google is your best friend for this! You have the list of common conditions, all you need to do is a google search on the most common ECG findings and x-rays in medical emergencies and you will be good to go. You can also always learn these from the doctors around you in the ED, as the more you see and try to interpret, the better you get at differentiating the normal from abnormal.
Before the rotation, read a review book, recall your basic knowledge from internal medicine/family medicine and surgery because EM almost covers all of the acute problems of those fields. Moreover, do not forget, EM is an independent specialty and has its’ own textbooks.
During the rotation – Learning what you see is the best way to keep things in your long term memory. After your shift ends, and you go home, get some rest, recall the cases of the day and read about them on Up to Date/ Medscape or any resource that you prefer, this will help you relate what you saw with what you are reading and will help you recall it better later on.
These are just a few tips to help in making the most of your EM rotation. Remember to study hard, but also practice, brush up on your communication skills, talk to patients, be there for them. The EM Clerkship prepares you for life as a doctor, as you practice every aspect of medicine during this time and learn to answer questions about acute medical problems and their severity when asked by those around you.
As the Canadian Resident Matching Service (CaRMS) application cycle approaches for the Class of 2020 in Canada, I have been reflecting on the common question of “Why Emergency Medicine (EM)?” This has encouraged me to consider all aspects of the specialty that I love, as well as some of the perceived challenges of pursuing EM residency training. Additionally, I have been asked about advice for medical students interested in exploring EM, mainly from those beginning medical school or clerkship this month. So, in an attempt at a personal reflection exercise, I am also hoping to provide some practical points for consideration for any medical student thinking about exploring this wonderful specialty.
Some of the reasons why I love Emergency Medicine:
1
Versatility
From the clinical presentations and various procedures, to the patients and team members working in the emergency department, I am constantly drawn to the multifaceted and dynamic nature of EM. Speaking to well-seasoned staff physicians, this versatility has them constantly learning and encountering new things. During my first EM shift of clerkship, the first patient of the day came in with atrial fibrillation, the second was hypothermic and without vital signs, the third had lower back pain, and the fourth presented with a COPD exacerbation. The range in presentations and levels of acuity are something that greatly appeal to me and allow for constant growth in Medicine. This diversity provides endless opportunities to learn new things in the setting of, at times, very limited information and time.
2
Opportunities for subspecialization
EM offers several formal opportunities to find your niche within the specialty, in the form of fellowships. These areas include ultrasound, trauma, resuscitation and reanimation, critical care, toxicology, pediatric EM, disaster medicine, and medical education. This is not an exhaustive list and will vary depending on where you are training. The Canadian Association of Emergency Physicians has developed an accessible directory for enhanced competencies: https://caep.ca/em-community/resident-section/enhanced-competency-directory/.
3
Portability
One long-standing interest of mine throughout my post-secondary education has been Population and Global Health. Therefore, something that I really appreciate about EM is its portability. EM is present in an array of settings, from rural to large academic centers. This flexibility allows you to tailor your practice to your interests, both within and outside of Medicine. In a recent post by one of iEM’s blog authors, Dr. Ibrahim Sarbay, 82 countries were identified as recognizing EM as a primary specialty. See “Countries Recognize Emergency Medicine as a Specialty” for a breakdown of countries: https://iem-student.org/2019/05/13/countries-recognize-emergency-medicine/)
4
Working with vulnerable populations
This is something that continues to draw me to EM, as the emergency department serves as an entry point into the healthcare system for some individuals. Throughout my rotations, I have been privileged to work with various patients, and have found myself constantly inspired from learning about their unique challenges within the healthcare system, as well as the various interventions that have been developed to target social determinants of health at institutional and systemic levels. While there is considerable work that still needs to be done to address these disparities, I continue being fascinated with the various advancements that are underway. This has additionally expanded my understanding of humanity and has forced me to reflect on how I approach clinical interactions. Overall, it has allowed for considerable growth within Medicine and on a personal level. This continues to be one of the aspects of EM that I truly value most.
Perceived challenges
I need to preface this by saying that it may be difficult to truly appreciate challenges of any specialty from solely experiencing it through the role of a medical student. However, these are points that I consider challenges of EM-based on my personal experiences during several EM rotations, as well as through discussion with residents and staff physicians.
1
Physician burnout
A recent study in JAMA by Dyrbye et al. (2018) surveyed second-year resident physicians in the United States. Their findings indicated a burnout prevalence (based on the Maslach Burnout Inventory) of 53.8% of surveyed EM residents. While EM did not exhibit the highest burnout rate (Urology, 63.8%; Neurology, 61.6%; Ophthalmology, 55.8%), it was on the higher end for specialties that were assessed. [1] The topics of burnout and wellness promotion have become fairly pronounced in the EM community. EM Cases released an episode in 2017 regarding burnout prevention and wellness during EM training, that featured Dr. Sara Gray and Chris Trevelyan. Link: https://emergencymedicinecases.com/preventing-burnout-promoting-wellness-emergency-medicine/
2
Practicing “fishbowl medicine”
I have heard this term thrown around quite a bit, alluding to the fact that specialties are observing the way that EM physicians are managing patients. The fishbowl effectreflects the tendency of a specialist in other disciplines to compare the actions of EM physicians to the standards of practice that are held in the setting of those specialists (e.g., the operating room, the specialty clinics, etc.). [2] While I recognize that this can occasionally cause conflict between groups, I personally love the multidisciplinary nature of EM and view the collaborative efforts with other specialties as further opportunities for growth regarding my understanding of various disease processes and overall management of patients. Dr. Sheldon Jacobson published an interesting reflection of how this concept can actually be viewed positively within the practice of EM [2].
Everyone has personal reasons for pursuing any specialty, and for many, the reasons for pursuing EM run deeper than those listed above. However, these are just some of the factors that I believe to be basic and practical considerations for this specialty. EM makes me excited to expand upon my knowledge base in Medicine, to constantly learn and better my understanding of the human condition, and to be a part of the supportive environment that multidisciplinary EM teams create. It is an ever-expanding field and I hope to one day be able to contribute to it in a meaningful way. I could go on and on about why I love the specialty, well beyond the limits of a blog post – I may be a little biased, but EM is pretty great!
References and Further Reading
Dyrbye LN, Burke SE, Hardeman RR et al. Association of Clinical Specialty with Symptoms of Burnout and Career Choice Regret Among US Resident Physicians. JAMA. 2018 Sep;320(11):1114-1130.
Jacobson S. The Fishbowl Effect. Acad Emerg Med, 2015 Oct;12(10):956-957.
As a medical student, I remember once watching a team of physicians and nurses resuscitating a patient who had a cardiac arrest. And while the team worked cohesively like cells that make up a multicellular organism, there was a clear team leader. The ER physician at the foot end of the bed was giving clear instructions to the team and leading the resuscitation. As time passed, I could see the expression of the ER physician change as he finally asked his team to stop resuscitating the patient. In that moment, I remember being aghast and even appalled at the decision of the doctor to stop resuscitating the patient. A few years and many exams later, having found myself in countless similar situations as an ER Resident, I have just begun to understand the complexity of making such decisions.
Can You?
As physicians, we constantly make decisions in the best interest of our patients and while finding confidence in our decision making is a slow and steady process, it is a process which begins even before we graduate. As a medical student, the choice of medical specialty can be one of the hardest decisions to make. There is a definite finality to the decision of which specialty one decides to pursue. Those who go into medical school with an intended career path may find it easier while others may make their decision as they are exposed to different specialties through their clerkships.
Is Emergency Medicine the right specialty for me?
If you are contemplating if a particular specialty is right for you, then you are already on the right track. All specialties have advantages and disadvantages. Dermatology is often viewed as an attractive specialty by those who like a bit of calm in their lives. But, I know many dermatologists who would not mind a little change from their usual routine of patients every once in a while. (Okay, not many but a few of them).
So, what are the pros and cons of Emergency Medicine?
Pros
Variety Is The Spice Of Life
The great thing about working in the ER is exposure to a variety of cases. At the end of a shift, you could have resuscitated a patient with myocardial infarction, sutured a bleeding scalp wound and even delivered a baby in the ER. If you are someone who enjoys working in a dynamic and fast-paced environment, then working in the ED will definitely be in your comfort zone.
No On Calls… Ever!
Limited working hours, predictability of hours and offs during the week are some factors that attract physicians towards a life in the ER. An ER attending once joked to me that he could not predict a single minute of the shift but knew the exact time he would be sleeping in his bed comfortably. The flip side however, is managing shift schedules and disrupted sleep patterns, which will be discussed under cons.
Hands Off While Delivering Shock but Hands-On Otherwise
I have to admit that not every shift will be like an episode of ‘Code Black,’ but you will still have many shifts where you would get to do hands-on procedures like chest tubes, intubations, and central lines as well as point of care ultrasound which is gaining rapid use in the ED and is an exciting area for further development in the ED.
Looking Into The Future
This can be listed as an advantage or disadvantage, depending on the way you look at it. Emergency medicine, as an independent medical specialty, is relatively young. If you are planning to pursue EM in a place where it is in its nascent stages, you are likely to hit a few speed bumps on the way. This, however, provides you with plenty of opportunities to develop a new model of health-care in your community and make a difference. If you are pursuing EM in a place where there are already well-developed training programs in place (for example the US, UK, Canada or Australia), there is still a lot of potential for research and exploring new tools that will make EM more efficient.
Cons
Burn-out
If you have already done a clerkship in the ER, then you would have probably heard the word ‘burnout’ at least a couple of times and if you have not then I simply do not believe you. Burnout continues to be a pervasive issue among physicians - but not just in the ER, it affects physicians from all specialties. The fact that burnout is discussed and debated so much in the ER is actually comforting as that means there are just as many people looking to fix and help with the problem.
Working in shifts
If you choose to be an ER physician, then working the night shift, on public holidays and weekends is now an unspoken truth of your life. This lifestyle may particularly get more difficult as one gets older and shoulders more responsibilities, especially towards the family. Another challenge that ER physicians face is the circadian rhythm changes, constantly shifting from day to night shifts and back to day, can certainly put one’s health at risk.
So what happened to my patient?
If you are someone who likes to develop long term relationships with your patients, the ER setting can be a challenge for you. However, for most ER physicians, the lack of follow up is a non-issue. Personally, I believe there are many opportunities to develop a rapport with the patient in the ER while knowing that you may never see the same patient again.
What if I am a woman wanting to work in the ER?
One of the success stories involving employment for women since the late 20th century has been the increasing proportion of women in the medical profession. Data from the US suggests that while there was a dramatic upward trend in the representation of women in EM programs (28% in 2001 to 38% in 2011), but sadly this trend has now plateaued in the last few years. Some of the reasons cited for women not choosing EM as a specialty include lifestyle in the ER (working shifts, weekends, etc.) and under-representation in EM leadership.
The reasons could be countless and influenced by the social and cultural norms of each place. The right people to guide you in your decision making are the female residents and attendings working in your local ER. So seek them out and definitely factor in their experience in your decision.
There are also many organizations and blogs which support the empowerment of women in Emergency Medicine. American Association of Women Emergency Physicians, Women in Emergency Medicine (WEM), FemInEM are few that you should definitely check out.
How do I finalize my decision?
Keeping an open mind throughout your clerkships helps. Try to experience each speciality to the maximum you can. So that by the end of medical school, you would have a fair idea of what choosing that specialty would entail.
Try to schedule electives in the speciality you would like to pursue. In the ER, use this opportunity to try working in shifts and get a taste of what it’s like to work in a fast-paced environment. Also, speak to the residents and attendings about their experiences to gain invaluable insight into the specialty.
What if I want to know more about EM?
A good way to learn more about emergency medicine is to join local and international professional emergency medicine organizations as a student. You can also sign up for newsletters, listen to podcasts and follow blogs dedicated to Emergency Medicine to keep up with the latest happenings in EM.
ISAEM is a global student organization which is a active collaborator of iEM Education Project
IFEM is a global organization aiming to improve emergency medical care and education. IFEM is the main endorsing organization of iEM Education Project
Final thoughts
I understand that the above article might portray an ER physician as a superhero/woman navigating through all that chaos, trying to make a difference in the world. But in reality, one does feel like that if lucky enough to pursue something that one is passionate about. So find your passion and do not stop until you do. If you find it in Emergency Medicine, perhaps we may cross paths in the future, if not, I still wish the best for you.
Cite this article as: Neha Hudlikar, UAE, "Decisions!," in International Emergency Medicine Education Project, August 2, 2019, https://iem-student.org/2019/08/02/decisions/, date accessed: March 22, 2023
Emergency Medicine in Brazil is still a small baby. In some states, it’s crawling, like here in Brasília. But even so, it already made my eyes shine. In Brasilia, we are moving to graduate the first group of emergency physicians. Several people were struggling for this to happen. And today, I’m going to talk a little about them, and why I decided to do emergency medicine, even though I’m still in the fourth year.
It is quite common for many medical students to have doubts about which residency to choose as if this decision were unique and definitive, and that weighs heavily. During the fellowship of an Airway course, I overheard one student from the last year say, “I have not yet found the specialty that makes my eyes shine.” And that made me think about how lucky I am because I’ve already found it. My intention here is not to make you choose Emergency Medicine as your only option, but to show you that the most serious patient needs the best doctor and the best treatment. It is to show you that the emergency department has to be ready for all the patients who can open through emergency doors, from the child to the elderly. And if you’re like me, who did not settle for a specialty that focused on only one part of the human body, you’re going to fall in love with the Emergency Medicine as well.
[BLS class offered by EMIG for medical freshmen] A great opportunity to improve knowledge, train and even teach!
I arrived at the emergency department of a hospital in the capital as a confused student, who still had no idea of my rotation. And whoever accepted me was the most fantastic doctor I could meet, no less than the boss of the state’s Emergency Medicine residency program. Well, I did not know that great detail of the time. But watching her play that “red room” was like watching an orchestra. Each bed is an instrument, which she commanded with mastery. I had never seen anything like it. She knew what she was doing. She was young and a strong woman. That by the standards of Brazil, borders the absurd, but there she was. In a public hospital, she was treating each patient as royalty. She maintained a firm posture, taught the students, and knew how to lead the team. It was beautiful to see. I knew that’s where I wanted to be; I knew I wanted to be at least 20% of the doctor she was. Despite the initial fear I had of her, little by little, she became my mentor. It was a big milestone in my life. She showed me what Emergency Medicine is and what is still going to be here in Brazil. And so, I was diving more and more into Emergency Medicine.
Rebeca is President of EMIG in Brasilia (LEM.DF : Emergency Medical League of the Federal District). They are medical students of different years who meet every two weeks for classes and practices focused on Emergency Medicine, with the help of doctors, teachers and proctors of different areas.
She taught me that the emergency department is not the messy garage entrance of a hospital. At least it should not. Here in Brazil, we face the overcrowding of emergency department and lack of resources. So an emergency physician here needs to be more than good, needs to be creative and resilient. However, generally in the country, the doctor who takes care of these patients is the most inexperienced. It’s usually the one who just got out of college and needs to work to earn money. And this needs to be changed. Some doctors saw this inconvenient situation and fought for it to be changed. But every change hurts, and it takes a lot of strength. Gradually, the movement grew. After several battles, Emergency Medicine managed to have an association of its own that finally took on the role of creating it. That’s why students with interest in the area are so valued, after all, it’s us who will keep this legacy.
[Airway Management Course] Offered by "Emergencia Rules," blog by Jule Santos. Contact with residents and the participation of various events will open up several opportunities for you, such as assisting in the organization of for an important course for Emergency Medicine.
I also learned from her the importance of being humble and training whenever possible. After all, the best professionals in each area spend more hours training than acting. Perfecting your technique, strengthening your mindset, is a must in medicine. Train, study, and be humble to recognize that you don’t know everything. Being an emergency physician is having to deal with every situation. You don’t have to deliver a diagnosis now, but the patient has to be stabilized until someone else can take over. And to reach this level of saying to death “not today,” you need to study and train!
[Rebeca B. Rios and Jule Santos] On the poster it says: I am the person you will want on call the day you have a heart attack. A phrase from Jule's book: Born to be Wild
If you are a Brazilian medical student and interested in the area, here are some tips. Be part of an EMIG (Emergency Medicine Interest Group). Thus, you will have contact with residents and preceptors of the area. Engage in the different opportunities within the Emergency Medicine field that arise, such as events and courses. Look for the associations in Brazil, and also outside the country. Accompany shifts with an emergency physician, so you can feel a little of the specialty and understand what your day to day life will be like. After graduating from college, you must take the test for the Emergency Medicine Residency. The residency lasts three years and already exists in several Brazilian states. After three years of residency, you must take the specialty exam (title test), to become an Emergency Medicine specialist. And if you can find your Emergency Medicine mentor in college, know that your path will become clearer, know that you will enter a world where you can hardly get out, because that’s the Emergency Medicine. A world far beyond only the doors of the emergency department.
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.
Here a few of our specific tasks:
Help with the registration of all attendees;
Usher people throughout the conference to make sure they would be at the right place at the right time;
Workshop support (eg. Manikin, time management, etc.);
Help with backstage and on-stage activities;
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.
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
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.
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?
How many countries recognize Emergency Medicine as a specialty? Acil Tıp kaç ülkede bir uzmanlık dalı olarak kabul edilmektedir?
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
