Andrew Singer

International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine

There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this need, physicians must be trained to deliver time-sensitive interventions and life-saving emergency care. Currently, there is no internationally recognized, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this lack, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for foundation training of medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is not designed to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership.

Re: Low-Fidelity Simulation in Global and Distributed Settings.

To Dr. Renouf: Thank you for your thoughtful response to our manuscript, “International Federation for Emergency Medicine Model Curriculum for Continuing Professional Development.” You make several excellent points and we appreciate your insights. We are also thankful for the opportunity to respond to your statements, clarify the intent of our manuscript, and further this important discussion. First, no manuscript of this type can cover every eventuality as to types of simulation experiences, and no matter what type of simulation is selected, sound educational principles must underpin the educational program in which it is used. We do believe that our premise that high-fidelity simulation is the most robust type of simulation for this cohort of advanced learners is valid; however, your comments suggest that we could have achieved greater clarity as to our intent in the use of the word “fidelity.” Our reference to high-fidelity simulation was intended to refer to the “fidelity” of the simulation type rather than the “fidelity” of equipment. For example, the fidelity of the simulation can be high even when lowfidelity manikins are used in in-situ simulation. Maran and Glavin agree with this premise and when discussing the engineering fidelity of the equipment state, “Of much greater importance is the concept of psychological or functional fidelity. This is the degree to which the skill or skills in the real task are captured in the simulated task. The level of fidelity required depends on the type of task and stage of training and influences skills transfer.” Although the use of all forms (lowand high-fidelity) of simulation is consistent with best practices in CPD, such as mastery learning and deliberate practice, it should be aligned with the curricular learning outcomes/ competencies for it to be effective. Low-fidelity simulation is more useful for the acquisition of new skills or more basic mechanical skills. Given that a component of CPD is around reinforcement and refinement of existing skills, high-fidelity simulation better fits these needs. While lowerfidelity simulations can apply to these situations, they may be less relevant, though we agree with the author that they are still better than nothing and certainly better than a less interactive form of education. We also agree that the often better portability of low-fidelity simulators and simulations means that they are useful and available in any setting, not just lowresource ones, and should be deployed when possible. As with all educational programs, there needs to be a balance between cost, availability, the desired outcome, and the ability of the simulation to achieve it. Again, we thank the authors of this letter for their contribution and for their engagement with global emergency medicine education. Cherri Hobgood, MD* Terrance Mulligan, MD† Guatam Bodiwala, MD‡ Peter Cameron, MD§ James Holliman, MD¶ James Kwan, MDǁ Andrew Singer, MD**†† Nicholas Jouriles, MD‡‡

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.

Emergency Medicine in the fourth decade: Angry young man or mid‐life crisis?

To the President, Dr Anthony Cross, Members of Council, Fellows (both old and new), Ladies and Gentlemen: thank you for the invitation to speak on this occasion. It is one that I have been looking forward to. I want to add my own welcome to those new Fellows, Diplomats, Certificants and prize winners here today. Firstly, and ahead of the formal Welcome to Country tomorrow, I wish to acknowledge that we are meeting on the land of the Kaurna people, and pay my respects to their Elders, both past and present. I also want to pay my respects to those Elders of our College that are present today, particularly Tom Hamilton, the first President of ACEM whom this speech honours, and who I think has probably been to every Oration ever made! I am very pleased that he is here today. This is the 30th Annual Scientific Meeting of the College, which marks the 30th anniversary of the decision to found the College. I think it is important that we note this because it is a big deal. While we are nowhere near the oldest college in Australia and New Zealand, there are several that are younger than us, including our critical care colleagues in Anaesthetics and Intensive Care. I think it is fair to say that the courageous decision made by our Founding Fellows 30 years ago to form a college has stood us in very good stead, and provided both an example to and inspiration for our critical care colleagues in taking the same path. There have been a number of achievements over the last 30 years, including the following: • The first Fellows by examination in 1986 (including the current Chief Medical Officer, Professor Chris Baggoley, Trish Saccasan-Whelan and others) • The introduction of the National Triage Scale in 1991, with a big note of thanks to Ed Brentnall and Gerry FitzGerald for the work that led to it, and noting the enormous influence it has had on triage not only in Australia and New Zealand, but the UK, Canada and numerous other countries as well • Our role as one of the four founding societies for the International Federation for Emergency Medicine in 1991 • Our formal recognition as a medical specialty in 1993 • Our accreditation by the Australian Medical Council in 2007, which has just been renewed for another 2 years • Celebrating our Silver Jubilee in Wellington in 2008 Today is my last day of 20 years, serving on either Board of Censors (as it was then) or Council, including 10 of those years on both simultaneously. I know you are thinking that it is about time I left! In any case, this experience and my other experiences as outlined by Anthony in his introduction have given me some special insight (I think) into how the College has travelled, and what are the challenges for the future for both ACEM and for Emergency Medicine in general. There is a lot I want to say about this, including some things maybe I shouldn’t. So, as the College enters its fourth decade, what are the challenges that we face? I believe that the College and emergency medicine in general is at an important transition point, though I am not sure how much we understand this, and I will speak more about it later. There are three particular challenges we need to meet, and I will talk about each of them in turn. They are: • Who are we treating? • Who are we training? • Who are we and what are we going to be in the future?