International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine
© Springer-Verlag London Ltd 2010
Received: 24 September 2009
Accepted: 4 November 2009
Published: 5 March 2010
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.
KeywordsCurriculum International emergency medicine Medical education Medical students
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.
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.
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.
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.
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
Environmental illness and injury
Transition point between community and hospital
Focused history and exam
Prioritized differential diagnoses
Lead role areas for emergency medicine in foundation training
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.
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 managementPerformance 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 measuresAt 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
- 1.Clinical care skills
History and examination
Continuity of care
- 2.Communication skills
With patients and caregivers
Breaking bad news
Working with a team
- 3.Maintaining good medical practice—lifelong learning
Audit and clinical outcomes
- 4.Professional behavior and probity—professional attributes
Career and professional development
- 5.Ethics and legal
Do not attempt resuscitation (DNAR) and advanced directives
The competent adult
- 6.Education—developing learning for others
Basic educational information delivery
Assessment and appraisal
- 7.Maintaining good clinical care—risk management
- 1.Generic objectives for resuscitation
- 2.Anesthetics and pain relief—pain management
Local anesthetic techniques
Safe conscious sedation
- 3.Wound management
Basic wound débridement and closure
Identification and treatment of infected wounds
- 4.Generic objectives for trauma
- 5.Generic objectives for musculoskeletal conditions
Upper limb disorders
Lower limb and pelvis disorders
Spine and spinal cord conditions
- 6.Vascular emergencies
Arterial limb threat
Venous—deep venous thrombosis (DVT)
- 7.Abdominal conditions
Undifferentiated abdominal pain
Anal pain and rectal bleeding
Abdominal aortic aneurysm
Acute urinary retention or bladder obstruction
Nephrolithiasis and colic
- 9.Sexually transmitted diseases
Identification and initial treatment for endemic diseases
- 10.Eye problems
Acute conjunctivitis—bacterial and viral
Acute vision loss
Acute eye trauma including globe rupture
- 11.Ear, nose, and throat (ENT) conditions
Infections of the head and neck
- 12.Dental emergencies
Dysfunctional uterine bleeding
Uncomplicated emergency vaginal delivery
Basic electrocardiographic analysis
Recognition and initial treatment of acute myocardial infarction
Recognition and initial treatment of life-threatening arrhythmia
- 16.Respiratory medicine
Asthma and restrictive airway disease
- 17.Neurological emergencies
Spinal cord lesions
Acute mental status change
- 18.Hepatic disorders
Acute cholecystitis and cholangitis
Treatment of acute ingestions
Identification of basic toxidromes
- 20.Acid-base and ventilatory disorders
Identification of acid-base disorders
Initial management of the mechanically ventilated patient
- 21.Fluid and electrolytes
Basic principles of fluid administration
- 22.Renal disease
Acute renal failure
- 23.Diabetes and endocrinology
Disorders of glucose metabolism
Disorders of red cell function
Disorders of clotting
- 25.Infectious diseases and sepsis
Endemic infectious diseases
Common infectious diseases or conditions (e.g., pneumonia)
Cellulitis and gangrene
Blistering and exfoliative diseases
Differential diagnosis of rash
Parasitic conditions and infestations
- 27.Rheumatology and immunology
- 28.Child protection and children in special circumstances
Child abuse signs and symptoms
Legal rights of parents to refuse care
Disorders of feeding
- 30.Environmental emergencies
Hypothermia and frostbite
Envenomation and environmental toxin exposure
Neutropenia and neutropenic fever
Complications of chemotherapeutic agents
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
Acute suicidal and homicidal ideation
- 34.Major incident management
Concepts and application of triage
Field to hospital communication and chain of command
- 35.Legal aspects of emergency medicine
Refusal of care
Formulating a research question
Review of the medical literature
Basic research design
Basic preparation of manuscripts and written publications
Leading teams and giving orders
Basic concepts of debriefing and giving feedback
Time flow management
- The Foundation Programme Committee of the Academy of Medical Royal Colleges. Curriculum for the Foundation Years in Post Graduate Education and Training. Academy of Medical Royal Colleges. Available via http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4107696.pdf. Accessed 22 Feb 2009
- Liaison Committee on Medical Education. LCME Accreditation Standards (with annotations). Liaison Committee on Medical Education June 2008. Available via http://www.lcme.org/functionslist.htm. Accessed 22 Feb 2009
- Frank JR. The CanMEDS 2005 Physician Competency Framework. Better Standard, Better Physicians, Better Care. The Royal College of Physicians and Surgeons of Canada. Accessed 1 Mar 2009Google Scholar
- Manthey DE, Coates WC, Ander DS et al (2006) Report of the Task Force on National Fourth Year Medical Student Emergency Medicine Curriculum Guide. Ann Emerg Med 47(3):e1–e7PubMedView ArticleGoogle Scholar
- Hockberger RS, Binder LS, Chisholm CD et al (2005) The model of the clinical practice of emergency medicine: a 2-year update. Ann Emerg Med 45(6):659–674PubMedView ArticleGoogle Scholar
- Chapman DM, Hayden S, Sanders AB et al (2004) Integrating the Accreditation Council for Graduate Medical Education Core competencies into the model of the clinical practice of emergency medicine. Ann Emerg Med 43(6):756–769PubMedView ArticleGoogle Scholar