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Australia and New Zealand__ The specialist medical college responsible for Emergency Medicine in Australia and New Zealand is the Australasian College for Emergency Medicine (ACEM).[15] The training program is nominally seven years in duration, after which the trainee is awarded a Fellowship of ACEM, conditional upon passing all necessary assessments.[16] Basic Training (24 months): Pre-vocational hospital rotation experience, which usually consists of the PGY1 internship year and PGY2 year as a junior medical officer.[17] Provisional Training (12 months): 6 months of Emergency Medicine training, plus 6 months of elective experience. Trainees must pass the ACEM Primary Examination before the end of this period, which tests basic and clinical science knowledge of trainees.[18] Advanced Training (48 months): 30 months of Emergency Medicine training, 6 months of intensive care and/or anaesthesia training, and 18 months of elective training relevant to Emergency Medicine. Trainees must pass the ACEM Fellowship Examinations in order to qualify as an Emergency Medicine specialist at the end of this period.[19] Dual fellowship programs also exist for Paediatric Medicine (in conjunction with the Royal Australasian College of Physicians) and Intensive Care Medicine (in conjunction with the College of Intensive Care Medicine). These programs nominally add one or more years to the ACEM training program.[20] For medical doctors not (and not wishing to be) specialists in Emergency Medicine but have a significant interest or workload in emergency departments, the ACEM provides non-specialist certificates and diplomas.[21] The EM Certificate requires minimum three years of postgraduate experience as a medical doctor, completion of minimum six months supervised training in Emergency Medicine, and pass marks in formal examinations.[22] The EM Diploma requires attainment of an EM Certificate (or equivalent training and experience), completion of a further 12 months of supervised training in Emergency Medicine and 6 months supervised training in clinical anaesthesia or intensive care, and pass marks in examinations.[23] Canada__ In Canada, there are a few different ways to become certified as an Emergency Physician. For all methods, one has to first complete a medical degree. The next most common step is to complete two years of family medicine residency offered by the College of Family Physicians Canada (CFPC) followed by a further one-year residency in Emergency Medicine.[24] There is also a 5-year residency offer by the Royal College of Physicians and Surgeons of Canada that may be completed instead of the above. The CFPC also allows those having worked a minimum of 4 years at a minimum of 400 hours per year in Emergency Medicine to challenge the examination of special competence in Emergency Medicine and thus become specialized.[24] China__ The current post-graduate Emergency Medicine training process is highly complex in China. The first EM post-graduate training took place in 1984 at the Peking Union Medical College Hospital. Because specialty certification in EM has not been established, formal training is not required to practice Emergency Medicine in China. For those physicians that do choose to obtain training in EM, several options are available. Graduates from medical school can apply directly to hospitals for staff physician-in-training positions, which eventually lead to a staff position at that same hospital. In addition, physicians from smaller hospitals can go to those larger academic centers for a 6 to 12-month post-graduate re-education. While these physicians may undergo the same training as the staff physicians, they will return to their own hospital once their training is completed. Finally, physicians having completed previous post-graduate training may choose to apply for fellowship positions for further training in Emergency Medicine. About one decade ago, Emergency Medicine residency training was centralized at the municipal levels, following the guidelines issued by The Ministry of Public Health. Residency programs in all hospitals are called residency training bases, which have to be approved by local health governments. These bases are hospital-based, but the residents are selected and managed by the municipal associations of medical education. These associations are also the authoritative body of setting up their residents' training curriculum. All medical school graduates wanting to practice medicine have to go through 5 years of residency training at designated training bases, first 3 years of general rotation followed by 2 more years of specialty-centered training. United States__ Emergency Medicine is a popular field for medical school graduates to enter. Both Doctors of Medicine (M.D) and Doctors of Osteopathic Medicine (D.O) can be fully trained and licensed as an Emergency Physician. In addition to the didactic exposure, much of an Emergency Medicine residency involves rotating through emergency departments, intensive care units, pediatric and obstetric units, and other specialties. By the end of their training, Emergency Physicians are expected to handle a vast field of medical, surgical, and psychiatric emergencies, and are considered specialists in the stabilization and treatment of emergent conditions. A number of fellowships are available for Emergency Medicine graduates including pre-hospital medicine (emergency medical services), critical care, hospice and palliative care, research, undersea and hyperbaric medicine, sports medicine, ultrasound, pediatric Emergency Medicine, disaster medicine, wilderness medicine, toxicology, and critical care medicine.[25] United Kingdom__ Emergency medical trainees enter specialty training after five years of medical school and two years of foundation training. During the two-year core training programme (Acute Care Common Stem), doctors complete training in anaesthesia, acute medicine, intensive care, and Emergency Medicine.[26] In the third year, the trainee learns about Emergency Medicine (paediatric focus) and musculo-skeletal Emergency Medicine. They must also pass the Membership of the College of Emergency Medicine (MCEM) examination. Trainees will then go onto Higher Training, lasting a further 3 years. Before the end of higher training, the final examination—the Fellowship of the College of Emergency Medicine (FCEM) must be passed. Upon completion of training the doctor will be eligible for entry on the GMC Specialist Register and allowed to apply for a post as a Consultant in Emergency Medicine. Emergency Medicine training in the UK is emerging. Historically, emergency specialists were drawn from anaesthesia, medicine, and surgery. Many established EM consultants were surgically trained; some hold the Fellowship of Royal College of Surgeons of Edinburgh in Accident and Emergency—FRCSEd(A&E). Some of these consultants will be referred to as 'Mister', whilst others choose either not to change from 'Doctor' or to change back to 'Doctor' after passing the FCEM exam. Others used the MRCP or the FRCA as their primary examination (now replaced by MCEM). Trainees in Emergency Medicine may dual accredit in Intensive-Care Medicine or seek sub-specialisation in Paediatric Emergency Medicine.[27] Turkey__ The only way to become a certified Emergency Medicine Physician is via attending Medical Board Examination (TUS) to become a resident. After TUS, candidates are allocated to different residencies according to their score and choice. Emergency Medicine residency lasts for 4 years in Turkey. During the programme doctors complete 13 months of rotation on different specialties, including anesthesia, orthopedics, pulmonary medicine, internal medicine, pediatrics, general surgery, radiology, neurosurgery, neurology, and cardiology. Last year, they design and manage a clinical or animal research, and write their dissertations. At the end of their residency they attend two different exams three months apart: Dissertation Exam, Emergency Medicine Specialty Exam. Both exams are oral, and doctor is expected to answer all questions asked by the Exam Board. Exam Board consists of 5 members: 2-3 from Emergency Medicine, others from Internal Medicine, Surgery or Anesthesia faculty members. After the exam, doctor starts to hold the title of Emergency Medicine Specialist. However, all the doctors should attend a 2-year Obligatory Service in Turkey to be qualified to have their diploma. After this period, EM specialist can choose to work in private or governmental ED's. Pakistan__ Emergency Medicine training in Pakistan lasts for 5 years. The candidate enters the program by clearing part 1 of FCPS (fellow of college of physicians and surgeons of Pakistan) and passing the entry test of one of the institutions offering Emergency Medicine residency in Pakistan. The initial 2 years involve trainees to be sent to various sub-specialties including both medicine and surgery. Major rotations include, Internal Medicine, ICU, Anesthesia and Pediatrics. The residents enrolled in the program rotate for 3 months each of first two years. They work in the emergency Department for about six months. After the two years they appear in the exams called Intermediate Module (IMM). In last three years trainee residents spend most of their time in emergency room as senior residents. Full-time faculty supervises the residents. The duration can vary from 60–80 hours per week depending upon the rotation. There is an extensive curriculum that is covered over 5 years. Certain certificate courses include ACLS, PALS, ATLS, and research and dissertations are required for successful completion of the training. At the end of 5 years, candidates become eligible for sitting for FCPS part II exam. After completion of requirements and passing the exam, the physician is called Emergency Medicine specialist and they can use FCPS with their names. Iran__ First residency program in Iran started in 2002 at Iran University of Medical Sciences (which merged with Tehran University of Medical Sciences later). There are now three-year standard residency programs running in Tehran, Tabriz, Mashhad, Isfahan, and some other universities. All these programs work under supervision of Emergency Medicine specialty board committee. There are now more than 200 (and increasing) board-certified Emergency Physicians in Iran.[14] |
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