2012 GEMA Newsletter No. III
The Global Emergency Medicine Academy (GEMA) aims to improve the global delivery of emergency care through research, education, and mentorship as well as to enhance SAEM's role as the international Emergency Medicine organization that augments, supports, and shares advances in global research, education, and mentorship.
What is in GEMA News? From The President Ian B.K. Martin, MD From The Editor Vicken Totten, MD From The President-Elect Scott Wiener, MD Report from the Fourth Inter-American Congress on Emergency Medicine Scott Wiener, MD First GEMA Awards at 2012 SAEM Annual Meeting Vicken Totten, MD The International Emergency Medicine Fellowship Consortium (IEMFC) Emergency Medicine In Brazil
Fernando Henrique Bergo de Souza e Silva, MD Marco Ant么nio de Carvalho Filho, MD, PhD
Effective, Sustainable Ultrasound Education for Rwandan Physicians - PURE Elizabeth Krebs Emergency Medicine Established in Lebanon Vicken Totten, MD Report of the Second International Preparedness and Response to Emergencies and Disasters Conference, January 15-19, 2012 Vicken Totten, MD Bits and NewsBites Vicken Totten, MD
From The President Ian B.K. Martin, MD
Greetings! This marks the third of a series of “From the President” installments which will appear in each issue of the GEMA Newsletter. This letter also marks the close of another successful Annual Meeting—this time in Chicago. For those of you could not attend the Annual Meeting, I will highlight the accomplishments of our inaugural year. I will also outline some future directions for this next year. One year in, I am proud to say we are strong as an organization and financially solvent. As of the Annual Meeting, GEMA has amassed nearly 160 members in total—making it the second largest of SAEM’s academies. With leadership from our Membership Committee, GEMA has already employed several strategies for increasing its own membership as well as that of SAEM by: • Proposing and implementing a tiered-dues structure to meet the financial challenges of members joining SAEM and/or GEMA from resource-limited countries; • Creating a presence at several major international Emergency Medicine conferences (e.g., the African Federation of Emergency Medicine’s conference in Cape Town); • Establishing a formal reciprocally promoting relationship between GEMA and Emergency Physicians International; • Collaborating with other SAEM entities to establish the first Chief Resident Forum International Scholarship bringing future leaders in EM from other nations to the Annual Meeting; and • Collaborating with SAEM on the formation of the International Outreach Task Force. As further evidence of our early success, we programmed over 12 hours of this year’s Annual Meeting in Chicago. This included the production of two high-quality didactics— one entitled, “Training the Trainers Who Train: A Workshop for Those Who Teach Emergency Medicine Elsewhere in the World” (soon to be submitted to Academic EM as an article) and the other, “More Than Just a Hobby: Building an Academic Career in Global Emergency Medicine”. Both attracted more than 65 audience members. We also, after years of leg work, hosted the first European Society for Emergency Medicine spotlight. It is worth mentioning, that
in return, the Europeans will host a similar event in Turkey this fall, spotlighting some state-of-the-art research by SAEM/GEMA members. GEMA has also led the way in the production of a consensus paper outlining safety guidelines for learners traveling abroad to do clinical rotations. This manuscript will soon be submitted for publication in Academic Emergency Medicine (AEM). As many of you are aware, 2013 AEM Consensus Conference is entitled, “Global Health and Emergency Care: A Research Agenda”, and GEMA has committed itself to being a major supporter of this endeavor. And finally, in terms of accomplishments, we held our first elections. Dr. Scott Weiner was elected our first President-Elect. I have to say that I can think of no more qualified person to assume the helm after my term as President. And because of our financial solvency, we were able to host a GEMA “Meet and Greet” at this year’s Annual Meeting. In addition, we were able to recognize the contributions of several GEMA members to the establishment of the organization as well as to the advancement of the field of Global Emergency Medicine at our first annual awards ceremony. Turning our attention to future directions, I outlined the following as goals for the 2012-2013 academic year: •Enrolling at least 70% of Global Emergency Medicine Fellowship Program Directors in GEMA—making it the de facto “home” for the fellowship programs; •Continuing to grow our international membership through many of the strategies described above; •Writing a humanitarian code of conduct as a guide for clinicians providing care, conducting research, or teaching abroad for publication; •Hosting a reception at the 2013 AEM Consensus Conference on Global Health research; Continue on next page
Continued from President page •Formalizing lines of communication to the International Federation of Emergency Medicine (IFEM) by way of SAEM; •Increasing communication with the American College of Emergency Physicians (ACEP) International Section leadership; and •Holding successful Executive Committee elections and assuring seamless transition of leadership May 2013. In addition, at this past Annual Meeting, I announced formation of the GEMA Benefits, Education, and Services Committee. This committee, to be chaired by Dr. David Walker (current GEMA Vice-President), will serve as a think-tank for the organization proposing and bringing to life innovative “products” and services for our membership. As I see it, this Annual Meeting marked the close of phase I of our organization—that is “getting it off the ground”. But as you can see, despite that being our focus, we have amassed many proud accomplishments as highlighted above. In transition to our organization’s next phase, the GEMA Benefits, Education, and Services Committee will play an integral role—assuring that our loyal members “get what they paid for”. Lastly, at our GEMA Business Meeting, I announced the launch of our “Adopt-a-Country / Region” Program. The idea of this endeavor is to create clinical, research, and educational synergies through combined efforts of members of GEMA. Again, this marks a shift in focus of our organization from infrastructure building (phase I) to production of needed, innovative services for our membership (phase II). I am excited to head into year two of our organization’s history. We have much to be proud of already, and I think, with our shift in focus to “products”, this next year will be better than our first year. Warmest regards, Ian B.K. Martin, M.D. FACEP Founder and President, GEMA
Attention Residents and Fellows!! Remember, in order for your FREE membership to GEMA to not be inturrupted you must renew your with your SAEM membership. Know someone interested in joining? Have them join by logging into their profile at www.saem.org. All questions regarding your SAEM or GEMA membership can be directed to membership@saem.org.
Save The Date May 15, 2013 2013 AEM Consensus Conference “Global Health and Emergency Care: A Research Agenda”
Atlanta, GA
From The Editor Vicken Totten, MD
Our third issue since our inception in 2011! This issue focuses on what GEMA’s activities were during the 2012 Annual Meeting. This was actually our first annual meeting. Last year we weren’t an academy until after the meeting. This year, we were a major component of the programming with our 4 offerings. The didactic on Training the Trainers Who Train Internationally has been written into a manuscript and will be submitted shortly to Academic EM. Watch for it!
breaking news is that the 14th AEM Consensus Conference will be on gender issues in emergency medicine. Other late-breaking news is that Sweden now has approval for a primary specialty of emergency medicine as of July of 2012, which will take effect in January 2013. Finland is expected to be the next European country to approve the specialty. Our next issue will have shorts from the ICEM and Scientific Assembly.
Even if you didn’t attend the Annual Conference, you can read about the GEMA awards, and updates from around the world. In this issue, you can read about the upcoming 13th Annual AEM Consensus Conference. Late-
Have a story to tell? Working internationally? Why not tell GEMA about it! Get your international voice heard with GEMA News. Also, it is said a picture is worth a thousand words. We welcome your submissions from around the globe! All article ideas and submissions can be sent to Vicken Totten, GEMA Editor for review and approval. Vicken.Totten@UHhospitals.org
From The President - Elect Scott G. Weiner, MD, MPH
As the president-elect of GEMA, I have been asked to write a brief summary about what to expect under my leadership. Before doing so, I wish to thank all of those involved in the nomination and election process, particularly Dr. Michael Runyon and Holly Gouin. Although I ran unopposed, the election process was innovative and efficient, and I believe that the model (including a personal statement and online YouTube video) will become a model for other academies as well. If you have had the chance to look at my embarrassing video, then you know my vision for the future of the organization. Overall, Dr. Ian Martin and I share a similar vision, so I hope to maintain the trajectory that he has established. In particular, when I think of what is in store for the future of GEMA, I think about the reasons that I, as a U.S. emergency physician, joined SAEM. As an academician, I was looking for four key factors that I had not found sufficient in the national specialty organizations. These factors were: educational resources, a home for EM fellowships, research opportunities and guidance, and academic mentorship. I envision that GEMA’s role is to carry these strengths of SAEM to emergency physicians internationally. Those of us on the executive board do not see SAEM as a U.S.specific organization, but one that can easily be global; GEMA is the key towards making this vision a reality. If we provide educational resources (including curricula, guidelines, easily exportable generic teaching lectures), provide a home for the international EM fellowships that exist around the world, provide exportable resources for proper research methodologies, and provide cross-cultural mentorship opportunities, then we will achieve our goal. Some specific ideas I have in addition to what we are already doing is to change the committee structure and get as many GEMA members as possible active in their areas of interest (fellowship, research, education and developing world). I also would like to have SAEM/GEMA sponsor the research forums held at various conferences around the globe. That is, I do not envision GEMA supplanting other organizations like EuSEM and IFEM that already run successful conferences, but rather, augmenting the effectiveness of the conferences they put on, by providing abstract judging, research forum moderators
and expert commentary about the research. This way we can advertise our strengths in academics to physicians around the world in a symbiotic fashion with other EM organizations. I also look forward to working closely with the founders of the Consortium of International Emergency Medicine Fellowships including Sassan Naderi and his group, who have created a website for their Consortium. GEMA fully endorses the Consortium, and by collaborating, I hope greater research and grant funding opportunities will become available. Finally, as I mentioned in my candidate video, I plan to leverage technology as much as possible. Since it is both financially and physically impossible to attend all of the various meetings which occur around the globe, I would like to investigate having web access to all of our conference calls and meetings (including the fantastic didactic sessions we hold) as a means of including those physicians who are not able to travel or attend conference calls (perhaps because of time difference or perhaps because they are the heroes who stay behind and cover the shifts so others can attend in person). Everyone must feel included in order for us to be successful. I am a strong believer that we must create valuable products and services which make worthwhile the additional membership fees that we all pay. The executive board and committees will continue with this as a primary goal. Finally, I am honored and humbled to accept this position. I am grateful to Ian Martin for setting such a fantastic example and hope to accomplish even half of what he has done in the position. I continue to look forward to working with him, David Walker and Vicken Totten on the executive board this year before becoming president at the annual meeting in 2013. For many of us, GEMA is a dream come true. For years we have discussed various projects surrounding global EM that could not get done because we lacked an organization infrastructure including administrative support and funding. Now that we have it, it’s time to accomplish our goals. I am always open to hear your thoughts and ideas as well! My e-mail address is sweiner@massmed.org.
Report from the Fourth Inter-American Congress on Emergency Medicine Scott Weiner, MD
The Inter-American Congress on Emergency Medicine was held in Buenos Aires, Argentina from May 16-18. The event was co-sponsored by the American Academy of Emergency Medicine (AAEM) and the Argentine Society of Emergency Medicine (SAE). This was the fourth iteration of this conference, and was a successful follow up to the previous Congress two years ago, at which the government announced its acceptance of EM as a primary training specialty in Argentina! The conference was again held at the Panamericano Hotel, which is directly across from Buenos Aires’ signature obelisk monument that commemorates the city’s founding. Overall, there were over 2000 attendees at the conference. The vast majority were pre-hospital and hospital-based physicians from Argentina, although there was representation from many other countries in South America, as well as participants from Europe, the Middle East, Australia and North America. The conference was divided into seven concurrent didactic tracks, including one English track that highlighted some of the most notable EM speakers including Drs. Judd Hollander, Nathan Kuppermann and Joe Lex. Intermixed with those speakers were EM experts from Argentina. Simultaneous translation into English or Spanish was provided at all times during that track, and the audience appeared to greatly appreciate the exchange of ideas that it offered. Several workshops were held during the conference, including an ultrasound workshop led by Dr. Gavin Budhram and an ED administration course led by Dr. Terry Mulligan. Both of these workshops were well-attended and participants gave positive feedback. I had the pleasure of co-chairing a research forum with Dr. Gary Gaddis. We had over 100 abstract submissions which were all presented orally and were featured over several hours at various times during the conference. Abstracts had been submitted from throughout the Americas in English, Spanish and Portuguese. Although many of the presented studies were simply case reports or observational studies, I noticed that the quality of the work has markedly improved in the two years since the last Congress, and is likely to continue to improve on a logarithmic pace. I wish to give hearty congratulations to Dr. Aaron Hexdall, the physician who was key in solidifying the relationship between U.S. and Argentine emergency physicians, and who was instrumental in organizing this conference over the past eight years. Dr. Hexdall
worked tirelessly with his Argentine colleagues Drs. Matias Fosco, Daniel Gonzalez, Silvio Aguilera and Edgardo Menendez; the conference was a resounding success. Although Dr. Hexdall has decided to step down from organizing future conferences, the very capable Dr. Gary Gaddis will continue in his footsteps. A highlight of the conference was a fantastic outing at an intimate restaurant where the company and conversation was great and the plates of delicious food coming from the kitchen seemed to be endless. If you have not experienced Buenos Aires, I strongly recommend that you make the trip, particularly for the fifth Congress which will take place in 2014.
First GEMA Awards
at the 2012 SAEM Annual Meeting GEMA had a great first year. In his “from the President” column, Dr. Martin has highlighted many of GEMA’s achievements. None of our accomplishments could have come to pass without the help of many, many persons. GEMA presented awards to some of the people who were instrumental in creating this Academy and forwarding its mission of moving SAEM into position as the foremost academic organization for emergency physicians throughout the world. Each year, GEMA will present 5 awards. This year, an additional 6 special recognition awards were given to the Advisors who helped make the Academy possible. The Special Recognition Awards were given to Dr. Kathleen Clem, Dr. Kenneth V. Iserson, Dr. Christine Houser, Dr. C. James Holliman, Dr. Mark Hauswald, and Dr. L. Kristian Arnold. Another one-time award was given by the GEMA board to Dr. Ian B.K. Martin, who worked tirelessly over that last 3 years to bring about the existence of the Academy. He was presented with the GEMA Founder's Award. Additionally, Dr. Martin gave GEMA Special Recognition Awards to Dr. Scott Weiner, Dr. Vicken Y. Totten, Dr. Kathleen Clem, and Ms. Holly Gouin, our SAEM staff liaison.
Annual Awards Annually, GEMA will present 5 awards to physicians who have made great contributions to international emergency medicine. Eligibility Criteria include being an active SAEM and GEMA membership.
Dr. C. James Holliman GEMA Lifetime Achievement Award
The GEMA Lifetime Achievement Award was given to Dr. C. James Holliman. This award is given to a GEMA member who consistently, over the course of his/her career, has embodied the GEMA ideal of improving the delivery of acute/emergent care the world-over through service, leadership, mentorship, and academic endeavor. This is GEMA’s highest honor awarded to a member and is reserved for an individual whose work serves as a beacon for all Emergency Physicians to follow. Few have been as active as Dr. Holliman has, for more than 30 years. Besides GEMA, Jim Holliman founded the Society for the International Advancement of Emergency Medical Care, has worked with the International Federation of Emergency Medicine and the US Army. He is professor of surgery and emergency medicine at M.S. Hershey Medical Center at Pennsylvania State University
where he is director of the Center for International Emergency Medicine, and director of the International Emergency Medicine Fellowship Program. Dr. Holliman received his medical degree from Washington University 1979 and completed his residency in general surgery from the University of Utah in 1983. In addition to working with SAEM, Dr Holliman serves on ACEP’s International Meetings Subcommittee, as secretary and newsletter editor for the Section of International EM and is co-editor for the Emergent Field Medicine book.
Dr. Mark Hauswald GEMA Academic Achievement Award The GEMA Academic Achievement Award was presented to Dr. Mark Hauswald. This award is given to a GEMA member who has made a significant contribution to the subspecialty of Global Emergency Medicine through investigative research and/or educational endeavors, and has at least 3 Global Health-related articles within the last 3 years. Dr. Hauswald has over 30 years of experience in emergency medicine. He is the Co - Director of Global Health Programs at University of Arizona, Professor Emeritus of Emergency Medicine, and Associate Dean Emeritus. He got his MD from UC San Francisco, MS from UC Berkeley, and a DTM&H in London. Dr. Hauswald is Associate Editor for International submissions for Academic EM. In the last 3 years he has published many articles with titles like, “The Haitian earthquake and academic emergency medicine, “International emergency medicine” and “Public health and emergency medicine.”
Dr. Bhakti Hansoti GEMA Young Physician Award
The GEMA Young Physician Award was given to Dr. Bhakti Hansoti. This award is given to a GEMA member at the medical student, resident, or fellow level, who has demonstrated commitment to the Academy and leadership potential. This awardee will have served GEMA with distinction during the year prior to being proposed for the award. Dr Hansoti is a Fellow in International Emergency Medicine. Initially from the UK, her subsequent training has been in the US. She has been very active in GEMA and attended most conference calls. She has served as
liaison between EMRA and GEMA. Together with Dr. Gabrielle Jacquet, she has created a directory of International EM fellowships. Incidentally, Dr. Hansoti also was awarded the Outstanding Resident of the year by the Academy for Women in Academic Emergency Medicine (AWAEM).
Dr. Adam Levine GEMA Humanitarian Service Award
The GEMA Humanitarian Service Award was given to Dr. Adam Levine. The GEMA Humanitarian Service Award is given to a GEMA member who has used specialty-specific skills to provide humanitarian assistance to distressed populations in a disaster situation. This award may also be given to an individual who has dedicated a significant portion of his/her career to providing charity clinical care in austere environments abroad and/or creating access to sustainable care. Dr. Levine is known to many for his blogs from Liberia during and after the war. Adam Levine's current research focuses on finding new tools for improving the diagnosis and management of dehydration in children with diarrhea, specifically in the developing world. He also serves as Editor-inChief for the International Emergency Medicine Literature Review, published annually in Academic Emergency Medicine, and has published many fine articles focusing on using EM specialty specific skills in austere settings.
Dr. Gunnar Öhlén GEMA EM Globalization and Advancement Award
The GEMA EM Globalization and Advancement Award was awarded this year to Dr. Gunnar Öhlén. This award is given to a GEMA member who has advanced the globalization of Emergency Medicine as a specialty, particularly to an individual who has helped establish or significantly further EM as a specialty in a country where it had not before been recognized. No one is more deserving of this than Dr. Öhlén. A GEMA member and a Swede, Dr. Öhlén is the immediate past-president of EuSEM. He was instrumental in establishing EM as a primary specialty in Sweden, a status achieved only this spring. Dr. Öhlén is a recognized expert at organizing congresses and meetings. According to The Meeting Planner: “Gunnar Öhlén puts his heart and soul, and a great deal of time and effort, into making Emergency Medicine an established specialist field throughout Europe.” He passionately believes that the ever-increasing expansion of medical knowledge requires ever more contact between experts from all over the world. These outstanding individuals are only a few of the many people who have been instrumental in furthering emergency medicine around the world. Fortunately, GEMA has many more to choose from for next year’s awards.
(l-r) Vicken Totten, Bhakti Hansoti and Ian Martin during the 2012 SAEM Annual Meeting - GEMA Awards presentation.
The International Emergency Medicine Fellowship Consortium (IEMFC) The Consortium met during ACEP’s Scientific Assembly in September, 2011. This Consortium was the brainchild of Terry Mulligan, (from the University of Maryland) and of Sassan Naderi and Kumar Alagappan, (from North ShoreLIJ). The idea for an International Consortium was first aired during the 7th NYC International EM Symposium in August 2010, and further fleshed out during subsequent meetings at the 2011 Scientific Assembly and again at the 8th NYC IEM Symposium in Aug 2011. The NYC International EM Symposia have become the de factor conferences for the International Fellowships. Interested participants came from as far away as South Africa, South America and Australia. The US military was represented; we learned that International Fellowships are now a DOD priority. The IEMFC hopes to be an umbrella organization, linking all of the over 30 IEM Fellowships in the USA, and the current 5 or more IEM Fellowships outside the US. The first question addressed by the attendees was: “Should the Consortium be a freestanding organization or should it be under some other organization?” The next was the proposed features of a website, and finally, funding was discussed. Dr. Sassan Naderi expressed his website suggestions. The website should be searchable, he said, and should house the list of all known International Fellowships. Each listed Fellowship should tell its history, and post information about where its members and graduates have worked. Each should share it’s focus is, and so on. The webpage should serve to communicate among the Fellowships, help the fellows find jobs after residency / fellowships, and be “the place” to look for an IEM Fellowship. It should be able to send automatic updating messages from members of the consortium – or at least from the institutions that sponsor the fellowship The webpage should be a way to communicate, and should be sophisticated. The website should serve as a clearing house. The Ultrasound Fellowship’s website was touted as a model. Proposed features would include: Jobs Wanted Fellows Wanted Grants Received Collaboration Requested Website finances were discussed. The website would require about $2500 to set up, and would require about the same on a yearly basis for maintenance. One potential source of maintenance revenue might be by “taxing” the member Fellowships; another might be from advertising jobs and persons seeking positions. Persons and sites that could handle the website were discussed; Logan Plaster’s list of Fellowships was praised.
Various potential umbrella organizations were discussed: IFEM, SAEM/GEMA; EPi, ACEP and the Australasian College. The sponsoring or umbrella organization might be willing to help defray some of the costs, but would also have to have a good IT team. The benefits of being an independent organization would be that the Consortium would be less regulated. However, if the Consortium were freestanding, it would still want to be linked to each of these (and other) organizations. Dr. Peter Cameron volunteered to post a link the Consortium on the IFEM Website. Drs. Kumar Alagappian, and Sassan Naderi agreed to collect suggestions for the website: Who, Which organizations, Which structure and functions, and What information should be presented. Interested persons should contact Sassan at sassan.naderi@ gmail.com and/ or and Terry at terrymulligan@yahoo.com.
We are delighted to present the first phase of the www. iemfellowships.com website! The website is ready for program directors and administrative assistants to enter their programs’ information. Feel free to check out the site today! We are fortunate to have had the website designed by an EM Physician who has very kindly charged us significantly less than the cost of making it. Payments can be made to the site developer directly by sending 1) the enclosed invoice (please fill in your name and program’s name) and 2) a check for $100 to : PSH Group, LLC 2818 Canterbury Road Columbia, SC 29204 Upon receipt of your payment toward the website design fee, we will email you your username and password so you can enter your program’s specific description and features into the website. The maintenance fee will be smaller in future years, and will be used toward developing and updating other aspects of the website. Once you receive your username and password, please try to enter your program information into the site as soon as possible; this will enable us to work out any kinks in the system before the IEM Symposium August 22-23 in NYC. At that point applicants will be able to apply using the website for this year’s application season! If you have any questions about this process or about the
site, please email gabrielle.jacquet@gmail.com
Emergency Medicine in Brazil
Fernando Henrique Bergo de Souza e Silva, MD & Marco Antônio de Carvalho Filho, MD, PhD Brazil is the largest country in South America. It covers of 8,514,876,599 sq Km, and boasts a population of 190.732.694 people (http://www.ibge.gov.br/home/). Medical training follows the European model, and Emergency Medicine is currently an emerging specialty.
Fortunately, during the last 2 years, Brazil has begun to realize that there is a need for a specialty of emergency medicine. Meetings and discussion have taken place between interested parties, including the Brazilian Medical Association and the responsible national authorities to recognize Emergence Medicine as specialty.
Potential physicians take the university entrance exam at the end of their secondary schooling. This exam determines which track a student will enter. Students apply separately to public and private universities, (depending on their interests and the availability of positions). They may, for example, use the same exam to apply to vacancies in schools of law, medicine, biological sciences, or humanities dependening upon what they want to do.
The Brazilian Association for Emergency Medicine (ABRAMEDE http://www.abramede.com.br/) is one entity that has been fighting for the recognition of Emergency Medicine as a specialty on the national scene. It counts on the support of institutions in other countries such as: The American Academy of Emergency Medicine, American College of Emergency Physicians, Canadian Association of Emergency Medicine, The College of Emergency Medicine – UK, the European Society of Emergency Medicine, the International Federation of Emergency Medicine and others.
As in many parts of the world, medical school is entered directly from high school. The entrance exam for medicine is the most competitive, with a candidate/vacancy ratio that can reach up 150 candidates per vacancy in one of the 186 Brazilian medical schools. The quality of teaching in the public universities, (which are free), is greater than that in most of the private universities (which also provide a high-quality service for the most part) and so the competition for public medical school is fierce. The medical school takes 6 years. Generally, there are 2 years of basic science and four years of clinical experience. At the end of these 6 years, the newly-minted physician can apply for the residency of their choice of specialty. Most residencies are “direct access” [‘categorical’, in our parlance –ed] (gynecology and obstetrics, pediatrics, dermatology, infectious diseases, neurology, neurosurgery, otolaryngology, ophthalmology, psychiatry, anesthesiology, occupational medicine, family medicine, pathology). Others, however, require clinical medicine/internal medicine and general surgery as prerequisite to entering a subspecialty area (e.g., endocrinology, cardiology after internal medicine; and urology, gastro surgery after general surgery). The majority of emergency medicine in Brazil (especially on the periphery of large cities) is provided by professionals who are not specially trained in emergency medicine or critical care. If fact, it is common to find recent graduated physicians and nurses staffing emergency rooms. In Brazil, there has traditionally been great resistance to recognition of emergency medicine as a bona fide medical specialty. In this scenario, trauma is the domain of general surgery; medical emergencies belong to clinical medicine/ internal medicine, etc. There are only two Brazilian states where specialty training in emergency medicine is offered. Rio Grande do Sul has had an emergency medicine training program for 15 years. The Ceara has had an EM training program for 4 years.
Some Brazilian physicians interested in emergency medicine seek training abroad and bring home their expertise. Others have gained their experience from practice. Either way, there is a long way to go; but we are on it!
Fernando Henrique Bergo de Souza e Silva, MD souzaesilvafhb@gmail.com Marco Antônio de Carvalho Filho, MD, PhD macarvalhofilho@gmail.com
Effective, Sustainable Ultrasound Education for Rwandan Physicians - PURE Elizabeth Krebs
I discovered Rwanda as a medical student, lucky enough to spend a month there on an elective rotation. Since that time, my interest in working to help these remarkable people to achieve their goals in development of their country has only grown. Now I am excited for this opportunity to tell all of you at GEMA about Rwanda and the project I am currently involved in, the Physicians Ultrasound in Rwanda Education initiative (PURE). The first thing that often comes to mind upon the mention of Rwanda is the horrific, 1994 Genocide of the Tutsis. In just 100 days it is estimated that 800,000 people were killed, and the country’s infrastructure was devastated . Just 18 years later, through the dedication, passion, and hard work of the government and people, Rwanda has made tremendous strides in development. English is widely spoken, as well as French and Kinyarwanda. Infrastructure for transportation improves every day, and Kigali has been recognized as one of the safest African capital cities . These factors have resulted in remarkable progress, and Rwanda has been recognized as one of the top 20 countries making progress towards achievement of the Millennium Development Goals. During my initial time in Rwanda I became friends with many young physicians, and we have remained close. I told them about my emergency medicine training, and they told me about their work as general practitioners staffing small, poorly equipped, overburdened, rural district hospitals. The great number of patients they cared for, with such limited diagnostics and assistance, was truly impressive. We found common ground on the subject of ultrasound; I was learning to use it at the bedside to care for my patients and they were noticing more and more of these machines showing up in donations to their hospitals. Unfortunately, they were of little use, since few people knew how to use them. Rwanda has a paucity of radiologists, and even fewer ultrasound technicians. My Rwandan physician friends and I agreed, this problem had a solution, thus began the process of building PURE. PURE has grown into a 501c3 nonprofit organization including over 130 emergency medicine physicians, radiologists, and others who are all dedicated to helping Rwanda design and execute a continuing medical education (CME) program to teach physicians to perform and interpret diagnostic ultrasounds at the bedside. Our guiding principles are that we work for Rwanda, to lend our skills to help authorities like the Ministry of Health and the National University of Rwanda to develop the kinds of educational programs that they see value in. PURE’s goal is to put ourselves out of business in Rwanda, by helping physicians in this country to develop their capacity so that ultimately ultrasound education can be executed by the National University of Rwanda independent of us. In the past year and a half, thanks to the hard work of my cofounder Dr. Trish Henwood and the dedication of so many
PURE volunteers, we have designed a curriculum in diagnostic bedside ultrasound that is limited enough to fit into a CME program and is focused on the medical problems most relevant to the Rwandan patient population. Barring any unforeseen complications, we will launch a pilot program of ultrasound training this summer on September 3rd, 2012. An additional goal of this pilot is to research the effectiveness of this CME program. Outcomes include assuring the competence of physician-trainees in ultrasound, determination of the optimal time and reinforcement of skills needed to help them achieve this competency, to validate the ability of a general practitioner to obtain and accurately interpret diagnostic-quality ultrasound scans, and to assess whether or not this educational opportunity and augmented ability to care for patients can increase physician job satisfaction in a resource-limited setting. The pilot program will begin with an intensive, two-week long training during which we will present the entire curriculum via didactics and practice scanning. Ultrasound is a skill that must be learned over time, and with plenty of hands-on time and one-on-one guidance. Therefore, we will send at least 5 trainers for that two-week period to educate 10-15 trainees who will all gather at one district hospital. The Ministry of Health requested that we train at least two physicians from each of Rwanda’s five provincial hospitals, so during the approximately five month follow up period, a trainer will visit each of the trainees’ home hospitals to reinforce skills, troubleshoot problems, and collect data. As part of achieving our goal of putting ourselves out of business in Rwanda, we will incorporate a “train the trainers” model. Over the course of this pilot we hope to identify particularly skilled and interested trainees who desire further education so that they can serve as trainers in subsequent programs. At the conclusion of the intensive introductory training we will begin follow up visits to the students home hospitals at two week intervals for the first 3 months, then monthly for the final 2 months. Monitoring and evaluation will occur continuously throughout the 5 month training period by analysis of trainee acquired scans and one-on-one evaluation to identify discrepancies in student knowledge and skills. At the start, at midpoint, and at the conclusion of the training, each trainee will be evaluated via both written and practical examinations to verify transfer of knowledge. PURE is planning to use the findings of this pilot program to guide the design of further ultrasound training for physicians in Rwanda, and to help guide the efforts of other institutions in resource-limited settings who want to administer a similar program. There is so much more I would love to tell each of you about this work if you’re interested in learning more. Rather than reading about it, please consider joining us! We are actively recruiting ultrasound trainers to travel to Rwanda for 2-3 week periods
continued from Effective, Sustainable Ultrasound
between September 2012 and February 2013. PURE is a dynamic group and we are always looking for new talent and perspectives to continue building this organization. You can find more information on our website,
http://www.ultrasound-rwanda.org or feel free to contact me by email at krebse@gmail.com. Elizabeth Krebs, MD CEO, Founder – PURE Duke University Medical Center Global Health Fellow - Emergency Medicine
http://news.bbc.co.uk/2/hi/1288230.stm http://www.africaanswers.com/destinations/kigali Millennium Development Goals Report Card: Measuring Progress Across Countries. Steer M, Levy S. Overseas Development Institute. September 2010.
Emergency Medicine Residency Established in Lebanon Vicken Totten, MD
The American University of Beirut Department of Emergency Medicine (EM) is proud to announce that it will welcome its first four EM interns in July 2012 to a brand new 4-year Emergency Medicine Residency Training Program. The Lebanese match program was modeled on the NRMP in the United States. This first EM match involved 453 applicants from 30 countries and EM matched its 4 interns out of its top 4 choices. This Residency is a historical milestone for Lebanon. This program will be the first properly supervised emergency medicine residency training in the country. This achievement was only made possible through the diligent hard work, passion and vision of Dr. Amin (Antoine) Kazzi, the founding chair and program director, who has worked relentlessly to establish the department and specialty. Thanks to the hard work of its core group of faculty founders, this program will graduate great clinicians and leaders in the field for years to come. The first residency director is Dr. Gilbert Abou-Dagher, and Dr. Eveline Hitti is the interim Chair. They will be taking this new residency program & the 5-year-old Department of Emergency Medicine up to the next phase: a flourishing academic department and training program – one that is committed to excellence in clinical service, education, administration and scholarly activity. Additional founders of this residency program include 2 additional ABEM-certified full-time faculty members: Dr. Mazen El-Sayed & Dr. Afif Mufarrij. They are respectively the Director of Operations and of Quality. These repatriated physicians have impressive credentials. Dr. Eveline Hitti and Dr. Kazzi both studied, then trained at Hopkins/Hopkins and at UCLA/Henry Ford. Dr. Afif Mufarrij and Dr. Gilbert Abou-Dagher trained at Henry Ford, and Dr. Mazen El-Sayed at the University of Maryland. They are soon going to be joined by Dr. Kim Medlej recently of New York. Dr. Kazzi is becoming more involved in hospital administration, assuming additional responsibilities as the AUB Medical Center Deputy Chief of Staff. In addition to his clinical duties, he plans to focus on addressing national issues of significant importance to our patients and to the specialty. These issues especially include: --Establishing an EM-specialist professional society --Revising national regulations to secure the proper credentialing of EM specialists & the establishment of a properly accredited specialty certification. --Securing proper categorization of EDs, EM services & hospitals, based on the capacities of their departments of Emergency Medicine, Trauma and Critical Care (absent in Lebanon)
I hope you will join me to welcome another excellent Emergency Medicine Residency Program, and its faculty and residents, and that you continue to support the development of EM throughout the world. ak63@aub.edu.lb; aub-fm-acad@aub.edu.lb; aub-residents@ aub.edu.lb; aubmc@aub.edu.lb; aub-s-fm3@aub.edu.lb; aub-sfm4@aub.edu.lb; aub-s-nu@aub.edu.lb
Report of the Second International Preparedness and Response to Emergencies and Disasters Conference, January 15-19, 2012 Vicken Totten, MD
The Second International Preparedness and Response to Emergencies and Disasters Conference (IPRED II) was held January 15 to 19, 2012 in Israel, and was a huge success. The First IPRED had been held in Tel Aviv, in January 2010. There were over 700 registrants at the conference from a total of 44 different countries. January 15 to 17 the conference was held at the David Intercontinental Hotel in Tel Aviv. Featured American plenary speakers included Dr. Nicole Lurie, representing the U.S. government, and Dr. Art Kellerman of the RAND Foundation. A large number of additional speakers provided multiple international perspectives on planning for and operating disaster and mass casualty responses. The third day of the conference was a large scale disaster exercise called Black Cloud 1, simulating the response to and management of a radiologically contaminated bomb
explosion with multiple simulated casualties. The exercise was conducted mainly in the northern Israeli city of Haifa, utilizing Carmel Hospital as the main simulated patient treatment site. Conference participants also received a guided tour of the Israeli national ambulance service Magen David Odom. All the conference participants are looking forward to the next IPRED which hopefully will be held in 2014 if not sooner.
Bits & NewsBites Vicken Totten, MD
Harvard announces the launch of the re-designed Harvard Affiliated Disaster Medicine/Emergency Management Fellowship website: www.HarvardDisasterMedicine.org. This program caters to the international community and provides comprehensive educational programs, from the full 1-2 year Fellowship to one month Concentrations in specific areas. In addition, an online program is scheduled to be released by the end of August. The website is still a bit of a work in progress so please check back for updates and contact us with any thoughts or inquiries. Sweden announces that Emergency Medicine is now a primary specialty rather than a supra-specialty.
Please send your brief announcements for inclusion in the next newsletter.