Developments in international emergency medicine

See also pp. 367–72 The development of an international curriculum is a major achievement in International Emergency Medicine.1 Until recently, it was not thought possible that emergency medical systems around the world would reach a stage in development, where the same topics in an undergraduate curriculum could be taught in Europe, The Americas, Asia, Africa and Australasia. Politics, economics and other path-dependent accidents of history had entrenched different forms of emergency care between Anglo-American emergency systems, Franco – German and other systems such as the Japanese.2 There were also concerns that differences in resources between developed and developing countries would make a generic approach difficult. Despite this, the rapid development of emergency medicine globally, changes in health-care delivery and funding, and the opportunity to exchange information quickly around the globe have allowed a quiet revolution to occur. There is now a growing consensus regarding a preferred approach to emergency care delivery and an increasing commonality between emergency care systems. Interest in international emergency medicine has become a major focus for many emergency physicians in Australia and New Zealand, the USA and in Europe. There are over 200 members of the International Emergency Medicine Special Interest Group (IEMSIG) just within the Australasian College for Emergency Medicine (ACEM). Likewise within the American College of Emergency Physicians (ACEP), where the international section is now the largest paid section, with over 1300 members. Along with this national interest among emergency medicine physicians, there has been a rapid growth in groups representing international emergency medicine. There are now regional groups including the Asian, European and Pan American societies, all representing many national societies. The umbrella group for all these societies is the International Federation for Emergency Medicine (IFEM), which was formed 20 years ago with a charter of association signed in 1991.3 It is the only international group that represents emergency medicine interest groups across all the continents and is inclusive of all societies representing emergency medicine at an international level. It is a Federation of national societies and does not generally represent individuals, although individuals might pay for individual membership if they wish. Initially the main aim of this Federation was to assist the founding national societies, ACEP, Canadian Association of Emergency Physicians (CAEP), the then UK Casualty Surgeons Association (CSA) and ACEM to conduct conferences every 2 years. This had the benefit of allowing the founding nations to share experiences, network, develop collaborations and assist trainees and specialists to rotate between countries and learn new approaches to old problems. Over the last 5–10 years however, there has been a gradual change in the IFEM, resulting in a rapid increase in membership and a more international focus. There are now 38 member societies, a permanent secretariat based in Melbourne (supported by ACEM) and an executive that meets regularly. A strategic workshop in Chicago in 2008 identified a number of key areas for the IFEM to focus on over the next few years. The principal goal was to develop financial sustainability within the next decade, so that essential activities could be undertaken. Many suggestions for funding were put forward however in the short to medium term, subscriptions, conferences and symposia appeared to be the most sustainable source of income. Other ideas such as charging fees for International Board examinations, accreditation and the franchising of educational materials were considered and might well develop in the future. There was little enthusiasm for private industry sponsorship, given the possible influence that industry could have on a peak body such as IFEM. Experience with other international organizations, such as the American Heart Association (AHA), where accusations have been made that policy documents have been influenced by industry, suggests that the short-term pain of developing funding models independent of industry will help the long-term credibility and utility of the organization.4 In parallel with financial sustainability, it was felt that as the peak emergency organization in the world, IFEM should move forward quickly in promoting emergency medicine internationally, ensuring a common terminology in emergency medicine, promulgating guidelines and protocols, developing common training programmes and curricula and assisting with the dissemination of educational material. To this end, the curriculum committee has been working for a number of years now bringing together experience from all continents. This committee is composed of international experts in the provision of emergency care, as well as expert educators whose primary professional responsibility is to the design and implementation of curricula. The committee was given a three-tiered charge: first, the development of a consensus document on undergraduate EM curricula, for educators worldwide. The second phase will be the development of an international curriculum for postgraduate training, which should be available for IFEM Board review in October 2009. The third and final phase will focus on continuing medical education (CME) requirements for practicing physicians. Through these documents, the IFEM will have developed an international consensus and defined a framework for emergency medicine education across the educational continuum. The committee undertook their work in the development of the first of these documents, the undergraduate EM curriculum, by completing the following three tasks. First, members reviewed current curricula and emergency medicine training standards in their member nations. Second, the committee analysed current emergency medicine needs as identified by input from the IFEM member nations and their own international work. Finally, through an iterative process the committee proposed a potential model for an EM-based undergraduate curriculum. The resulting product of this committee the undergraduate EM curriculum has been approved by the IFEM Board after extensive review by the IFEM Executive and all member nations. This curriculum, published in this issue of Emergency Medicine Australasia, is the first international consensus document of its kind.1 The undergraduate EM curriculum outlines a rationale for the course of study and identifies components that support best educational practices irrespective of the practice setting. It also provides a framework for assessment that can be derived from the learning objectives for each of the content areas. This learning objective/focused assessment model allows individual educators to define assessment techniques that match local resources and faculty expertise. The content areas are necessarily basic, and it is anticipated that faculty in all medical schools adopting this framework will modify it to fit local endemic diseases and injury patterns. It is also demonstrated how the curriculum can be expanded and provide a tiered process for faculty to implement and utilize this general model. By maintaining an open structure the model curriculum provides a simple common language, nomenclature and framework through which emergency medicine educators around the world can work together to unify our educational paradigm. This formative first step meets the goals of the IFEM and emergency medicine specialists around the globe. Australian and New Zealand emergency physicians have played a key role in the development of emergency medicine internationally. This has occurred at an individual level and at a College level. The College has supported IFEM as it is the peak emergency medicine body internationally and has the potential to improve emergency medical care globally. The promulgation of a common undergraduate curriculum at an international level is a major step forward. The potential for agreement on an international postgraduate curriculum on emergency medicine next is most exciting. This could potentially allow for an international board examination, with common and shared educational material, continuing medical education programmes and accreditation of training and service facilities. The ability to share knowledge and skills, reduce duplication and target deficits in emergency service provision could lead to major improvement in emergency medical care internationally. We encourage emergency physicians in Australia and New Zealand to engage with these developments as they are likely to have a major impact on the system of emergency care delivery globally.