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Fellowships in International Emergency Medicine in the USA
Abstract and Introduction
Abstract
Objective Experts 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 their perspectives differ and the barriers preventing fellowships from covering them.
Methods From 1 November 2011 to 30 November 2011, a survey was administered to PDs, current fellows and recent graduates of the 34 US IEM fellowships. Respondents quantified their fellowship experience in six proposed core curriculum areas: emergency medicine (EM) systems development, EM education, humanitarian assistance, public health, emergency medical services and disaster medicine. Analysis was performed regarding what per cent of programmes fulfil the six curriculum areas. A paired t test determined the difference between PDs' and fellows' responses. Agreement between PDs and fellows within the same programme was determined using a κ statistic.
Results Only 1/18 (6%) (according to fellows) to 2/24 (8%) (according to PDs) of programmes expose fellows to all six components. PDs consistently reported higher exposure than fellows. The difference in mean score between PDs and fellows was statistically significant (p<0.05) in three of the 6 (50%) core curriculum elements: humanitarian aid, public health and disaster medicine. Per cent agreement between PDs and fellows within each programmes ranged from poor to fair.
Conclusions While IEM fellowships have varying structure, this study highlights the importance of further discussion between PDs and fellows regarding delineation and objectives of core curriculum components. Transparent curricula and open communication between PDs and fellows may reduce differences in reported experiences.
Introduction
The field of international/global emergency medicine (EM) is continuously expanding. Growth in this area stems from the need to provide humanitarian assistance, and the intent to develop the field of EM in countries where it does not currently exist or where it is still in its early stages. Increasing globalisation of medical education has, in turn, fostered a growing interest in international training, particularly in the field of EM. Currently more than 30 countries recognise EM as a specialty. Many emergency physicians are involved in international projects; however, the majority do not have formal international health training.
In the USA, after completing residency (specialty training after medical school) in EM, some physicians choose to further develop their niche by completing 1–3 years of fellowship (subspecialty training after residency) in fields such as international emergency medicine (IEM), toxicology, sports medicine, paediatric EM, medical education, emergency medical systems (EMS), ultrasound and critical care. Currently the Accreditation Council for Graduate Medical Education (ACGME) accredits some of these fellowship categories such as Medical Toxicology and EMS, but not others, such as IEM fellowships. With ACGME accreditation comes standardisation of requirements and accordingly of curriculum. Consequently, the curricula of IEM fellowships are quite variable in content, duration and structure.
As of November 2011, when the survey was conducted, there were 34 IEM fellowships, and this number has increased over the past several years. Many articles have proposed core curriculum components for IEM fellowship training. To date, no published study has examined whether fellowship programmes are consistently covering these core curriculum components. It is therefore important to compare and contrast the perspectives of the IEM program directors (PDs) and fellows regarding the extent of the fellows' experience in core curriculum areas. Lastly, no study has sought potential barriers to meeting proposed core curriculum components. This study attempts to answer the three questions listed above.
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