Fellowships in international emergency medicine in the USA: a comparative survey of program directors’ and fellows’ perspectives on the curriculum

Global Emergency Medicine Fellowships: Survey of Curricula and Pre-Fellowship Experiences

INTRODUCTION

Lack of accreditation requirements affords global emergency medicine (GEM) fellowships the flexibility to customize curricula and content. A paucity of literature exists describing the state of GEM fellowship programs. We describe the current state of GEM fellowship curricula including which components are commonly included, and highlighting areas of higher variability.

METHODS

We identified GEM fellowships and invited them to participate in a web-based survey. Descriptive statistical analysis was performed.

RESULTS

Of the 46 fellowship programs invited to participate, 24 responded; one duplicate response and one subspecialty program were excluded. The 22 remaining programs were included in the analysis. Nineteen programs (86%) offer a Masters in Public Health (MPH) and 36% require an MPH to graduate. Additionally, 13 programs (59%) offered graduate degrees other than MPH. Fellows average 61 clinical hours per month (95% confidence interval, 53-68). Time spent overseas varies widely, with the minimum required time ranging from 2-28 weeks (median 8 weeks; interquartile range [IQR] 6,16) over the course of the fellowship. The majority of programs offer courses in tropical medicine (range 2-24 weeks, median 4 weeks) and the Health Emergencies in Large Populations course. Only 32% of programs reported offering formal ultrasound training. Fellows averaged 1.3 research projects prior to fellowship and median of 2.5 during fellowship (IQR 1,3). While the majority of GEM fellowship graduates worked at US academic centers (59%), 24% worked in US community hospitals, 9% worked for non-profit organizations, and 9% worked internationally in clinical practice.

CONCLUSION

Our results highlight the wide variability of curricular content and experiences offered by GEM fellowships.

Cross-Sectional Survey of Former International Emergency Medicine Fellows 2010-19

Introduction

International emergency medicine is a new subspecialty within emergency medicine. International emergency medicine (EM) fellowships have been in existence for more than 10 years, but data is limited on the experiences of the fellows. Our goal in this study was to understand the fellowship experience.

Methods

The study employed a cross-sectional survey in which participants were asked about their demographics, fellowship program, and advanced degree. Participants consisted of former fellows who completed the fellowship between 2010–19. The survey consisted of both closed and open-ended questions to allow for further explanation of former fellows’ experience. Descriptive analysis was conducted on the quantitative survey data while content analysis was conducted to ascertain salient themes from the open-ended questions.

Results

We contacted 71 former fellows, of whom 40 started and 36 completed surveys, for a 51% response rate (55.6% women). Two-year fellowships predominated, with 69.4% of respondents. Prior to fellowship, a subset of fellows spoke the native languages of their service sites: French, Spanish, Haitian Creole, Mandarin, or Kiswahili. Half the respondents spent 26–50% of their fellowship in field work, with 83.3% of institutions providing direct funding for this component. Many respondents stated a need for further institutional support (money or infrastructure) for fieldwork and mentoring. Non-governmental organizations comprised 29.7% of respondents’ work partners, while 28.6% were with academic institutions in country, focused mostly on education, health systems development, and research. The vast majority (92%) of respondents continued working in global EM, with the majority based in American academic institutions. Those who did not cited finances and lack of institutional support as main reasons.

Conclusion

This study describes the fellow experience in international EM. The majority of fellows completed a two-year fellowship with 26–50% of their time spent in fieldwork with 83.3% of institutions providing funding. The challenges in pursuing a long-term career in global EM included the cost of international work, inadequate mentorship, and departmental funding.

Towards developing a consensus assessment framework for global emergency medicine fellowships

Background

The number of Global Emergency Medicine (GEM) Fellowship training programs are increasing worldwide. Despite the increasing number of GEM fellowships, there is not an agreed upon approach for assessment of GEM trainees.

Main body

In order to study the lack of standardized assessment in GEM fellowship training, a working group was established between the International EM Fellowship Consortium (IEMFC) and the International Federation for Emergency Medicine (IFEM). A needs assessment survey of IEMFC members and a review were undertaken to identify assessment tools currently in use by GEM fellowship programs; what relevant frameworks exist; and common elements used by programs with a wide diversity of emphases. A consensus framework was developed through iterative working group discussions. Thirty-two of 40 GEM fellowships responded (80% response). There is variability in the use and format of formal assessment between programs. Thirty programs reported training GEM fellows in the last 3 years (94%). Eighteen (56%) reported only informal assessments of trainees. Twenty-seven (84%) reported regular meetings for assessment of trainees. Eleven (34%) reported use of a structured assessment of any sort for GEM fellows and, of these, only 2 (18%) used validated instruments modified from general EM residency assessment tools. Only 3 (27%) programs reported incorporation of formal written feedback from partners in other countries. Using these results along with a review of the available assessment tools in GEM the working group developed a set of principles to guide GEM fellowship assessments along with a sample assessment for use by GEM fellowship programs seeking to create their own customized assessments.

Conclusion

There are currently no widely used assessment frameworks for GEM fellowship training. The working group made recommendations for developing standardized assessments aligned with competencies defined by the programs, that characterize goals and objectives of training, and document progress of trainees towards achieving those goals. Frameworks used should include perspectives of multiple stakeholders including partners in other countries where trainees conduct field work. Future work may evaluate the usability, validity and reliability of assessment frameworks in GEM fellowship training.

Disaster medicine education for medical students: Is it a real need?

BACKGROUND

Disasters are serious public health problems that have increased over the last century. This study evaluated the familiarity and training needs of medical students regarding disaster medicine in Qassim University College of Medicine (QUCOM).

METHODOLOGY

A mixed quantitative and qualitative study was conducted in which students in the clinical phase were asked to respond to a questionnaire. Clinical teachers of the college, emergency physicians and health administrators were interviewed for the qualitative part of the study. Data were analyzed using SPSS and relevant tool for the qualitative part.

RESULTS

Two-hundred twenty-nine students (91.6%) responded. Familiarity of students with disaster medicine was low with a mean score of 1.65 out of five points. However, male students demonstrated significantly higher mean scores in certain themes of disaster medicine. Students endorsed the idea that a training course is needed with a mean score of 3.66/5 and supported the idea that disaster medicine training should be provided to the general public as well (mean 3.85/5). Qualitative data affirmed inclusion of relevant topics in the curriculum based on students' inputs and needs and as defined by the community.

CONCLUSION

Disaster medicine education for medical students is recommended by students and experts, while the applicability and feasibility needs further exploration.