Postgraduate Emergency Medicine Training Research Articles

The Education and Implementation of Clinical Reasoning Education in Post-Graduate Emergency Medicine Training: An Integrative Review

The ability to clinically reason is a necessity for doctors to reduce the possibility of diagnostic error in patients. Emergency medicine doctors work in a highly active, challenging and, at times, cognitively formidable setting that can affect clinical reasoning. This review aims to study the literature on post-graduate training programs and how clinical reasoning education is incorporated. Methods: CINAHL, Embase and Medline were used to obtain relevant literature from 2010 to 2023. A review was undertaken of clinical reasoning curriculums and resources in medical and surgical specialties in Australia, New Zealand, USA, UK, Ireland and Canada. Results: 23 articles were included in the review. Educational themes to teach clinical reasoning were a) simulation b) technological and innovative methods, c) morning report, d) peer teaching, and e) curriculum related. Surgery, General practice, and Internal Medicine colleges appear to have embedded clinical reasoning courses and resources within their curriculum and training. Conclusion: Specialty colleges are recognising the importance of clinical reasoning and have incorporated formal curricula into their training. Teaching can occur at a college, hospital and departmental level using a variety of educational modalities that vary in the resources required and is a possible option for Emergency Medicine training.

Current postgraduate training in emergency medicine in the Nordic countries

BackgroundEmergency Medicine (EM) is an independent specialty in all five Nordic countries. This study aims to evaluate the structure of post-graduate EM training in the area.MethodsA leading hospital or hospitals in EM training in each country were identified. An e-survey was sent to each hospital to gather data on patient volume and physician staffing, curriculum, trainee supervision, and monitoring of progression in training.ResultsData were collected from one center in Iceland and Norway, two in Finland and Sweden, and four centers in Denmark. The data from each country in Denmark, Finland, and Sweden, were pooled to represent that country. The percentage of consultants with EM specialist recognition ranged from 49–100% of all consultants working in the participating departments. The number of patients seen annually per each full time EM consultant was almost three times higher in Finland than in Sweden. In Iceland, Denmark, and Sweden a consultant was present 24/7 in the ED but not in all centers in the other countries. The level of trainee autonomy in clinical practice varied between countries. Requirements for completing standardized courses, completing final exams, scientific and quality improvement projects, and evaluation of trainee progression, varied between the countries.ConclusionsAll Nordic countries have established EM training programs. Despite cultural similarities, there are significant differences in how the EM training is structured between the countries. Writing and implementing a standardized training curriculum and assessment system for EM training in the Nordic countries should be considered.

Exploring a case for education about sexual and gender minorities in postgraduate emergency medicine training: forming recommendations for change

ABSTRACT Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.

Factors influencing HINTS exam usage by Canadian Emergency Medicine Physicians.

The HINTS examination (head impulse, nystagmus, test of skew) is a bedside physical examination technique that can distinguish between vertigo due to stroke, and more benign peripheral vestibulopathies. Uptake of this examination is low among Emergency Medicine (EM) physicians; therefore, we surveyed Canadian EM physicians to determine when the HINTS exam is employed, and what factors account for its low uptake. We designed and tested a 26-question online survey, and disseminated it via email to EM physicians registered with the Canadian Association of Emergency Physicians (CAEP), with 3 and 5-week reminder emails to increase completion. This anonymous survey had no incentives for participation, and was completed by 185 EM physicians, with post-graduate medical training in either Emergency Medicine or Family Medicine. The primary outcomes were the frequencies of various responses to survey questions, with secondary outcomes being the associations between participant characteristics and given responses. 88 respondents (47.8%) consistently use the HINTS examination in the work-up of vertigo, and 117 (63.7%) employ it in scenarios where its clinical utility is limited. The latter is more common among physicians working in non-academic settings, without 5-year EM residency training, and with greater years of practice (p < 0.01). The most frequent explanations for non-use were a lack of need for the HINTS examination, the lack of validation of the exam among EM physicians, and concerns surrounding the head-impulse test. Though HINTS exam usage is common, there is a need for education on when to apply it, and how to do so, particularly as concerns the head-impulse test. Our attached rubric may assist with this, but quality-improvement initiatives are warranted. Low uptake is partly due to the lack of validation of this examination among EM physicians, so effort should be made to conduct well-designed HINTS trials exclusively involving EM physicians.

Pitfalls in Emergency Medicine: Survey-Based Identification of Learning Objectives for Targeted Simulation Curricula by Emergency Department Staff.

Introduction: The emergency department is a complex practice environment into which numerous factors may introduce both human and system error. Emergency physicians have to assemble and manage multidisciplinary teams with a moment’s notice to manage critically ill patients. The EM training programs across Canada are diverse with considerable variation among programs. Acquisition of both high acuity low occurrence (HALO) and crisis resource management (CRM) skills are crucial to the development of proficient emergency room physicians. Physicians and allied health workers were surveyed to identify potential causes of error in local emergency departments and to find simulation-driven solutions. Methods: An anonymous survey was prepared to evaluate potential pitfalls of emergency care in St. John’s, NL, Canada. It was distributed electronically to 108 medical staff, including physicians, nurses, and postgraduate year three (PGY3) residents. Respondents were asked about their experience with simulation education, and whether or not they feel that there is an opportunity for it in postgraduate emergency medicine training. Results: The response rate was 30%. Communication - with the emergency department team, consulting services, and patients - was identified as a potential topic for simulation, along with interruptions. Burnout, busy department, departmental crowding, end of shift handover, and incomplete/missing patient medical history were identified as topics that should be included in the emergency medicine curriculum. Following a review with the simulation expert panel, it was determined that end of shift handover could also be incorporated as a simulation in the existing curriculum.Discussion: This survey looked at pitfalls in emergency medicine through a CRM lens. Six pitfalls were identified as important for patient safety, but not best addressed with simulation. These could be incorporated into the half-day curriculum as didactic lectures. Four important patient safety pitfalls were identified that could potentially be addressed with simulation and incorporated in the existing emergency medicine simulation curriculum.

Learner-centered Survey of Point-of-care Ultrasound Training, Competence, and Implementation Barriers in Emergency Medicine Training Programs in India.

Point-of-care ultrasound (POCUS) is important to the practice of emergency medicine (EM), but requires training to achieve competence. The purpose of this study was to describe the current state of POCUS practice and perceived barriers to the implementation in EM training programs in India. A cross-sectional survey consisting of 28 questions was administered to 378 faculty and residents in postgraduate EM training programs across India. Data were collected from 159 physicians from 16 institutions; 76% of them were EM residents, with a response rate of 42%. Respondents overwhelmingly reported high interest (91%) in learning POCUS topics. Respondents identified highest levels of comfort with the performance and interpretation of trauma ultrasound (US) and echocardiography. Conversely, there was a scarce interest and low levels of competence in performing obstetric US, which may be a result of the practice of triaging these complaints to obstetricians and gynecologists. Lack of US equipment and dedicated training were the highest rated barriers by a significant margin, which 56% of respondents ranked as "very important." While significant interest in POCUS exists among the Indian EM physicians, comfort and competence were limited to trauma and echocardiography applications. Expansion of and comfort with POCUS use in these settings may be sought through improvement of access to US equipment and a dedicated US curriculum.

Three- vs. Four-Year Emergency Medicine Training Programs.

Postgraduate training in emergency medicine (EM) varies in length among different programs. This fact creates a dilemma for applicants to the specialty of EM and prevents EM educators from reaching a consensus regarding the optimal length of training. Historically, EM training existed in the postgraduate year (PGY) 1-3, 2-4, and 1-4 formats, until the PGY 2-4 program became obsolete in 2011-2012. Currently, three-quarters of EM programs follow the PGY 1-3 format. In this article, we clarify for the applicants the main differences between the PGY 1-3 and PGY 1-4 formats. We also discuss the institutional, personal, and graduate considerations that explain why an institution or an individual would choose one format over the other.

Conducted forms of postgraduate training in emergency medicine of the staff of EMCC in Bulgaria. A retrospective 20 year study

Conducted forms of postgraduate training in emergency medicine of the staff of EMCC in Bulgaria. A retrospective 20 year study

Simulation curricular content in postgraduate emergency medicine: A multicentre Delphi study

There is increasing evidence to support integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum exists. Using Delphi methodology, we aimed to identify and establish content validity for adult EM curricular content best suited for simulation-based training, to inform national postgraduate EM training. A national panel of experts in EM simulation iteratively rated potential curricular topics, on a 4-point scale, to determine those best suited for simulation-based training. After each round, responses were analyzed. Topics scoring <2/4 were removed and remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics rated ≥ 3.5/4 were considered "core" curricular topics, while those rated 3.0-3.5 were considered "extended" curricular topics. Forty-five experts from 13 Canadian centres participated. Two hundred eighty potential curricular topics, in 29 domains, were generated from a systematic literature review, relevant educational documents and Delphi panellists. Three rounds of surveys were completed before consensus was achieved, with response rates ranging from 93-100%. Twenty-eight topics, in eight domains, reached consensus as "core" curricular topics. Thirty-five additional topics, in 14 domains, reached consensus as "extended" curricular topics. Delphi methodology allowed for achievement of expert consensus and content validation of EM curricular content best suited for simulation-based training. These results provide a foundation for improved integration of simulation into postgraduate EM training and can be used to inform a national simulation curriculum to supplement clinical training and optimize learning.

LO43: Simulation curricular content in postgraduate emergency medicine: a multicenter delphi study

Introduction: There is increasing evidence to support the integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum currently exists. Using Delphi methodology, we aimed to identify and establish content validity evidence for EM curricular content best suited for simulation-based training to inform national postgraduate EM training. Methods: A national panel of experts in EM simulation-related education iteratively rated potential curricular topics, on a 4-point scale, to determine those best suited for simulation-based training. After each round, responses were analyzed and topics scoring &amp;lt;2/4 were removed. Remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics that were rated ≥3.5/4 were considered core curricular topics, while those rated 3.0-3.5 were considered extended curricular topics. Results: Forty-four experts from 13 Canadian centres participated. Two hundred and eighty potential curricular topics, in 29 domains, were generated from a systematic review of the literature, analysis of relevant educational documents and a survey of Delphi panelists. Three rounds of Delphi surveys were completed before consensus was achieved, with response rates ranging from 93-100%. Twenty-eight topics, in 8 domains, reached consensus as core curricular topics. An additional 35 topics, in 14 domains, reached consensus as extended curricular topics. Conclusion: Delphi methodology allowed for achievement of expert consensus and content validation of EM curricular content best suited for simulation-based training. These results provide a foundation for improved integration of simulation into postgraduate EM training and can be used to inform a national simulation curriculum to supplement clinical training and optimize learning.

Palliative and end-of-life care education in Canadian emergency medicine residency programs: A national cross-sectional survey.

Emergency physicians play an important role in providing care at the end-of-life as well as identifying patients who may benefit from a palliative approach. Several studies have shown that emergency medicine (EM) residents desire further training in palliative care. We performed a national cross-sectional survey of EM program directors. Our primary objective was to describe the number of Canadian postgraduate EM training programs with palliative and end-of-life care curricula. A 15-question survey in English and French was sent by email to all program directors of both the Canadian College of Family Physicians emergency medicine (CCFP(EM)) and the Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) postgraduate training programs countrywide using FluidSurveys™ with a modified Dillman approach. We received a total of 26 responses from the 36 (response rate = 72.2%) EM postgraduate programs in Canada. Ten out of 26 (38.5%) programs had a structured educational program pertaining to palliative and end-of-life care. Lectures or seminars were the exclusive choice to teach content. Clinical palliative medicine rotations were mandatory in one out of 26 (3.8%) programs. The top two barriers to implementation of palliative and end-of-life care curricula were lack of time (84.6%) and curriculum development concerns (80.8%). Palliative and end-of-life care training within EM has been identified as an area of need. This cross-sectional survey demonstrates that a minority of Canadian EM programs have palliative and end-of-life care curricula. It will be important for all EM training programs, RCPSC-EM and CCFP(EM), in Canada, to develop an agreed upon set of competencies and to structure their curricula around them.

MP17: Evaluating the efficacy of the flipped classroom model in postgraduate emergency medicine training

Introduction: As the value of interactive teaching becomes increasingly recognized, the Flipped Classroom model is receiving more attention in the medical education community. In this model, learners master core declarative knowledge through self-learning prior to class and then expand upon this learning with integrative class exercises. The objective of this study was to assess the effectiveness of the new Flipped Classroom in a Canadian Emergency Medicine postgraduate program. Methods: The residents and staff were educated on the new model. An online questionnaire was sent to all EM residents and staff who had participated in the program 9 months after implementation. The survey tool assessed the participants opinions on utility, time-management, effectiveness in learning material, sustainability, collaboration with other members and overall impressions. Resident scores on national preparatory examinations including the Canadian In-Training Examination (CITE) and the American Board of Emergency medicine (ABEM) were compared before and after implementation of the new model. Results: Teaching staff were trained in the Flipped Classroom model and the majority of teaching sessions for the 2016 academic year were carried out using this paradigm. In addition, third year postgraduates received intensive training in the theory and implementation of interactive teaching techniques. A curriculum renewal committee generated objectives for each teaching session and suggested materials for learner pre-reading. Conclusion: Overall, both residents and staff physicians indicated that the flipped classroom model is a better format for EM academic day learning. Residents and staff collaborated more and felt more engaged during academic day. Residents spent more time preparing for the sessions with the new model, while staff spent less time preparing. Paired comparisons of same residency years for test exam scores using Wilcoxon signed-rank test showed an improvement in both CITE and ABEM exam test scores. In conclusion, the new flipped classroom model produced improvements in educational experience, satisfaction, and test examination scores.

“Do you reckon I should sit?” Is it possible to predict success in the ACEM fellowship examination?

Introduction: The ACEM (Australasian College for Emergency Medicine) fellowship examination is a high-stakes assessment occurring at the end of postgraduate training in emergency medicine. The objectives of this study were to identify factors that allow prediction of success or failure in the ACEM fellowship examination, information that may be useful to those involved in examination preparation. Methods: From 2009–2012, six consecutive cohorts of Victorian ACEM trainees sat a practice written examination and completed surveys regarding examination preparation. Subsequent ACEM fellowship examination outcome was obtained by contacting trainees and using ACEM annual reports. Univariate analysis was undertaken to determine which factors would most reliably predict examination success. Each sitting of the practice examination was viewed separately. Results: From the 150 examination candidates, we received responses on 111 occasions from a total of 80 trainees (several candidates sat the exam more than once). Pass/fail data was available for 72 datasets. The strongest positive predictors for examination success included the number of examination sections passed in the practice examination (OR 3.34, 95% CI 1.61–6.90), reading outside of the major international emergency medicine textbooks (OR 2.53, 95% CI 1.21–5.28) and a belief that attending a course was helpful for examination preparation (OR 1.70, 95% CI 1.06–2.73). Years since graduating from medical school (OR 0.79, 95% CI 0.69–0.91) was negatively associated with examination success. Conclusions: In this cohort of Victorian trainees, performance in a practice examination had one of the strongest associations with performance in the real ACEM fellowship examination. Practice examinations are a useful method to provide benchmarking and advice to candidates prior to the formal examination.

Simulation in Canadian postgraduate emergency medicine training - a national survey.

Simulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada. A national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE. Resident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0-150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs. SBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.

P015: Leadership and administration: a novel elective rotation for emergency medicine residency training

Introduction/Innovation Concept: In 2015, the Royal College of Physicians and Surgeons of Canada set out to redefine the CanMEDS roles including replacement of the “manager” role to that of the “leader”. This was to highlight the fact that skills in leadership are crucially important as ongoing health care improvement occurs. This educational innovation was born out of a need for formal education in leadership and administration in post graduate emergency medicine training. Methods: Few post graduate emergency medicine training programs in Canada have leadership and administrative curricula involving either longitudinal or discrete 4 week rotations. We sought to create an evidence based leadership and administrative experience based on the CanMEDS roles. We adapted components of pre-existing rotations from other universities and selected competencies from Thoma et al in order to compile a list of objectives. This was coupled with a reading list, various departmental, hospital, and regional meetings, a physician leadership training seminar, a departmental presentation, and a leadership project. Curriculum, Tool, or Material: The curriculum involved 4 weeks combining 8 emergency department (ED) clinical shifts with a leadership and administration component. The latter involved clinical interdepartmental meetings, a hospital medical advisory council (MAC) meeting, a provincial medical directors meeting, a health authority MAC meeting, and taking part in planning for an ED quality improvement initiative focused on triage. Attendance at a 2-day physician administrator leadership training seminar was also included. The reading list included books on leadership and references to ED quality improvement. In addition, exposure to a B.C. Ministry of Health document entitled, “Setting Priorities for the Health Care System,” the KGH Medical Staff Rules, and the B.C. Health Quality Matrix occurred. A summary presentation to the full ED on change management and leadership in residency occurred at completion. Conclusion: This innovative leadership and administration elective was the culmination of a need to see more formal post graduate leadership training in residency. The rotation was based on the CanMEDS framework, particularly the “leader” competency, and was based on recent evidence regarding leadership and administration competencies in emergency medicine. We hope this serves as a potential model for other rotation based electives or core rotations that desire to blend leadership competencies with clinical emergency medicine.

Examining critical factors affecting graduate retention from an emergency medicine training program in Addis Ababa, Ethiopia: a qualitative study of stakeholder perspectives

In Ethiopia, improvement and innovation of the emergency care system is hindered by lack of specialist doctors trained in emergency medicine, underdeveloped emergency care infrastructure, and resource limitations. Our aim was to examine the critical factors affecting retention of graduates from the Addis Ababa University (AAU) post-graduate emergency medicine (EM) training program within the Ethiopian health care system. One post-graduate trainee and one program manager from the AAU and the University of Toronto (UT) partnership conducted qualitative interviews with current AAU EM residents and stakeholders in Ethiopian EM. Qualitative inductive thematic analysis was performed. Resident and stakeholder participants identified critical factors in three domains: the individual condition, the occupational environment, and the national context. Within each domain, priority themes emerged from the responses, including the importance of career satisfaction over the career continuum (individual condition), the opportunity to be involved in the developing EM program and challenges associated with resource, economic, and employment constraints (occupational environment), and perceptions regarding the state of awareness of EM and the capacity for change at the societal level (national context). This work underscores the need to continue to address multiple systemic and cultural issues within the Ethiopian health care landscape in order to address EM graduate retention. It also highlights the potential success of a retention strategy focused on the career ambitions of keen EM doctors.

LO064: Simulation in Canadian postgraduate emergency medicine training — a national survey

Introduction: Simulation-based medical education (SBME) is an important training strategy in emergency medicine (EM) postgraduate programs yet the extent of its use is variable. This study sought to characterize the use of simulation in FRCP-EM residency programs across Canada. Methods: A national survey was administered to residents (PGY2-5) and program representatives (PR), either a program director or simulation lead at all Canadian FRPC-EM programs. Residents completed either paper or electronic versions of the survey, and PR surveys were conducted by telephone. Results: The resident and PR response rates were 60% (187/310) and 100% (16/16), respectively. All residency programs offer both manikin-based high fidelity and task trainer simulation modalities. Residents reported a median of 20 (range 0-150) hours participating in simulation training annually, spending a mean of 16% of time in situ, 55% in hospital-based simulation laboratories, and 29% in off-site locations. Only 52% of residents indicated that the time dedicated to simulation training met their training needs. All PRs reported having a formal simulation curriculum with a frequency of simulation sessions ranging from weekly to every 6 months. Only 3/16 (19%) of programs linked their simulation curriculum to their core teaching. Only 2/16 programs (13%) used simulation for resident assessment, though 15/16 (93%) PRs indicated they would be comfortable with simulation-based assessment. The most common PR identified barriers to administering simulation by were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Both PRs and residents identified a desire for more simulation training in neonatal resuscitation, pediatric resuscitation, and obstetrical emergencies. Multidisciplinary involvement in simulations was strongly valued by both residents and PRs, with 76% of residents indicating that they would like greater multidisciplinary involvement. Conclusion: Among Canadian FRCP-EM residency programs, SBME is a frequently used training modality, however, there exists considerable variability in the structure, frequency and timing of simulation exposure for residents. Several common barriers were identified that impact SBME implementation. The transition to competency-based medical education will require a national, standardized approach to SBME that includes a unified strategy for training and assessment.

Survey of student perception of medical education environment among emergency medicine residents of an academic medical centre in Northern India.

BackgroundThe specialty of emergency medicine is in its infancy state in the long history of the Indian health sciences education system. Little analytical published data is available at the moment in India regarding the quality of medical education as perceived by the students.Roff et al. (Med Teach 19: 295–299, 1997) developed a methodology using a Delphi panel to standardize the measurement of medical education known as the Dundee Ready Education Environment Measure (DREEM), which is widely utilized.The purpose of this survey is to investigate student perceptions of medical education environment among emergency medicine residents of an academic medical centre in Northern India using the DREEM tool.MethodsThe DREEM questionnaire was administered to the students undergoing 3-year post-graduate emergency medicine training in our residency programme. A total of 35 students enrolled from all 3 years of the residency programme completed the survey in May 2013. The results were analysed using STATA 9.0.ResultsThe reliability coefficient which was calculated using Cronbach’s alpha for the totality of items of this study was 0.92, which indicates high internal consistency.The mean (95 % CI) for the overall DREEM was 139.8 (133.3, 146.2), which showed excellent educational environment among the medical students.ConclusionsThe DREEM score is a universal tool for assessment of education provided by health science institutes. With a total score of 139.8, the study conducted at our institute showed comparable results to the original DREEM study conducted by Roff et al. The good scores in all the five subscales reveal an excellent educational programme and learning environment as perceived by the students enrolled at our institution.

Postgraduate Emergency Medicine Training in India: An Educational Partnership with the Private Sector

BackgroundEmergency medicine (EM) is a recently recognized specialty in India, still in its infancy. Local training programs are developing, but remain very limited. Private, for-profit hospitals are an important provider of graduate medical education (GME) in India, and are partnering with United States (US) universities in EM to expand training opportunities. ObjectiveOur aim was to describe current private-sector programs affiliated with a US university providing postgraduate EM training in India, the evolution and structure of these programs, and successes and challenges of program implementation. DiscussionPrograms have been established in seven cities in India in partnership with a US academic institution. Full-time trainees have required didactics, clinical rotations, research, and annual examinations. Faculty members affiliated with the US institution visit each program monthly. Regular evaluations have informed program modifications, and a local faculty development program has been implemented. Currently, 240 trainees are enrolled in the EM postgraduate program, and 141 physicians have graduated. A pilot survey conducted in 2012 revealed that 93% of graduates are currently practicing EM, 82% of those in India; 71% are involved in teaching, and 32% in research. Further investigation into programmatic impacts is necessary. Challenges include issues of formal program recognition both in India and abroad. ConclusionsThis unique partnership is playing a major early role in EM GME in India. Future steps include official program recognition, expanded numbers of training sites, and a gradual transition of training and education to local faculty. Similar partnership programs may be effective in other settings outside of India.

Designing Assessment Programmes for the Model Curriculum for Emergency Medicine Specialists.

There has been a proliferation of competency-based postgraduate training programmes in emergency medicine (EM) worldwide, including Australia, Canada, Singapore, the United Kingdom, and the United States. Several competency frameworks have been developed at national and international levels as a basis for competency-based postgraduate training programmes. These frameworks include the Accreditation Council of Graduate Medical Education (ACGME) competencies in the United States, the Canadian Medical Educational Directives for Specialists (CanMEDS), and Common Competences for Emergency Medicine in the United Kingdom. In response to this increased emphasis on competency-based education during postgraduate training in EM, the International Federation for Emergency Medicine (IFEM) has recently developed a model curriculum to define the basic minimum standards for specialist training in EM. The goal for specialist training in EM is to ensure that its trainees develop the necessary knowledge, skills, and professional attitudes to provide safe, expert, and independent emergency care within their own country. Accurate assessment of trainees’ progress during specialist training is of paramount importance to the educational process. In recent years there have been changes to the assessment process. Traditionally, assessment has been considered exclusively as a process of measuring whether trainees have acquired the necessary knowledge, skills, and professional attitudes to practice independently as a specialist in EM, or assessment of learning. However, it is now recognized that an equally important function of assessment is to stimulate the individual’s learning process—in other words, assessment for learning. This new paradigm of the role of assessment should be firmly embedded in the educational process. As a result of this conceptual change in assessment, there has been a shift from considering individual methods to programmes of assessment, to allow adequate sampling of performance of complex competencies in authentic contexts.