SEARCH

SEARCH BY CITATION

See also pp. 359–364

Introduction

  1. Top of page
  2. Introduction
  3. History of emergency medicine development
  4. Recognising emergency medicine training
  5. Private versus public sector emergency training
  6. Need for faculty
  7. Conclusion
  8. References

With 1.2 billion people, India is the second most populous country in the world. Unfortunately, with a paucity of pre-hospital and emergency care, it also has a staggering number of preventable deaths annually, which is increasing. The World Report on Road Traffic Injury Prevention (World Health Organization) projects that in 2020, road trauma will be responsible for 546 000 deaths worldwide, making it one of the leading causes of death.[1] Other leading causes of death are heart attacks and strokes, which again are among the top three causes in India.[2, 3] Emergency care in India is inadequate and variable at best. Emergency medicine (EM) lags far behind its sister specialties that in some places are at the cutting-edge of medicine. Currently, there are fewer than 300 emergency-trained physicians in India, yet there is a projected need for approximately 8000 trained emergency physicians (EPs) by 2020. As a result, there is now a major emphasis on EM training in India.

History of emergency medicine development

  1. Top of page
  2. Introduction
  3. History of emergency medicine development
  4. Recognising emergency medicine training
  5. Private versus public sector emergency training
  6. Need for faculty
  7. Conclusion
  8. References

In Australasia, the need for EM as a specialty was brought to light in the late 1970s. The Australasian Society for Emergency Medicine was established in 1981, and EM as a specialty was recognised by the Commonwealth Ministry of Health Board of Medical Specialties in 1993.[4]

Similarly, the need for EM was brought to light in the late 90s. The first conference of EM took place in Hyderabad, Andhra Pradesh, in 1999 and was supported by several international EPs. At this conference, the Society of Emergency Medicine of India was created to promote interest of EM.[5, 6]

Since the outset, EM in India has benefited from international advocacy. In 2001, the American Academy of Emergency Medicine in India was created to promote EM in India, enhance the quality of emergency care and raise the public awareness of EM.[7] In 2005, the All India Institute of Medical Sciences collaborated with the University of Florida to create the Indo-US Society of Emergency Medicine for advocacy in EM.[8]

As in other countries, it took 10 years of hard work from the early proponents of EM to achieve the Medical Council of India (MCI) recognising EM as a specialty. This happened in 2009.[9, 10] Since then, the MCI has recognised just 32 training seats across 17 medical colleges.[10] Following in the MCI's footsteps, the National Board of Examinations (NBE) recognised EM as a specialty in May 2013.[7, 10] The National Board EM training programmes are expected to start in 2014.

Recognising emergency medicine training

  1. Top of page
  2. Introduction
  3. History of emergency medicine development
  4. Recognising emergency medicine training
  5. Private versus public sector emergency training
  6. Need for faculty
  7. Conclusion
  8. References

Postgraduate training in India is governed by two apex bodies: the MCI[10] and the NBE.[11] The MCI recognises and awards a certain number of seats in designated university-based training programmes, registers doctors with recognised medical qualifications, and accepts reciprocity with foreign countries in the recognition of medical qualifications. Graduates of these seats are awarded an MD degree. In contrast, the NBE recognises and awards a certain number of seats in designated hospital-based training programmes; they allow these graduates to earn the Diplomate of National Board (DNB). Both these apex bodies are still working on the production of a core curriculum for EM training.

In 2001, in the absence of any nationally recognised training programmes, and with strong advocacy for EM through international collaboration, several programmes were established in the private sector. The training and the degrees awarded from these institutions are varied. The paper by Pothiawala and Anantharaman in this issue of Emergency Medicine Australasia addresses the details of these various programmes, which are of 1, 2 or 3 years duration.[12]

To summarise:

  • 1.
    One-year programmes award a Fellow of EM (FEM): The Royal College of General Practitioners was the first body to become formally involved with corporate hospitals in India to facilitate fellowships in EM.[13]
  • 2.
    Two-year programmes encourage graduates to take the UK College of EM exam to earn membership of the College of Emergency Medicine (MCEM). The MCEM is an entry-level exam for the UK training system, and so allows Indian trainees access to the UK training system. This has the adverse potential to contribute to a ‘brain-drain’ as MCEM qualified candidates move to UK to ease the ED staffing shortages there.

Through the MCI Amendment Act of 2001, the MCEM has the potential to be a recognised qualification in India. However, the college of EM, UK, clearly recommends another minimum of 3 years of supervised training post-MCEM exam to become a fully qualified EM specialist.[14]

  • 3. 
    Three-year, US-affiliated International Masters of Emergency Medicine Programs have core curricula that are based on the American Accreditation Council for Graduate Medical Education core curriculum, modified for the Indian milieu.

George Washington University started its first 3-year programme in 2006. The demand for this programme has increased rapidly, and over the past 5 years, eight corporate hospitals have enrolled approximately 123 trainees across four cities.

Other university-affiliated programmes that have started in India include those from North Shore-LIJ and SUNY Upstate. US faculty visit each month, and local specialists provide support for these programmes as adjunct faculty. Currently, several additional US universities have started, or are in the process of starting, EM programmes taught in India.

The one criticism that all of these programmes have suffered is that there are several different hospitals and universities offering several different programmes, and many more are coming up. There is a real need for a common standard or accreditation of these varied programmes. Furthermore, there is no national or international recognition of this training.

Private versus public sector emergency training

  1. Top of page
  2. Introduction
  3. History of emergency medicine development
  4. Recognising emergency medicine training
  5. Private versus public sector emergency training
  6. Need for faculty
  7. Conclusion
  8. References

While some experts claim that training in the public sector is ideal because of the high ED patient volumes and diversity,[8] others argue that private sector training is better as private hospitals have the necessary equipment, often state-of-the-art, to optimally provide training in the latest practices consistent with international standards. A recent study conducted in South India by Oxford University showed that 60% of health incidents in a poor population were attended to in the private sector. Seventy per cent of people's health expenditure (poor and non-poor) is also in the private sector.[15] There is a legal expectation that any patient with a life- or limb-threatening condition will be stabilised regardless of the commercial nature of hospital.

Need for faculty

  1. Top of page
  2. Introduction
  3. History of emergency medicine development
  4. Recognising emergency medicine training
  5. Private versus public sector emergency training
  6. Need for faculty
  7. Conclusion
  8. References

With an increasing emphasis on EM training, increasing MCI programmes, the upcoming DNB programmes and the burgeoning number MEM programmes, there is clearly a dearth of EM faculty. Hence, faculty training in India has become a major recognised need. Several international and local EM faculty training programmes are evolving.

Conclusion

  1. Top of page
  2. Introduction
  3. History of emergency medicine development
  4. Recognising emergency medicine training
  5. Private versus public sector emergency training
  6. Need for faculty
  7. Conclusion
  8. References

There is a huge demand for EM training programmes in India, as is well described by Pothiawala and Anantharaman. Educated Indians rightly demand access to state-of-the-art care not only in well-established specialties, such as cardiology and infectious disease, but in new specialties as well, such as emergency care. Graduating medical students are now fascinated by the new specialty of EM. The MCI and the NBE recognise the need to start more EM training programmes to ever be able to address the huge needs of the country. US universities and Indian hospitals alike are also responding to these demands.

Some experts call for setting one common standard for training across the board. Although this is a laudable goal, it just might not be practical. The goal should be to have quality training and standard examinations for the various paths, which should culminate in national recognition of qualified training.

Academic collaboration is considered an opportunity in the western world. As India endeavours to establish EM, sharing of successful practices and research collaboration between leaders of EM will enhance plans to rapidly move forward.

Competing interests

PA is the current president of the American Academy of Emergency Medicine in India (AAEMI). AB is the current president of the Global Academy of Emergency Medicine (GAEM). TK is the current president of the Society for Emergency Medicine India (SEMI). CC is a section editor for Emergency Medicine Australasia.

Editor-in-Chief acknowledgement

The Editor-in-Chief, Professor Anthony Brown, wishes to recognise the expert input of Professor Chris Curry, Section Editor – International Emergency Medicine, to this editorial and its accompanying article by Pothiawala and Anantharaman.

References

  1. Top of page
  2. Introduction
  3. History of emergency medicine development
  4. Recognising emergency medicine training
  5. Private versus public sector emergency training
  6. Need for faculty
  7. Conclusion
  8. References