How to make the most of your EM Clerkship

How to make the most of your EM Clerkship

Emergency Medicine has something for everyone!

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.

Here is a list to help you get started: Core EM Clerkship Topics

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.

Books

Before the rotation

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.

iEM Clerkship book is a very good source to get started with! Download Now! – iEM Book (iBook and pdf)

If you are the kind, who likes solving questions, the Pretest Emergency Medicine is a great source.

During the rotation

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.

Cite this article as: Sumaiya Hafiz, "How to make the most of your EM Clerkship," in International Emergency Medicine Education Project, October 4, 2019, https://iem-student.org/2019/10/04/how-to-make-the-most-of-your-em-clerkship/, date accessed: October 16, 2019

Why Emergency Medicine? A medical student’s reflection

why emergency medicine - nada radulovic - canada

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.

Versatility

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/

Subspecialization

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/)

Portability

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. 

Vulnerable Populations

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 effect reflects 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]. 

Fishbowl

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

  1. 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.
  2. Jacobson S. The Fishbowl Effect. Acad Emerg Med, 2015 Oct;12(10):956-957.

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Cite this article as: Nada Radulovic, "Why Emergency Medicine? A medical student’s reflection," in International Emergency Medicine Education Project, August 30, 2019, https://iem-student.org/2019/08/30/why-emergency-medicine-a-medical-students-reflection/, date accessed: October 16, 2019

Decisions!

Decisions

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.

ER physicians make difficult 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.

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Cite this article as: Neha Hudlikar, "Decisions!," in International Emergency Medicine Education Project, August 2, 2019, https://iem-student.org/2019/08/02/decisions/, date accessed: October 16, 2019

Why Emergency Medicine?

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.

why emergency medicine 2
[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.

jule santos 2
Dra. Jule Santos
why emergency medicine 4
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.

jule santos 3
[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!

why emergency medicine 3
[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.

Dedicated to Jule Santos.

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Cite this article as: Rebeca Rios, "Why Emergency Medicine?," in International Emergency Medicine Education Project, July 22, 2019, https://iem-student.org/2019/07/22/why-emergency-medicine/, date accessed: October 16, 2019

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

If you liked this story, you may like these too!

Cite this article as: Lucas Silva, "SMACC Sydney 2019: A Student Volunteer Experience," in International Emergency Medicine Education Project, May 20, 2019, https://iem-student.org/2019/05/20/smacc-sydney-2019-a-student-volunteer-experience/, date accessed: October 16, 2019

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.

Cite this article as: iEM Education Project Team, "Update on Countries Recognize EM As A Specialty," in International Emergency Medicine Education Project, May 17, 2019, https://iem-student.org/2019/05/17/update-on-countries-recognize-em-as-a-specialty/, date accessed: October 16, 2019

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?

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0
0
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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
Cite this article as: Ibrahim Sarbay, "Countries Recognize Emergency Medicine as a Specialty," in International Emergency Medicine Education Project, May 13, 2019, https://iem-student.org/2019/05/13/countries-recognize-emergency-medicine/, date accessed: October 16, 2019

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: 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 of Emergency Medicine. 

Highlights from the interview

How many medical school in Mexico?

180

What percentage medical schools have EM course for medical students?

80%

How many EM residency spot every year?

400

How many EM residency program in Mexico?

75

What do graduates do after the graduation?

80% starts working in the EDs. 20% starts residency.

Video Interview – Rob Rogers – Part 3

Great messages for medical students, interns and new EM residents!

Watch the part 3 here!

You can listen full interview here!

ICEM2020

Dr. Edgardo Menendez and Dr. Gonzalo Camargo present ICEM2020 and invite medical students to the Buenos Aires, Argentina.

ICEM2020 - Invitation - English

ICEM2020 - Invitación - Español

Video Interview – Rob Rogers – Part 2

Great messages for medical students, interns and new EM residents!

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Rob Rogers.

Trained in Emergency Medicine and Internal Medicine, Rob Rogers currently practices Emergency Medicine at the University of Kentucky’s Chandler Hospital in the Department of Emergency Medicine. An innovative medical educator on the cutting edge of creativity, he shares his knowledge on the monthly medical education Medutopia Podcast. Rob co-founded The Teaching Institute and in 2014 created The Teaching Course at The University of Maryland. As a passionate medical education enthusiast, podcast evangelist, learning choreographer, and entrepreneur, Rob works tirelessly to change the world of medical education by reinventing it.

The full interview is 24 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview will be published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

Cite this article as: iEM Education Project Team, "Video Interview – Rob Rogers – Part 2," in International Emergency Medicine Education Project, March 25, 2019, https://iem-student.org/2019/03/25/video-interview-rob-rogers-part-2/, date accessed: October 16, 2019