International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine.

There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this need, physicians must be trained to deliver time-sensitive interventions and life-saving emergency care. Currently, there is no internationally recognized, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this lack, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for foundation training of medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is not designed to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions' educational leadership.

Executive summary

Vision: To create an international model curriculum for medical student foundation training in emergency medicine.

Rationale: There is critical, overwhelming, and growing need for emergency physicians and other administrative, professional, clinical, and academic emergency medicine resources worldwide. Currently, there exist a small number of national curricula for emergency medicine, but there is no standard, widely recognized international curriculum for medical students.

Demand: Currently worldwide, there are roughly 50+ countries involved in the processes of emergency medicine development. Internationally, a consensus is building regarding the demand for an international minimum basic standard for emergency medicine curriculum content.

Goal: To establish, develop, and maintain an international curriculum for medical student foundation training in emergency medicine. The curriculum should be compiled by an international consortium of physicians, health professionals, and other experts in emergency medicine and international emergency medicine development. Further it should be approved, amended, and maintained by an international collection of such experts.

Endpoint: To further train and educate physicians, medical professionals, and other experts in emergency medicine in order to provide the best quality emergency care in the multiple and growing number of nations where it is currently practiced and to further establish emergency medicine as a medical profession worldwide.

Mission statement

The International Federation for Emergency Medicine believes that:

Society has a right to expect that at the completion of their undergraduate medical school training all physicians possess the basic knowledge of emergency care and the skills to manage common acute problems.

Emergency medicine is a core medical discipline and should be a required portion of the curriculum for every medical school, and every medical student, in the world.

Every physician, and graduating medical student, should be able to provide care in an emergency situation without any faults or lack of confidence and should be independent of the site of the emergency.

Every physician, and medical student, should be able to manage clinical decision-making under pressure of time when it is essential to save lives.

Competence in basic emergency medicine should be an outcome measure for all medical students and represent a criterion required for conferral of the degree.

Introduction

This curriculum establishes an international consensus on the core content of undergraduate level emergency medicine training with the goal of elevating the quality of acute care worldwide through an expansion of basic emergency medicine education. This curriculum further reflects the importance of emergency medicine as a medical profession worldwide. The document is organized sequentially, as a framework rather than a comprehensive plan. Educators using this curriculum should make use of the framework to develop educational programs that are contextualized and specifically meet local educational requirements. This model allows easy adaptation of any of the features and provides an example of an expanded 4-year curriculum for a single learning objective.

Professional development

The clinical settings and environmental context for medical education varies widely throughout the world. To attain minimum basic competency in emergency medicine core learning objectives, medical students must be given a variety of opportunities for professional development. These opportunities should be longitudinal in nature, begin early in the preclinical years, and extend into clinical contexts that allow focus on acute and emergency conditions. The following basic guidelines should structure the educational process of achieving core competencies in minimum emergency medicine knowledge and skills.

During undergraduate and early training every medical student should:

Acquire a fundamental knowledge of basic sciences as applied to emergency medicine and have the ability to assess and immediately treat common emergencies.

Develop existing clinical examination skills and apply them in clinical practice to develop differential diagnoses and provisional management plans for acute medical conditions and undifferentiated patients.

Acquire expertise in a range of commonly used emergency procedural skills, including basic life support.

Perform allocated tasks, learn to process serially so as to optimally manage time within the shift, and meet clinical deadlines.

Teach informally in the clinical setting and in specified circumstances in a more formal setting.

Develop an understanding and basic awareness of clinical management issues when applied to acute care situations.

Select and perform simple audit projects and understand the audit cycle to monitor care delivery and improve care quality.

Understand the principles of critical appraisal and research methodology and apply these to acute care situations.

Demonstrate the capacity to work in multiprofessional teams.

Learn to recognize his or her own limitations in the provision of emergency care.

Educational outcomes—learning objectives

These learning objectives are designed to allow easy modification to the local needs and are written so that objective measures of performance and competency can be designed to measure attainment of the learning objective.

The student should

Acquire basic life support skills, including the diagnosis and treatment of shock and the related basic procedural skills, and demonstrate the basic application of these principles in real or simulated patient care scenarios.

Demonstrate the capacity to differentiate and treat common acute problems.

Provide a comprehensive assessment of the undifferentiated patient.

Demonstrate proficiency in basic life support skills and cardiopulmonary resuscitation.

Recognize and initiate first aid for airway obstruction.

Recognize and be prepared to intervene for all causes of shock in any age group.

Be able to provide rapid stabilization with intravenous access and fluid/blood administration.

Understand the principles of cerebral resuscitation in brain illness and injury.

Demonstrate proficiency in the use of an automatic external defibrillator (AED).

Understand the principles of wound care.

Demonstrate basic wound care techniques.

Understand the principles of trauma management.

Demonstrate basic trauma management skills, such as initial assessment using the ABC approach and full spine immobilization.

Demonstrate mastery of basic procedural skills, such as airway management and venous access.

Recognize life-threatening illness or injury and apply basic principles of stabilization to the early management of these entities.

Demonstrate the capacity to prioritize attention to those patients with more urgent conditions.

Describe the importance of the emergency department as a key link between the general population and the health care system.

Understand the role of the situations that are unique to emergency medicine: acute critical illness, intoxicated patients, media, out-of-hospital personnel, death notification for sudden unexpected death, disaster, language barriers, environmental illness/injury, injury prevention, assessment of complex and undifferentiated patients, and ability to synthesize multiple and often incomplete sources of information to develop a management plan.

Unique content areas for emergency medicine in foundation training

Undifferentiated patient presentation

Time-constrained decision-making

Environmental illness and injury

Prehospital care

Transition point between community and hospital

Focused history and exam

Prioritized differential diagnoses

Lead role areas for emergency medicine in foundation training

Acute illness

Acute injury

Disaster management

Death notification

Injury prevention

Medical decision-making

Resource utilization

Toxicology

Example curriculum format

To assist educators in crafting a curriculum that fits local needs, we have provided an example of a 4-year plan for a single learning objective. Educators may use this as a guide to construct individual-, national-, and institution-specific models for content delivery. This method is not intended to be prescriptive, but to provide a simple model for tailoring content to the unique educational models that exist throughout the world.

Learning objective # 5: recognize and initiate first aid for airway obstruction

Curriculum year 1:

Readings—basic life support manuals, basic first aid manuals (e.g., American Heart Association Advanced Life Support Manual, Dallas, TX, USA or equivalent manuals from the local community)

Performance indicators:

Obtain basic cardiac life support (BCLS) certification

Demonstrate chin lift

Demonstrate bag-valve mask ventilation

Demonstrate the ability to clear an obstructed airway

Curriculum year 2

Readings—pathophysiology of respiratory failure

Curriculum year 3 and/or 4

Readings—introduction to anesthesia, introduction to airway management

Performance indicators:

Demonstrate endotracheal intubation

List indications for intubation

List contraindications for intubation

Describe medications used for rapid sequence intubation

Describe the physiology of artificial ventilation

Outcome measures

At the time of graduation, the student will demonstrate the ability to:

Manage an obstructed airway

Manage a basic airway, and

Perform an endotracheal intubation

This will be assessed by simulation on a mannequin or using direct observation of student skills by trained faculty during clinical situations.

Undergraduate emergency medicine curriculum content

Skills curriculum

Clinical care skills

History and examination

Documentation

Decision-making

Time management

Safe prescribing

Continuity of care

Therapeutic interventions

Communication skills

With colleagues

With patients and caregivers

Breaking bad news

Working with a team

Maintaining good medical practice—lifelong learning

Audit and clinical outcomes

Critical appraisal

Information management

Professional behavior and probity—professional attributes

Career and professional development

Ethics and legal

Do not attempt resuscitation (DNAR) and advanced directives

The competent adult

Informed consent

Education—developing learning for others

Basic educational information delivery

Assessment and appraisal

Feedback

Maintaining good clinical care—risk management

Medicolegal issues

Confidentiality

Specialty-specific curriculum

Generic objectives for resuscitation

Resuscitation—airway

Cardiac arrest/peri-arrest

Shock—all varieties

Coma

Anesthetics and pain relief—pain management

Local anesthetic techniques

Safe conscious sedation

Wound management

Basic wound débridement and closure

Identification and treatment of infected wounds

Generic objectives for trauma

Major trauma

Head injury

Chest trauma

Abdominal trauma

Spinal injury

Maxillofacial trauma

Burns

Orthopedic trauma

Generic objectives for musculoskeletal conditions

Upper limb disorders

Lower limb and pelvis disorders

Spine and spinal cord conditions

Vascular emergencies

Arterial limb threat

Venous—deep venous thrombosis (DVT)

Abdominal conditions

Undifferentiated abdominal pain

Hematemesis/melena

Anal pain and rectal bleeding

Diverticulitis

Abdominal aortic aneurysm

Urology

Acute urinary retention or bladder obstruction

Nephrolithiasis and colic

Sexually transmitted diseases

Identification and initial treatment for endemic diseases

Eye problems

Acute conjunctivitis—bacterial and viral

Acute vision loss

Acute eye trauma including globe rupture

Ear, nose, and throat (ENT) conditions

Epistaxis

Infections of the head and neck

Dental emergencies

Dental abscess

Dental fracture

Gynecology

Pelvic pain

Dysfunctional uterine bleeding

Obstetrics

Ectopic pregnancy

Uncomplicated emergency vaginal delivery

Cardiology

Basic electrocardiographic analysis

Recognition and initial treatment of acute myocardial infarction

Recognition and initial treatment of life-threatening arrhythmia

Respiratory medicine

Airway obstruction

Respiratory failure

Asthma and restrictive airway disease

Acute pneumothorax

Pulmonary embolism

Neurological emergencies

Acute stroke

Spinal cord lesions

Peripheral neuropathies

Acute mental status change

Migraine

Meningitis

Vertigo

Hepatic disorders

Acute hepatitis

Liver failure

Acute cholecystitis and cholangitis

Toxicology

Treatment of acute ingestions

Identification of basic toxidromes

Acid-base and ventilatory disorders

Identification of acid-base disorders

Initial management of the mechanically ventilated patient

Fluid and electrolytes

Basic principles of fluid administration

Dehydration

Hyperkalemia

Hyponatremia

Renal disease

Acute renal failure

Diabetes and endocrinology

Disorders of glucose metabolism

Thyroid disorders

Hematology

Anemia

Disorders of red cell function

Disorders of clotting

Infectious diseases and sepsis

Endemic infectious diseases

Sepsis

Common infectious diseases or conditions (e.g., pneumonia)

Cellulitis and gangrene

Dermatology

Blistering and exfoliative diseases

Differential diagnosis of rash

Parasitic conditions and infestations

Rheumatology and immunology

Crystal arthropathy

Arthritis

Immune disorders

Anaphylaxis

Child protection and children in special circumstances

Child abuse signs and symptoms

Legal rights of parents to refuse care

Neonatology

Neonatal resuscitation

Hyperbilirubinemia

Disorders of feeding

Neonatal fever

Environmental emergencies

Hyperthermia

Hypothermia and frostbite

Envenomation and environmental toxin exposure

Oncology

Acute leukemia

Neutropenia and neutropenic fever

Solid tumors

Complications of chemotherapeutic agents

Pediatrics

Basic management of pediatric airway

Basic pediatric resuscitation

Common infectious diseases of childhood

Fever in the first 6 months of life

Common injury patterns for normal children

Psychiatry

Acute psychosis

Mood disorders

Personality disorders

Acute suicidal and homicidal ideation

Substance abuse

Major incident management

Concepts and application of triage

Field to hospital communication and chain of command

Legal aspects of emergency medicine

Refusal of care

Informed consent

Malpractice

Research

Formulating a research question

Review of the medical literature

Basic research design

Basic preparation of manuscripts and written publications

Management

Leading teams and giving orders

Basic concepts of debriefing and giving feedback

Time flow management