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Emergency Medicine Training in LDCs

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Slides and speaker notes from a talk on Emergency Medicine Training in LDCs, using examples from PMG, Nepal and Botswana. The talk was given by Dr Chris Curry FACEM at the 2011 ACEM ASM.

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Emergency Medicine Training in LDCs

  1. 1. Emergency Medicine Training PNG and Nepal – examples from least developed countries Chris Curry Assoc. Professor, University of Western Australia Fremantle Hospital
  2. 2. contentsLeast developed countriesEM program structuresCurriculaBotswanaSupervisionAssessment
  3. 3. Least Developed Countries UN 2010Africa :33 of 48 LDCs, of 58 African countriesAngola Ethiopia NigerBenin Gambia RwandaBurkina Faso Guinea Sao Tome andBurundi Guinea-Bissau PrincipeCentral African Lesotho SenegalRepublic Liberia Sierra LeoneChad Madagascar SomaliaComoros Malawi SudanCongo Mali TogoDjibouti Mauritania UgandaEquatorial Guinea Mozambique TanzaniaEritrea Zambia
  4. 4. Least Developed Countries UN 2010Asia : 8 of 48 LDCsAfghanistan LaosBangladesh MyanmarBhutan NepalCambodia Yemen
  5. 5. Least Developed Countries UN 2010Pacific : 6 of 48 LDCsKiribati Timor-LesteSamoa TuvaluSolomon Islands Vanuatu(Haiti makes 48)
  6. 6. Human Development Index HDI• “A composite index measuring average achievement in three basic dimensions of human development—a long and healthy life, knowledge and a decent standard of living.” Human Development Report 2011 (published 2nd November)• Papua New Guinea – 153 out of 187 countries• Nepal – 157 out of 187 countries
  7. 7. Australia : 2 of 187
  8. 8. PNG : 153 of 1871980 – 2010: HDI rose 1.3% annually
  9. 9. Nepal : 157 of 1871980 – 2010: HDI rose 2.4% annually
  10. 10. Australiahttp://hdr.undp.org/en/data/profiles/
  11. 11. PNG
  12. 12. Nepal
  13. 13. Health indicators Australia PNG NepalGDP per capita $40,286 $2,395 $1,189(US$ 2008)Maternal mortality 8 250 380/100,000 live births = 1 in 12,500 = 1 in 400 = 1 in 263Under 5 mortality 6 69 51/1000 livebirths = 1 in 167 = 1 in 14 = 1 in 20
  14. 14. rural populations overcrowding in EDslimited resources in EDs
  15. 15. ED Bed Occupancy at 3pm, 13Nov. Bed No. Male Female Total 1 1 2 3 2 1 1 2 3 2 2 4 4 1 2 3 5 2 2 6 1 3 4 7 2 2 4 8 1 1 2 9 2 1 3 10 2 1 3 11 2 1 3 12 1 1 13 2 2 14 1 1 15 1 1 Total 15 Total 38
  16. 16. Program managementPNG Postgraduate Committee School of Medicine and Health Sciences University of Papua New GuineaNepal Institute of Medicine Tribhuvan University Teaching Hospital Tribhuvan University
  17. 17. Years of training Australasia PNG Nepal (IOM)undergraduate 4-6 5 4.5PGY1 intern intern internPGY2 RMO intern MOPGY3 Provisional MO MD GPPGY4 Advanced MO MD GPPGY5 Advanced MMedEM MD GPPGY6 Advanced MMedEM DM EMPGY7 Advanced MMedEM DM EMPGY8 (or more) MMedEM DM EMPGY9 (or more)PGY10
  18. 18. PNG MMedEMrotations months concurrentsurgery 12 Part 1 exams (surgery)medicine >4 Research projectpaediatrics >4O&G >4anaesthesia >4emergency department >6ENT 1ophthalmology 1Diplomas: child health, 12G&O, anaesthesia eachTOTAL 4-6 years Part 2 exams
  19. 19. Nepal MD GProtations months concurrentsurgery (4) + ortho (2) 6 dermatology 10 x ½ daymedicine 6 oral 10 x ½ daydistrict hospital 6 forensic 10 x ½ daypaediatrics 5 ENT 10 x ½ dayO&G 4 ophthalmology 2 weeksED + GP OPD 4 family practiceanaesthesia 3 imagingpsychiatry 1elective 1
  20. 20. Nepal DMs and MChsDoctor of Medicine Master of Chirurgie (Surgery)cardiology cardiothoracic and vascular surgerynephrology urologygastroenterology gastroenterologic surgeryneurology neurosurgery
  21. 21. Nepal DM EMrotationsmonths concurrentemergency 24 research thesis proposal in first 6 monthsanaesthesia 3ICU 3elective 6 complete in 36 months
  22. 22. Curricula• PNG - ACEM curriculum - Contents of PNG guides for acute care – medicine, paediatrics, O&G - 35 pages• Nepal - IFEM model curricula – undergraduate and postgraduate. (EMA 2011; 23: 541-553) - 34 pages
  23. 23. IFEM model curriculum“..these (17) seemingly different curricula specify nearly the same specialist with nearly the same competencies, despite differences in length, style and content....the epidemiology and caseloads of patients who present to EDs around the world show many more similarities than differences.” (EMA 2011; 23: 527)
  24. 24. Development of Emergency Medicine in Botswana Developpement de la medecine d’urgence au Botswana Ngaire Caruso *, Amit Chandra, Andrew Kestler Department of Emergency Medicine, University of Botswana School of Medicine, Private Bag 00713, Gaborone, Botswana Available online 12 September 2011
  25. 25. Botswana: 118 of 187
  26. 26. Botswana
  27. 27. Australia 2 Botswana 118PNG 153 Nepal 157
  28. 28. Australia 2 Botswana 118PNG 153 Nepal 157
  29. 29. Health indicators Australia Botswana PNG NepalGDP per capita $40,286 $12,154 $2,395 $1,189(US$ 2008)Maternal 8 190 250 380mortality/100,000 live = 1 in 12,500 = 1 in 526 = 1 in 400 = 1 in 263birthsUnder 5 6 57 69 51mortality/1000 live = 1 in 167 = 1 in 18 = 1 in 14 = 1 in 20births
  30. 30. Botswana MMedEMrotations months concurrentemergency 30 researchsurgery (1) + ortho (2) 3medicine 3anaesthesia 3ICU 3paediatrics 3O&G 2prehospital 1
  31. 31. Comparison PNG, Nepal, Botswana PNG Nepal BotswanaEntrance PGY5 PGY3 PGY3 Minimums (months)emergency 6 30 30surgery 12 6 3medicine >4 6 3anaesthesia/ICU >4 (12) 9 6paediatrics >4 (12) 5 3O&G >4 (12) 4 2district hospital 6 1/prehospitalothers 2 7Totals 48-72 72 48
  32. 32. SupervisionPNG HODs of surgery, medicine, paediatrics, O&G, anaesthesia, visiting emergency physiciansNepal professor of GP&EM HODs of rotationsvisiting emergency physicians ?Botswana emergency physicians x4 (FACEM x2)
  33. 33. ACEM contributors to PNG over a decade Peter Aitken, Jamie Hendrie, Luke Pritchard, Michael Augello, Jack Hodge, Sandra Rennie, Colin Banks, Rachel Hoyle, Guy Sansom, Peter Barnett, Phil Hungerford, Nick Ryan, Michael Bastick, Sandy Inglis, Niall Small, Andrew Bezzina, Simon Jensen, Paul Spillane, Antony Chenhall, Pip Keir David Symmons, Chris Curry, John Kennedy, Peter Thompson, Will Davies Farida Khawaja Ric Todhunter, Katrina Dening Chris Kruk, Greg Treston, Andrew Dent, Marian Lee, Chris Trethewy, Steve Dunjey, Sally McCarthy, Simon Young, David Eddey, Mark Millar, Bryan Walpole, Jeremy Furyk, Gerard O’Reilly, James Wheeler, Steve Grainger, Georgina Phillips, Danielle Wood, Naren Gunja, Kate Porges, Matthew Wright, x 48
  34. 34. Assessment• PNG Part 1 – surgery Part 2 – SAQ, VAQ, cases x8, vivas x5 (similar to ACEM) Visiting examiner – FACEM• Nepal MD (most likely GP) Annual SAQ, MCQ. Final exams including cases x4, vivas x4 Visiting examiner• Botswana South African system
  35. 35. Summary• LDCs operate within challenging constraints• Increasingly, they want to improve delivery of acute care• They need to build programs and processes within their own structures and resources• They can borrow extensively from other sources, and modify• EM competencies are similar everywhere• FACEMs can contribute usefully
  36. 36. Conclusions• “the emerging role of International Emergency Medicine should be to suggest and inform standards and final competencies, leaving the fine details of selection, training, methods and evaluation to individual countries...”Mulligan T, Hobgood C, Cameron P. EMA 2011; 23: 528• LDCs benefit from EP contributions made in-country• EPs contributing from more developed systems may have more to learn than to teach.
  37. 37. ,Thank you
  • BaisiLajaOlaogun

    Apr. 26, 2019
  • AndrewThomas196

    Oct. 23, 2016
  • bishanrajapakse

    Dec. 12, 2011

Slides and speaker notes from a talk on Emergency Medicine Training in LDCs, using examples from PMG, Nepal and Botswana. The talk was given by Dr Chris Curry FACEM at the 2011 ACEM ASM.

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