Emergency Medicine Training Programmes:
1. Objectives of Training
The goal of training in emergency medicine is to develop trainees into specialists who are competent to accept and exercise the highest responsibility in the field of emergency medicine. In particular, the doctor should demonstrate knowledge and skill in the:
- Recognition, Resuscitation, Stabilization, Evaluation and Care of the critically ill or injured patient.
- Arrangement of appropriate follow-up or referral as required
- Prehospital care of acutely ill or injured patients
- Management of Emergency Medical System providing prehospital care
- Administration of Emergency Department
- Teaching of Emergency Medicine
- Research in areas relevant to the practice of Emergency Medicine.
2. Enrollment of Trainees
- Trainees must be doctors who are fully registrable with the Karnataka Medical Council
- Trainees shall enrol with the College at the commencement of their training by recommendation of the training supervisors of accredited training centres where they are working.
- Clinical experience obtained before enrolment, whether local or overseas, shall be subjected to individual assessment by the College for the purpose of recognition as accredited training. Due considerations will be given to whether the training is supervised, relevant to emergency medical and of comparable standard. The decision of the College shall be final medicine and of comparable standard. The decision of the College shall be final.
3. Structure of Training
The training of specialist in emergency medicine should span six years. Elective rotations will be required to give the trainee a wide exposure in other disciplines of medicine of importance to the practice of emergency medicine. There are two phases of training, namely, basic training and higher training. Basic training must include at least one year of accredited A&E training and one year of mandatory rotations stated in 3.2 Trainees may sit for the intermediate examination after 20 months of training.
A basic trainee will become a higher trainee only if he/she has completed the basic training and passed the Intermediate Examination for Emergency Medicine or its equivalent. Higher training comprises at least 2 years of accredited training in Emergency Medicine After at least six years of accredited training and on compliance with the training requirements, trainees may sit the Exit Examination for Emergency Medicine. All training must be accredited by the Education Committee of the College.
3.1 3 Years of Mandatory Training in Emergency Department
All trainees must go through three years of recognised training in accredited Emergency Departments of which two years must be as higher trainee after passing the intermediate examination. The objectives of training in emergency department are to expose the trainees to wide varieties of emergencies and to equip them with the basic knowledge and skills to handle these critical events. Trainees will be gradually given more responsibility to manage patients commensurate with their experience.
3.2 One Year of Mandatory Rotations
Rotations outside Emergency Department are required to give trainees a broader perspective of the practice of emergency medicine. This also gives trainees a better appreciation of interdisciplinary approach to patient care with cooperation by different specialties. This serves to lay a firm foundation for further training. The rotations will include:
- 6 months in surgical stream drawn from the following list
- general surgery
- cardiothoracic surgery
- orthopaedic surgery
- paediatric surgery
- plastic surgery
- 6 months in non-surgical stream drawn from the following list
- internal medicine
- critical care
- intensive care
3.3 Optional Rotations outside Emergency Department
Only rotations in units accredited by the College as suitable for training will be counted. The minimum period of hospital appointment for approved training is three months. Category A rotations A maximum duration of 24 months only may be accredited by the College for the following elective rotations
- internal medicine
- general surgery
- orthopaedics & traumatology
- Category 8 rotations, for this category of elective rotations, a maximum of 12 months may be accredited.
- Critical care
- Plastic surgery
- Pediatric surgery
- Category C rotations, Only a maximum of six months may be accredited for the following rotations:
- Obstetrics & Gynecology
- Diagnostic Radiology
- Family Medicine
- Rehabilitation medicine
- Pre-hospital emergency medical service
For Dermatology, ENT or Ophthalmology elective, attachment to outpatient clinics for lesser duration could be accepted.
Trainees with interests in other special areas not listed above should discuss with his or her supervisor and seek approval from the Education Committee.
Trainees who wish to undergo overseas attachment for longer than 3 months in fields related to emergency medicine must obtain prior approval from the Education Committee.
4. CONTENTS OF TRAINING
Contents of training should cover both knowledge and skills that are required for the management of critically ill patients. In general, the following aspects should be covered:
- basic sciences
- clinical skills
- review of current literature
- communication skills
- prevention and treatment of illness and promotion of health
- management skills
- knowledge and skills which cross specialty boundaries
- professional ethics and conduct
5. METHODS OF TRAINING IN EMERGENCY DEPARTMENT
Trainees are responsible to keep adequate record of their own training activities in the training logbook issued by the College. The forms of educational activities can vary a lot depending on the topic. For example:
- didactic lectures
- case conference
- mortality and morbidity meeting
- X-ray review
- journal club
- bedside coaching
- courses e.g. ACLS, ATLS
- research and clinical studies
Trainees should be given increasing responsibilities and exposure to all areas relevant to the practice of Emergency Medicine. The following points should be observed:
- Trainees will be given increasing responsibility in all areas relating to the clinical practice of emergency medicine.
- Trainees with subspecialty interests will be encouraged to widen their exposure in their areas of interest.
- Trainees will take up teaching of junior staff.
- Trainees should be given chances to participate in academic presentations and research at some stage of their training.
- Trainees should take part in Quality Assurance activities.
- Trainees should be given chances to participate in department hospital. administration. They are also encouraged to take up management courses.