The document discusses the development of post-graduate programs in emergency medicine in India. It provides an overview of the current status of emergency medicine in India, noting that it is a nascent specialty with few formally trained emergency physicians. It also outlines some of the key milestones in the development of emergency medicine services in India, including emergency medicine being recognized as a separate specialty by the Medical Council of India in 2009. The document examines the limited number of post-graduate seats for emergency medicine programs compared to other specialties and the large scope for further growth of emergency medicine in India given the country's health needs.

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Development of Post Graduate Program in Emergency Medicine in
India: Current Status, Scope and Career Pathways

2. Astrocyte ¦ Oct-Dec 2014 ¦ Volume 1 ¦ Issue 3218
New Frontiers
Medical Education
Introduction
Emergency medicine (EM) is a recognized medical specialty
in over 60 countries, and this is growing in low and middle-
income countries. Recent epidemiologic and demographic,
public health data highlight the growing need for EM services
that can include management of trauma, acute care and
pediatric emergencies. Many low-and middle-income countries
are devising EM training programs to address the needs of
local communities who increasingly desire these services on a
round-the-clock basis to help stabilize and dispose of patients
as per their medical needs.
The International Federation for Emergency Medicine (IFEM)
defines EM as a field of practice based on the knowledge and
skills required for the prevention, diagnosis and management
of acute and urgent aspects of illness and injury affecting
patients of all age groups with a full spectrum of episodic
undifferentiated physical and behavioral disorders. IFEM
further encompasses an understanding of the skills needed to
develop EM services and includes the need for prehospital and
in-hospital emergency medical systems to manage patients
properly.[1]
Currently in India, a few hospitals have well-structured EM
departments, but they often still want for formally qualified
EM faculty. Medical emergencies are usually managed by
residents pooled from other various specialties, such as General
Surgery or Medicine, and initial assessment and a plan-of-care
for the patient can vary depending on which specialty doctor is
called when a patient presents. External issues such as lack of
infrastructure, manpower, and equipment and training facilities
further compound the challenge of managing emergency care.
As the establishment of Emergency Department (ED) in
various public and private hospitals is increasing in India,
the need for physicians specifically trained in EM is also
accelerating. Developing a comprehensive and recognized
EM program for training physicians in India must occur
simultaneously to meet demand for emergency care services.
Current Status of Emergency Medicine in India
In India, EM is a nascent specialty and there are very few
formally trained emergency physicians, and most EM
physicians are concentrated in institutes that have supported
EM’s growth. In many of the hospitals the services provided
are called “Casualty Centers” and often are staffed by junior
physicians who usually do not have specialty qualification in
EM.Additionally medically staffed ambulances, which provide
pre-hospital care, are often privately owned and operate on a
fee-for-service basis that is often not coordinated within the
operational or catchment area.
The milestones that have been achieved in the field of EM and
EM Services in India till date are given in Table 1.[2,3]
Emergency medicine was recognized as a separate specialty
by Medical Council of India on July 21, 2009. The first
Development of Post Graduate Program in Emergency Medicine
in India: Current Status, Scope and Career Pathways
Manish Jain, Bipin Batra, Elizabeth G. Clark1
, Tamorish Kole2
National Board of Examinations, Medical Enclave, Ansari Nagar, 2
Max Healthcare, 2, Press Enclave Road, Saket, New Delhi,
1
Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
Recent epidemiologic and demographic public health data highlight the growing need for emergency medicine (EM) services in India and
highlight its importance as a recognized medical specialty. Developing a comprehensive and recognized EM program for training physicians
in India is of utmost priority and should not be neglected at any point of time. This review article attempts to highlight the development of a
post-graduate program in EM in the country.
Key words: Emergency medicine, development, postgraduate program
Abstract
Address for correspondence: Dr. Manish Jain,
National Board of Examinations, Medical Enclave, Ansari Nagar,
New Delhi - 110 029, India. E-mail: Manish.mjonline@gmail.com
Access this article online
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DOI:
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3. Jain, et al.: Post Graduate Program Development of Emergency Medicine in India
Astrocyte ¦ Oct-Dec 2014 ¦ Volume 1 ¦ Issue 3 219
program of MD-EM was started in Sri Ramachandra Medical
College and Research Institute, Chennai with an initially
six seats being approved by the Government of India as per
provisions of IMC Act. At present various universities in
India offer 48 seats in MD-EM at 24 Institutions across India
as shown in Table 2.[4]
Of the total 23,075 seats offered for Post Graduate Medical
Courses, MD-EM comprises only 48 seats out of them.[4]
A
descriptive figure showing the number of PG seats offered
in some of the other disciplines is shown in Figure 1. On
the comparison, it is found that EM offers only 0.21% of the
total PG Medical seats available in the country. A subject
wise comparison the number of seats being offered in EM as
compared to other disciplines is as follows:
• General medicine: 2.05%
• General surgery: 2.26%
• Anesthesia: 3.09%
• Orthopedics: 4.95%
• Radiology: 6.28%
• Psychiatry: 11.54%
• Pulmonary medicine: 14.59%.
In addition to above, certain foreign universities like George
Washington University, Washington and UpState Medical
University, New York have also been running PG training
programs in EM in the country.
Scope of Emergency Medicine in India
The scope for growth of EM in India is quite large and this
relatively new service line needs to be carefully managed
in order to fully take-off and meet the needs of the Indian
population. India has a significant requirement for EM services
due to the high prevalence of infectious diseases, symptoms
resulting from chronic diseases such as complications from
diabetes, cardiovascular disease, and traumatic injury.
At present, the lack of an appropriate referral system in
India results in many patients presenting at secondary and
tertiary care emergency care centers, and as a result these
EDs are crowded and over-burdened with problems, which
can be better managed at out-patient care settings. Better
coordination of care and explaining to the public what truly
Table 2: MD-EM in India: Current Status
Name of Medical College/Medical Institution State Annual
intake
(seats)
Kamineni Institute of Medical Sciences,
Narketpally
Andhra
Pradesh
2
Narayana Medical College, Nellore Andhra
Pradesh
2
P.E.S. Institute Of Medical Sciences and
Research, Kuppam
Andhra
Pradesh
2
Sri Venkateswara Institute of Medical Sciences,
Tirupati
Andhra
Pradesh
2
Gauhati Medical College, Guwahati Assam 2
B.J. Medical College, Ahmedabad Gujarat 2
Government Medical College, Surat Gujarat 2
Medical College, Baroda Gujarat 1
Smt. N.H.L.Municipal Medical College,
Ahmedabad
Gujarat 2
JJM Medical College, Davangere Karnataka 3
JSS Medical College, Mysore Karnataka 2
Kempegowda Institute of Medical Sciences,
Bangalore
Karnataka 2
S S Institute of Medical Sciences and Research
Centre, Davangere
Karnataka 3
St. Johns Medical College, Bangalore Karnataka 1
Vydehi Institute Of Medical Sciences and
Research Centre, Bangalore
Karnataka 2
Academy of Medical Sceiences, Pariyaram,
Kannur
Kerala 2
Amrita School of Medicine, Elamkara, Kochi Kerala 2
Government Medical College, Kozhikode, Calicut Kerala 2
Jubilee Mission Medical College and Research
Institute, Thrissur
Kerala 2
Mahatma Gandhi Missions Medical College,
Navi Mumbai
Maharashtra 2
Padmashree Dr. D Y Patil Medical College,
Pimpri, Pune
Maharashtra 2
Padmashree Dr. D.Y.Patil Medical College,
Navi Mumbai
Maharashtra 2
SRMC, Chennai Tamil Nadu 2
Vinayaka Missions Kirupananda Variyar Medical
College, Salem
Tamil Nadu 2
SRMC: Sri Ramachandra Medical College and Research Institute
Table 1: Milestones Achieved in the Field of EM and EM
Services in India
Year Milestone
1971-1988 MCI recommendations on postgraduate Medical Education
1971 (revised up to 1988), showed that Accidental and EM
was a recognized MD degree. It was listed as the 24th
specialty
1994 First Academic EM Department setup at CMC Vellore
1994 SRMC Chennai started a formal Emergency Department on
23rd
August, 1994. It later became the first institute in India
to offer the MD in EM
1997 Apollo Hospital, Hyderabad, started a formal Emergency
Department. It later became the first institute to start UK-
affiliated EM programs and an easy access number 1066 for
ambulance service
2000 SEMI registered as a nonprofit
2006 Vinayaka Mission University, Salem started MD-EM program
which later expanded to other affiliated medical colleges
2007 An American-supported program for EM training started
at two hospitals in Kerala with Indo-US EM partnership,
which later extended to 7 sites
2009 EM was recognized as an MD discipline and was added as
the 30th
discipline for MD on 21st
July, 2009
2013 National Board of Examinations introduced DNB-EM
2014 First batch of DNB-EM constituting of 45 seats in 14
institutions across the country was placed in various
accredited institutions
2014 Indian College of EM formed
MCI: Medical Council of India, SRMC: Sri Ramachandra Medical College
and Research Institute, EM: Emergency Medicine, SEMI: Society for
Emergency Medicine in India, DNB-EM: Diplomate of National Board
Emergency Medicine

4. Jain, et al.: Post Graduate Program Development of Emergency Medicine in India
Astrocyte ¦ Oct-Dec 2014 ¦ Volume 1 ¦ Issue 3220
Career Pathways in Emergency Medicine
Emergency Medicine as a career choice offers many benefits
to doctors wishing to pursue this specialty. The economic
opportunities are strong for an EP in a secondary or tertiary
care setting. Remuneration for EPs is high compared with other
specialties (MD/MS) as shown in Table 3.[9]
Launch of DNB-emergency medicine 2013
The National Board of Examinations assessed the following
aspects of EM before approving a post graduate program in EM:
• Global trends and current status of EM
• Emergency medicine in India: Current status
• Emergency medicine in India: Career pathways for
graduates
• An approach to curriculum for EM in Indian context
• Program development in EM, accreditation for faculty
development.
An expert committee also recommended the significant impact of
the DNB EM program on the quality of emergency medical care
servicestothepublicat-large.Theyalsosupportedthedevelopment
of career pathways for medical graduates with a 3-year Post
GraduateDNBEMprogramandcalledfortheimplementationby
the National Board of Examinations on a priority basis.[10]
The National Board of Examinations at present offers 66 seats
in DNB-EM at 20 institutions across India as shown in Table 4
(as in November 2014).
constitutes a medical emergency needs support from all
levels of government as well as the hospital and doctors who
provide care.
The experience of International EM suggests that the
development of EM goes through three stages called the “EM
development pyramid” as shown in Figure 2.[5-8]
Stage-I or primary development consists of academic and
clinical EM and patient care systems development. This will
result in upgrading the present causality departments into
well-equipped and autonomously functioning ED manned by
trained emergency physicians (EP).
Stage-II or secondary development involves administrative
and managerial training, financial and economic systems
development, reimbursement and systems analysis.
Stage-III or tertiary development looks at macro issues such
as health legislation, health policy, public health systems/
agendas, patient safety and acute healthcare as a human right.
Development of these three stages overlap, and ideally
should run concurrently. Though the development of EM has
broad similarities all over the world, blind adoption without
validation in the Indian population will be unsatisfactory,
given India’s unique epidemiology, geography, and cultural
and economic diversity.
Figure 1: Total number of postgraduate seats in Medical Council of India
recognized colleges.
Figure 2: Emergency medicine development pyramid.
Table 3: Pay Offered to EP
Place Pay
Metro cities (Mumbai, Chennai, Bangalore, New
Delhi, Kolkata, Hyderabad)
6.25–15.60 lakhs/
annum
Nonmetro major cities (Bhubaneswar, Ahmedabad,
Madurai, Pondicherry, Guwahati, Ludhiana)
5.75–8.76 lakhs/
annum
United Kingdom 75000 GBP/annum
United Arab Emirates 900,000 AED/
annum
EP: Emergency physicians

5. Jain, et al.: Post Graduate Program Development of Emergency Medicine in India
Astrocyte ¦ Oct-Dec 2014 ¦ Volume 1 ¦ Issue 3 221
skills in other aspects of EM, which they may not currently
possess with a proposed faculty training program
• The need for a post graduate program in EM is strong,
and this program has a potential to offer approximately
1000 Post Graduate seats per annum in the country
• The introduction of EM can help make healthcare services
more accessible and inclusive for patients and create job
opportunities in the field of EM including new roles for
doctors, nurses and allied health professionals.
Summary
• Need of nurturing as a “specialty of medicine”
• Adopting minimum standards to ensure effective and
quality delivery of services to patients
• Program development to follow international standards
and be adapted to local needs
• Introduction of faculty training and development programs
is critical
• Commitment to creating free standing Departments of EM
• This program has a potential to offer approximately 1000
post graduate seats per annum in India
• The introduction of EM can help make healthcare services
more accessible and inclusive for patients and create job
opportunities in the field of EM including new roles for
doctors, nurses and allied health professionals.
References
1. Available from: http://www.ifem.cc/About_IFEM.aspx. [Last accessed
on 2014 Dec 04].
2. Alagappan K, Cherukuri K, Narang V, Kwiatkowski T, Rajagopalan A.
Early development of emergency medicine in Chennai (Madras), India.
Ann Emerg Med 1998;32:604-8.
3. David SS, Vasnaik M, Ramakrishnan TV, Emergency medicine in
India: why are we unable to 'walk the talk'? Emerg Med Australas. 2007
Aug;19(4):289-95.
4. Available from: http://www.mciindia.org/InformationDesk/CollegesCourses
Search.aspx. [Last accessed on 2014 Dec 08].
5. Mulligan T. ED Development in Netherlands, Emergency Physicians
Monthly; July 20, 2010.
6. Das AK, Gupta SB, Joshi SR, Aggarwal P, Murmu LR, Bhoi S, et al.
White paper on academic emergency medicine in India: INDO-US Joint
Working Group (JWG). J Assoc Physicians India 2008;56:789-98.
7. Subhan I, Jain A. Emergency care in India: The building blocks. Int J
Emerg Med 2010;3:207-11.
8. Rajavelu P, Rajagopala A. Need for Epidemiology for Indian EM: An
Evidence Based Approach, EMS India.
9. Available from: http://www.emergencymedicine.in. [Last accessed on
2014 Dec 04].
10. Emergency Medicine-Programme Development by NBE: Report of
Consultative Meeting.
Recommendations
• Emergency medicine as a discipline needs nurturing as a
medical specialty
• Both public and private sector hospitals must adopt
minimum standards for establishing and managing
Departments of EM and the establishment of minimum
standards shall ensure effective and quality delivery of
services to the patients as monitored by key performance
indicators
• Program development of Indian EM training must be
customized to the local burden of disease
• Emergency medicine programs in India must adopt
global best practices as is appropriate to serve the local
community
• Introduction of training and development programs for
faculty and residents of EM is a highly important need
because there are very few physicians specifically trained
as EPs
• For EM to progress in India, academic institutions must
commit to creating free standing Departments of EM,
with dedicated faculty focused on developing a career in
EM. This faculty, initially arising from diverse medical
fields, can develop their faculty skills by sharing acute care
knowledge from their respective fields while developing
How to cite this article: Jain M, Batra B, Clark EG, Kole T. Development
of post graduate program in emergency medicine in India: Current status,
scope and career pathways. Astrocyte 2014;1:218-21.
Source of Support: Nil. Conflict of Interest: None declared.
Table 4: DNB - EM in India: Current Status
Hospital/Institute State Number
of seats
Ananthapuri Hospitals and Research Institute Kerala 2
Apollo Hospital Karnataka 4
Apollo Hospital Tamil Nadu 4
Apollo Hospital Andhra Pradesh 2
Apollo Super Specialty Hospital Tamil Nadu 2
Bangalore Baptist Hospital Karnataka 4
Deenanath Mangeshkar Hospital and
Research Centre
Maharashtra 4
Fortis Hospital Uttar Pradesh 3
Jehangir Hospital Maharashtra 3
Kerala Institute of Medical Sciences Kerala 4
Lourdes Hospital Kerala 4
Malabar Institute of Medical Sciences Ltd. Kerala 4
Manipal Hospital Karnataka 4
Max Super Specialty Hospital Delhi 3
Max Super Specialty Hospital Delhi 2
MES Medical College and Hospital Kerala 4
Narayana Hrudayalaya Karnataka 4
Pushpagiri Institute of Medical Sciences and
Research Centre
Kerala 4
Yashoda Hospital Andhra Pradesh 3
Yashoda Super Specialty Hospital Andhra Pradesh 2
DNB-EM: Diplomate of National Board Emergency Medicine