K. Douglass

Guidelines for Safety of Trainees Rotating Abroad: Consensus Recommendations from the Global Emergency Medicine Academy of the Society for Academic Emergency Medicine, Council of Emergency Medicine Residency Directors, and the Emergency Medicine Residents' Association

The goal of a global health elective is for residents and medical students to have safe, structured, and highly educational experiences. In this article, the authors have laid out considerations for establishing a safe clinical site; ensuring a travelers personal safety, health, and wellness; and mitigating risk during a global health rotation. Adequate oversight, appropriate mentorship, and a well-defined safety and security plan are all critical elements to a successful and safe experience.

Clinical and Translational Research in Global Health and Emergency Care: A Research Agenda

As policy-makers increasingly recognize emergency care to be a global health priority, the need for high-quality clinical and translational research in this area continues to grow. As part of the proceedings of the 2013 Academic Emergency Medicine consensus conference, this article discusses the importance of: 1) including clinical and translational research in the initial emergency care development plan, 2) defining the burden of acute disease and the barriers to conducting research in resource-limited settings, 3) assessing the appropriateness and effectiveness of local and global acute care guidelines within the local context, 4) studying the local research infrastructure needs to understand the best methods to build a sustainable research infrastructure, and 5) studying the long-term effects of clinical research programs on health care systems.

Society for Academic Emergency Medicine's Global Emergency Medicine Academy: Global Health Elective Code of Conduct

Resumen El numero de residentes y estudiantes de medicina que participan en asignaturas optativas de salud global en medicina de urgencias y emergencias (MUE) se ha incrementado exponencialmente en los ultimos anos. Las asignaturas optativas de salud global siguen siendo un instrumento fuerte de reclutamiento y pueden contribuir a la formacion de los alumnos. Sin embargo, segun crece el numero de estudiantes que llevan a cabo experiencias internacionales en el campo de la MUE global, se tiene la necesidad de desarrollar estandares aceptables de comportamiento en el escenario internacional. Los miembros de la Global Emergency Medicine Academy (GEMA) se dieron cuenta de la ausencia de recomendaciones internacionales o guias para estas experiencias.[1-3] Un grupo de miembros voluntarios de la GEMA se comprometieron con la tarea de crear un documento que pudiese usarse por los estudiantes cuando llevaran a cabo asignaturas optativas de salud global. Los autores procedian de diversas instituciones y tenian distintos niveles de formacion y experiencia internacional. En el desarrollo de este documento, se llevo a cabo una revision sistematica en la literatura de cualquier informacion en codigos de conducta/profesionalidad[4, 5] cuando se trabaja en el escenario internacional; tambien se revisaron documentos similares de numerosas instituciones[6, 7] de diferentes especialidades[8] y se busco ent la literatura gris.[9] Las referencias clave seleccionadas se muestran mas abajo. Esta informacion se combino para producir un unico documento, que se reviso usando una metodologia de consenso hasta que alcanzo un acuerdo por parte de todos los miembros del grupo. El documento resultante se muestra en la figura de mas abajo. Se anima a las instituciones comprometidas con la formacion de estudiantes a adoptar este como estandar de su formacion en salud global.

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

BACKGROUND Emergency 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. OBJECTIVE Our 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. DISCUSSION Programs 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. CONCLUSIONS This 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.

Creation and implementation of an emergency medicine education and training program in Turkey: an effective educational intervention to address the practitioner gap

BackgroundThe specialty of Emergency Medicine has enjoyed recognition for nearly 20 years in Turkey. However, the majority of underserved and rural Turkish emergency departments are staffed by general practitioners who lack formal training in the specialty and have few opportunities to increase emergency medicine-specific knowledge and skills.MethodsTo address this “practitioner gap,” the authors developed a four-phase comprehensive emergency medicine education and training program for general practitioners practicing in government hospitals in Turkey.ResultsFrom April 2006 until June 2009, 42 courses were taught by 62 trainers across seven regions in Turkey. A total of 2,262 physicians were trained. The mean course pre-test score for all regions was 42.3 (95% CI 39.8 to 44.7). The mean course post-test score was 70.1 (95% CI 67.2 to 72.9). The difference between the mean scores was 27.8 (95% CI 25.3 to 30.4, P <0.0001), reflecting an improvement of 65.7%.ConclusionsA partnership between an academic emergency medicine department and an emergency medicine society to implement country-wide training of physicians practicing in public emergency departments can serve as a successful model for capacity-building global emergency medicine endeavors.

Emergency medicine Joint Fellowship Curriculum.

BACKGROUND The authors describe a Joint Fellowship Curriculum instituted for emergency medicine fellows in diverse fellowships. The curriculum is based on commonalities established among the varying fellowships offered within their Department of Emergency Medicine. Fellowships included in the curriculum development include Disaster/Emergency Medical Services, International Emergency Medicine, Health Policy, Ultrasonography, and Medical Toxicology. OBJECTIVES The focus of this educational activity is to promote the development of the fellow into an expert within their field of specialization. DISCUSSION Recognizing that topics such as scholarly activities, career development, clinical practice of medicine, business of medicine, and personal development are universally applicable to a variety of emergency medicine fellowships, the curriculum attempts to provide uniform instruction. The quality and applicability of this instruction was assessed and found to have been very well received by the participating fellows. CONCLUSION The authors encourage academic emergency medicine departments with a number of fellowship training opportunities to consider providing such a uniform curriculum of instruction as well.

Reducing mortality in near-hanging patients with a novel early management protocol: A prospective cohort study in India

Background: Hanging is one of the most common causes of suicide world‐wide, more prevalent in developing countries. There are no established protocols for early management of near‐hanging patients who present to the emergency department (ED). The use of early intubation, strict blood pressure control and targeted temperature management has shown promise in small studies. Objective: To detect changes in mortality and neurological deficits in near‐hanging patients before and after implementation of a novel early management protocol in a tertiary care hospital in India. Methods: Prospective cohort study conducted at a tertiary‐care hospital in Tamil Nadu, India from August 2014–July 2016. For first year of study (pre‐implementation), near‐hanging patients were treated without a structured protocol. For second year of study (post‐implementation), near‐hanging patients were treated per a protocol including early intubation, strict blood pressure control and targeted temperature management. Primary outcomes included: (1) in‐hospital mortality and (2) hospital discharge without neurological deficit. Results: 65 patients were included (27 in the pre‐implementation phase and 38 in the post‐implementation phase.) At presentation, there was no difference between the two groups in mean heart rate, mean arterial pressure, mean oxygen saturation, Glasgow coma score, or mean respiratory rate. Protocol implementation decreased mortality (10/27 (37%) versus 2/38 (5%), P < 0.05) and increased the number of patients discharged without neurological deficit (10/27 (37%) versus 35/38 (92%), P < 0.05). Conclusions: This novel early management protocol reduced mortality and increased the number discharged without neurological deficit in near‐hanging patients in a single tertiary care center in India.

Faculty Development Program for Emergency Medicine Physicians in India: A Pilot Program

The specialty of emergency medicine (EM) is developing worldwide at a rapid pace. While more and more postgraduate training programs are developing, a major gap persists in numbers and availability of well‐trained academic faculty members. This article describes a pilot faculty development program (FDP) aimed to develop advanced academic skills among a group of EM physicians in India.