Postgraduate emergency medicine teaching and simulation

Introduction

Emergency departments (EDs) are fertile learning environments for postgraduate doctors. The varied clinical case mix, procedural practice and enthusiastic teaching by emergency physicians have made emergency medicine an important experience for new medical graduates. Many of these same factors attract doctors to vocational training in emergency medicine.

Postgraduate training in this field, like most other specialties, traditionally followed an apprenticeship model. However, contemporary emergency medicine practice demands new knowledge and skills, must meet different expectations from patients and health care systems, and needs contemporary educational approaches.

Oversight of training programs

The governance of emergency medicine training, certification and credentialing varies internationally. In Australasia, training and assessment is by the Australasian College for Emergency Medicine (ACEM), in conjunction with hospitals and health services. Formal specialist recognition is granted by the Medical Boards of Australia (MBA) or New Zealand (MBNZ). ‘Non-specialist’ training in emergency medicine is provided by the both ACEM and Australian College of Rural and Remote Medicine (ACRRM).

Other governance models of specialist training exist internationally and include oversight by universities (Malaysia), professional societies (Sweden, USA) government organizations, cross-specialty professional associations (Royal College of Physicians and Surgeons of Canada) or combinations (UK). Organized training programs in low- and middle-income countries (LMICs) are now more common.

Curricular trends in emergency medicine

There has been a global trend in postgraduate medical education toward ‘outcomes-based’ curricular models. This has resulted in a shift from curricula defining a knowledge base to be acquired, to outcome concepts of roles and competencies for specialist physicians.

The CanMEDS model, developed in Canada and adopted by the ACEM, requires training to be orientated toward preparing emergency physicians (and other specialist trainees) for their roles as medical expert, communicator, collaborator, manager, health advocate, scholar and professional.

Integral to this curricular trend has been increased recognition of teamwork, leadership, patient safety, quality improvement, physician wellness, and communication with patients and peers as training goals. New domains of learning, such as medical informatics and evidence-based medicine, have become explicit curricular content.