|
 
 |
| MEDICAL EDUCATION: NEW FRONTIERS |
|
| Year : 2014 | Volume
: 1
| Issue : 3 | Page : 218-221 |
|
Development of post graduate program in emergency medicine in India: Current status, scope and career pathways
Manish Jain1, Bipin Batra1, Elizabeth G Clark2, Tamorish Kole3
1 National Board of Examinations, Medical Enclave, Ansari Nagar, New Delhi, India
2 Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
3 Max Healthcare, 2, Press Enclave Road, Saket, New Delhi, India
| Date of Web Publication | 27-May-2015 |
Correspondence Address:
Manish Jain
National Board of Examinations, Medical Enclave, Ansari Nagar, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2349-0977.157766
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. Keywords: Emergency medicine, development, postgraduate program
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 |
How to cite this URL:
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 [serial online] 2014 [cited 2023 Jun 4];1:218-21. Available from: http://www.astrocyte.in/text.asp?2014/1/3/218/157766 |
| 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]  | Table 1: Milestones Achieved in the Field of EM and EM Services in India
Click here to view |
Emergency medicine was recognized as a separate specialty by Medical Council of India on July 21, 2009. The first 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: | Figure 1: Total number of postgraduate seats in Medical Council of India recognized colleges.
Click here to view |
- 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 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],[6],[7],[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.
| 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 services to the public at-large. They also supported the development of career pathways for medical graduates with a 3-year Post Graduate DNB EM program and called for the implementation by 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).
| 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 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. | |
| 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. | |
| 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 : I0 NDO-US Joint Working Group (JWG). J Assoc Physicians India 2008;56:789-98. |
| 7. | Subhan I, Jain A. Emergency care in India : t0 he building blocks. Int J Emerg Med 2010;3:207-11. [ PUBMED] |
| 8. | Rajavelu P, Rajagopala A. Need for Epidemiology for Indian EM: An Evidence Based Approach, EMS India. |
| 9. | |
| 10. | Emergency Medicine-Programme Development by NBE: Report of Consultative Meeting. |
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]
|
Search Pubmed for