International Emergency Medicine Fellowship Research Articles

Challenges and barriers to implementing the WHO Trauma Care Checklist in an emergency department in Nepal: the need for Transformational Leadership

Challenges and barriers to implementing the WHO Trauma Care Checklist in an emergency department in Nepal: the need for Transformational Leadership

Prof. Abdelouahab Bellou, MD, MSc,PhD, Director of Quality & Safety, Administration & Leadership, and International Emergency Medicine Fellowship, Harvard Medical School, USA.

Prof. Abdelouahab Bellou, MD, MSc,PhD, Director of Quality & Safety, Administration & Leadership, and International Emergency Medicine Fellowship, Harvard Medical School, USA.

Fellowships in international emergency medicine in the USA: a comparative survey of program directors’ and fellows’ perspectives on the curriculum

ObjectiveExperts have proposed core curriculum components for international emergency medicine (IEM) fellowships. This study examined perceptions of program directors (PDs) and fellows on whether IEM fellowships cover these components, whether...

Experience with the core curricular elements for international emergency medicine fellowships

BackgroundThe number of international emergency medicine (IEM) fellowships available in the US has grown dramatically since the inception of subspecialty training in 1994 Bayram et al. (Acad Emerg Med 17:748–757, 2010). These fellowships vary according to their curricular structure, intensity of fellow exposure and requirements for program completion. The variety of fellowship structures may have negative connotations for graduates from its fellowships and reflect upon the translatability of their skill sets.The recent article “Core Curricular Elements for International Emergency Medicine Fellowships” Alagappan and Holliman (Emerg Med Clin 23(1):1–10, 2005) was designed as a curricular development tool and enumerates seven foci within the broad field of IEM.ObjectivesThe authors of this article describe their experience using this curriculum development tool. Individual experiences in each of the seven categories described in the “Core Curricular Elements” article were identified and undertaken within the typical 2-year training period.DiscussionA curricular structure is described that integrates exposure to all seven areas along with the Master’s of Public Health (MPH) degree, the clinical component and the academic component thematic to existing fellowships. Benefits of this curriculum include increased exposure to multiple areas of IEM, potential for greater standardization and increased translatability of skill set. Disadvantages include superficial exposure to areas of IEM and potentially decreased travel time.ConclusionThe result is a plausible curriculum where fellows would gain exposure to more areas of IEM than they may have otherwise while still earning their MPH, working clinical shifts and carrying out academic fellowship requirements. The authors conclude that this structure allows fellowships to continue drawing on their strengths, provides a more well-rounded fellowship experience and increases structure without requiring standardization.

Improving knowledge and process for international emergency medicine fellowship applicants: a call for a uniform application.

Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary. Objectives. To measure fellows' knowledge of their programs' curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system. Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates. Results. Most fellows (70%) did not know their program's curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81% and 67%, resp.) and deadline (85% for both). A minority of program directors (35%) and fellows (30%) support a formal match. Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process.

(P1-45) Harvard Humanitarian Initiative (HHI) and Federal University of Paraiba (UFP) Joint Emergency Medicine and Disaster Preparedness Training Center A Model for Academic and Clinical Exchange of Expertise

IntroductionEvolving health systems frequently seek guidance with emergency medicine related topics. This has lead to countless international collaboration between organizations attempting to meet this need.BackgroundParaiba, a state of 3.6 million, ranks near the bottom in Brazil for per capita income. The medical establishment has private, public and military systems without emergency medicine training and no disaster plans. HHI and Harvard International Emergency Medicine Fellowship are academic research and service oriented organizations with an emergency medicine and disaster preparedness focus. In 2009 a request for technical assistance was made to HHI from Paraiba, concerning disaster preparedness, clinical emergency medicine and pre-hospital training.MethodsExchange of correspondence surrounding needs and expectations of the partner organizations was conducted until the August 2010. During August a series of meetings was conducted among the civilian, military and federal representatives and a collaborating body was formed under the guidance of UFP consisting of SAMU (prehospital care), the medical school and the five main hospitals of the city. In September HHI staff conducted a series of meetings and assessments in Paraiba. Plan Evaluation, educational and programmatic steps were decided on to be conducted over the several year project. Space and resources for the training center at the UFP was allocated. Establishment of 8–12 teaching modules for practicing physicians and nurses, built and taught by local staff with HHI support will be implemented and become a requirement to work in emergency areas. An assessment of disaster risks and emergency metrics will be conducted concomitantly. Exchange of staff between Brazil and USA will occur throughout the project.ConclusionNo standard model of collaboration exists regarding international emergency medicine and disaster planning but ours demonstrates that exchange of information can evolve to match the abilities and expectations of both parties.

Further recommendations for trauma training of Indian medical officers and medical students

Further recommendations for trauma training of Indian medical officers and medical students

Core Curricular Elements for Fellowship Training in International Emergency Medicine

The objective was to describe the common educational goals, curricular elements, and methods of evaluation used in international emergency medicine (IEM) fellowship training programs currently. IEM fellowship programs have been developed to provide formal training for emergency physicians (EPs) interested in pursuing careers in IEM. Those fellowships are variable in scope, objectives, and duration. Previously published articles have suggested a general curriculum structure for IEM fellowships. A search of MEDLINE, EMBASE, and CINAHL databases from 1950 to June 2008 was performed, combining the terms international, emergency medicine, and fellowship. Online curricula and descriptive materials from IEM fellowships listed by the Society for Academic Emergency Medicine (SAEM) were reviewed. Knowledge and skill areas common to multiple programs were organized in discrete categories. IEM fellowship directors were contacted for input and feedback. Eight articles on IEM fellowships were identified. Two articles described a general structure for fellowship curriculum. Sixteen of 20 IEM fellowship programs had descriptive materials posted online. These information sources, plus input from seven fellowship program directors, yielded the following seven discrete knowledge and skill areas: 1) emergency medicine systems development, 2) humanitarian relief, 3) disaster management, 4) public health, 5) travel and field medicine, 6) program administration, and 7) academic skills. While IEM fellowships vary with regard to objectives and structure, this article presents an overview of the current focus of IEM fellowship training curricula that could serve as a resource for IEM curriculum development at individual institutions.

International Emergency Medicine

International Emergency Medicine

International partnerships to foster growth in emergency medicine in Romania

Emergency medicine (EM) is a growing specialty internationally, but has yet to be cultivated in countries with otherwise advanced health care systems. To promote the growth of EM, emergency physicians from countries where EM is a mature specialty can assist with knowledge transfer and development of emergency medical systems to make a lasting impact on the community served. We present our experience in assisting the development of emergency medicine in a university-affiliated regional hospital in Romania. The International Emergency Medicine Fellowship program at the University of Toronto established links in Cluj-Napoca, Romania, in order to provide expertise and assist local leadership to stimulate growth in EM. In October 2005, a 3-member team travelled to Cluj-Napoca to provide input on how to best use a new physical plant, to deliver continuing education to physicians and nurses, and to help establish long-term development goals. The team identified the following priorities through a comprehensive needs assessment: physical plant organization and patient flow, staffing, staff education, equipment, medication and supplies, and infection control practices. In conjunction with local counterparts, a plan was developed addressing each priority. Staff, hospital administration and university officials report positive growth in EM as a result of the collaboration. Further work is underway to implement the plan, including international exchange trips to promote mutual growth between partners.

The International Journal of Emergency Medicine: a new journal for a new era

The past decade has witnessed the emergence and substantial growth of the specialty of emergency medicine as a truly international medical discipline that refuses to be restrained by barriers of language, culture or geography. While the formal recognition of the specialty of emergency medicine is relatively young in most countries and nonexistent in some, the provision of emergency care is as ancient as the art of medicine itself. Descriptions of emergency care are documented in the Ebers Papyrus of ancient Egypt (2600 BC) [1], in the ancient teachings of traditional Chinese [2] and Ayurvedic [3] medicine and in the earliest writings of western medical care [4]. The growth of emergency medicine globally has been spurred by a number of factors, including population growth, urbanization, globalization and increasing expectations of patients around the world who are aware of what can be done to provide for emergency care [5]. The international growth of emergency medicine has resulted in an expanding presence of emergency medicine and related topics in scientific journals. In addition, the US has recently seen substantial growth in the number of international emergency medicine fellowship programs [6], and the international section and interest groups of emergency medicine societies are typically among the largest and most active in these organizations. A recent review of international emergency medicine from 2006 noted that one of the greatest obstacles to continue the growth of international emergency medicine remains the lack of high-quality, consolidated, and easily accessible evidence-based literature in this field [7]. This review of the literature from 2006 identified 25 international emergency medicine research articles. These articles include broad categories that cover the areas of evaluating EMS and trauma care services in both developed and developing countries, the global spread of emergency medicine and ways to improve emergency care for special populations within a developing country. A large proportion of international emergency medicine studies examines the methods for evaluating morbidity and mortality and improving the delivery of humanitarian aid during disasters and conflicts. The field of international emergency medicine has several major components that have been identified. These include (1) relief and disaster medicine, (2) prehospital care systems and infrastructure, (3) health-care policy at the national, regional and local levels, (4) clinical emergency medicine including the provision of emergency care in settings of limited resources, (5) emergency medicine research and (6) emergency medicine education. All of these domains have enjoyed development and continue to grow robustly.

International Emergency Medicine: A Review of the Literature from 2006

The field of international emergency medicine (IEM) has grown rapidly over the past several decades, with a rise in the number of IEM fellowship positions, sustained growth in the international sections of major emergency medicine organizations, and an increase in the range of topics included under its rubric. One of the greatest obstacles to the continued growth of IEM remains the lack of a high-quality, consolidated, and easily accessible evidence base of literature. In response to this perceived need, members of the Emergency Medicine Residents' Association IEM Committee, in conjunction with members of the Society for Academic Emergency Medicine International Health Interest Group, embarked on the task of creating a recurring review of IEM literature. This article reviews 25 IEM research articles published in 2006. Research articles were selected for the review according to explicit, predetermined criteria that included both methodological quality and perceived impact of the research. It is the authors' hope that this annual review will act as a forum for disseminating best practices while also stimulating further research in the field of IEM.

International Emergency Medicine: A Review of the Literature from 2006

The field of international emergency medicine (IEM) has grown rapidly over the past several decades, with a rise in the number of IEM fellowship positions, sustained growth in the international sections of major emergency medicine organizations, and an increase in the range of topics included under its rubric. One of the greatest obstacles to the continued growth of IEM remains the lack of a high-quality, consolidated, and easily accessible evidence base of literature. In response to this perceived need, members of the Emergency Medicine Residents' Association IEM Committee, in conjunction with members of the Society for Academic Emergency Medicine International Health Interest Group, embarked on the task of creating a recurring review of IEM literature. This article reviews 25 IEM research articles published in 2006. Research articles were selected for the review according to explicit, predetermined criteria that included both methodological quality and perceived impact of the research. It is the authors' hope that this annual review will act as a forum for disseminating best practices while also stimulating further research in the field of IEM.

Current Status of International Emergency Medicine Fellowships in the United States

A consensus panel of Emergency Physicians with experience in international health has published a recommended curriculum for a formal fellowship in International Emergency Medicine. This article reviews the current International Emergency. Medicine (IEM) fellowships available to residency-trained Emergency Physicians in the United States. Every allopathic Emergency Medicine (EM) residency program in the United States was contacted via e-mail or telephone. Programs that reported having an IEM fellowship were asked detailed information about their program, including: (1) the number of years the program has been offered; (2) the duration of the program; (3) the number of fellows taken each year; (4) the number of fellowship graduates from each program and their current practice patterns; (5) how the fellowship is funded; and (6) whether a Masters Degree in Public Health (MPH) is offered. All 127 allopathic EM residency programs responded. Eight (6.8%) of these programs offered IEM fellowships. Of a total of 29 graduates identified, 23 (79.3%) were employed in academic medicine. All of the fellowships offered formal public health training and were funded by a combination of clinical billing and project-specific grants and scholarships. All IEM fellowships described a curriculum that reflected the previously published recommendations. Opportunities in formal training in international health are increasing for graduates of EM residencies in the United States. The proposed curriculum for IEM fellowships seems to have been implemented and graduates of IEM fellowships seem to be applying their training in international projects.

International emergency medicine fellowship: The basics

[Ann Emerg Med. 2003;41:144-47.]

Influence of international emergency medicine opportunities on residency program selection.

In the last several years, there has been increasing interest in international emergency medicine (IEM) programs. A number of residency programs offer or encourage international opportunities during residency. The purpose of this study was twofold: 1) to determine whether the availability of international opportunities during residency affected the ranking of emergency medicine (EM) residency programs by graduating medical students and 2) to determine whether prior international health experience among medical students influences interviewing and ranking of residency programs with international opportunities. An eight-question survey measuring interest in IEM and its effect on ranking of programs was mailed to all 1,205 first-year EM residents from 122 accredited allopathic EM residency programs in the United States. International opportunities were defined as any program that offered an international elective during residency or had an IEM fellowship. Data were analyzed using descriptive statistics and chi-square tests. Of the 1,205 mailed surveys, 34% were returned by the first-year residents. Of all respondents, 281/408 (69%) interviewed at programs with international opportunities. Study findings revealed 62% (164/264) of the students who interviewed at programs with international opportunities considered the availability of international opportunities a positive factor in ranking residency programs. Analysis revealed that applicants with previous international health experience, 68% (104/152), were more likely to rank EM residency programs with international opportunities higher than those that did not. This study suggests that the availability of international opportunities during residency positively affected residency ranking. This relationship was stronger in medical students with prior international health experience.

Influence of International Emergency Medicine Opportunities on Residency Program Selection

Abstract Objectives: In the last several years, there has been increasing interest in international emergency medicine (IEM) programs. A number of residency programs offer or encourage international opportunities during residency. The purpose of this study was twofold: 1) to determine whether the availability of international opportunities during residency affected the ranking of emergency medicine (EM) residency programs by graduating medical students and 2) to determine whether prior international health experience among medical students influences interviewing and ranking of residency programs with international opportunities. Methods: An eight‐question survey measuring interest in IEM and its effect on ranking of programs was mailed to all 1,205 first‐year EM residents from 122 accredited allopathic EM residency programs in the United States. International opportunities were defined as any program that offered an international elective during residency or had an IEM fellowship. Data were analyzed using descriptive statistics and chi‐square tests. Results: Of the 1,205 mailed surveys, 34% were returned by the first‐year residents. Of all respondents, 281/408 (69%) interviewed at programs with international opportunities. Study findings revealed 62% (164/264) of the students who interviewed at programs with international opportunities considered the availability of international opportunities a positive factor in ranking residency programs. Analysis revealed that applicants with previous international health experience, 68% (104/152), were more likely to rank EM residency programs with international opportunities higher than those that did not. Conclusions: This study suggests that the availability of international opportunities during residency positively affected residency ranking. This relationship was stronger in medical students with prior international health experience.

Proposed curriculum for an "observational" international emergency medicine fellowship program.

This article presents information on considerations involved in setting up and conducting fellowship training programs in emergency medicine (EM) for physicians from other countries. General goals for these programs are to assist in providing physicians from other countries with the knowledge and skills needed to further develop EM in their home countries. The authors report their opinions, based on their cumulative extensive experiences, on the necessary and optional structural elements to consider for international EM fellowship programs. Because of U.S. medical licensing restrictions, much of the proposed programs' content would be "observational" rather than involving direct "hands-on" clinical EM training. Due to the very recent initiation of these programs in the United States, there has not yet been reported any scientific evaluation of their structure or efficacy. International EM fellowship programs involving mainly observational EM experience can serve as one method to assist in EM development in other countries. Future studies should assess the impact and efficacy of these programs.