- Email: [email protected]
Recommended undergraduate medical school curriculum for emergency medicine and services
sp~ECIAL CONTRIBUTION
Recommended Undergraduate Medical School Curriculum for Emergency Medicine and Services A Joint ACEP and UA/EMS Position Paper The U n d e r g r a d u a t e E d u c a t i o n C o m m i t t e e of t h e American College of E m e r g e n c y Physicians, in conjunction with the Medical Education C o m m i t t e e of the University Association for E m e r g e n c y Medical Services, has formulated the following r e c o m m e n d a t i o n s r e l a t i v e to a uniform c u r r i c u l u m for medical students in the U n i t e d States and C a n a d a as it applies to e m e r g e n c y medicine and e m e r g e n c y medical services. This c u r r i c u l u m constitutes a body of knowledge applicable to all p h y s i c i a n s in every specialty. It is recommended t h a t one faculty member be i d e n t i f i e d as r e s p o n s i b l e for t h e coordination and q u a l i t y of undergraduate e d u c a t i o n in e m e r gency medical care.
Freshman Year To ensure a basic level of competence for the medical s t u d e n t , a core c u r r i c u l u m s h o u l d b e g i n a t t h i s earliest level of formal t r a i n i n g . It is recommended t h a t the c u r r i c u l u m committee of the medical school include a compulsory didactic and practical course t h a t results in every s t u d e n t being tested and certified in t h a t s t a t e (according to its s t a n d a r d s ) as an E m e r g e n c y M e d i c a l Technician. This is not i n t e n d e d to extend to so called " p a r a m e d i c " or advanced life s u p p o r t s k i l l s t h a t require e x t e n s i v e clinical e x p e r i e n c e and s u p e r v i s i o n , but more to the c u r r e n t l y acknowledged or r e c o m m e n d e d basic experiences t h a t g e n e r a l l y require 60 to 80 hours. The i n t e n t of s e e k i n g EMT certification is to a s s u r e that the s t u d e n t s have proper confidence and competence in r e n d e r i n g i n i t i a l care when h a p p e n s t a n c e places t h e m in a s i t u a t i o n in which they m i g h t be looked to for primary assistance. W h e n t h e y r e n d e r such care, t h e y are recognized as a t l e a s t as c o m p e t e n t as t h e i r s t a t e ' s ~inimum standards.
Sophomore Year A course should be developed by the c u r r i c u l u m committee t h a t provides knowledge and a w a r e n e s s of EMS systems, to specifically include: t r i a g e methodology for raass c a s u a l t i e s and the "unscheduled" utilization of t h e emergency d e p a r t m e n t ; of concepts of e m e r g e n c y dePartment organization; communications (including biomedical t e l e m e t r y ; t h e role of t h e v a r i o u s p u b l i c services; first response and e v a c u a t i o n methods; d i s a s t e r planning and m a n a g e m e n t concepts; consumer education aad s y s t e m access and o t h e r r e l a t e d components. This
J~P
May 1976
p r o g r a m would e n t a i l 20 to 40 didactic hours. In addition, a field expermnce in p r e h o s p i t a l care is r e c o m m e n d e d to allow an a p p l i c a t i o n of the skills acquired by a n t e c e d e n t EMT certification. The student can t h e r e f o r e f u n c t i o n a b o v e t h e l e v e l o f a n observer a n d be p l a c e d in a p o s i t i o n of legally p a r t i c i p a t i n g in p r e h o s p i t a l care. This experience should not be framed to time components as much as to experience components. For example, a busy m e t r o p o l i t a n rescue service m i g h t provide sufficient field experiences in much less time t h a n would be r e q u i r e d to gain s i m i l a r exposure in a r e l a t i v e l y inactive setting.
Junior Year Experience in this study should e m p h a s i z e student involvement with p a t i e n t s p r e s e n t i n g with r e l a t i v e l y minor unscheduled problems, in c o n t r a d i s t i n c t i o n to major or critical unscheduled problems. Supervision under n o n e m e r g e n t or r e l a t i v e l y n o n u r g e n t conditions will provide a clinical introduction t h a t does not jeopardize pat i e n t service. This recognizes t h a t m a n y good clinical experiences in unscheduled care will be r e a d i l y available in the community. It is a s s u m e d t h a t these experiences will r a n g e from o b s e r v a t i o n to p a r t i c i p a t i o n in a c t u a l care u n d e r p r o p e r s u p e r v i s i o n . T h i s e x p e r i e n c e w i t h unscheduled o u t p a t i e n t s need not exceed four weeks since sufficient c u m u l a t i v e experience with scheduled outpat i e n t s will be afforded by o t h e r specialty rotations.
Senior Year For four to six weeks, the s t u d e n t should directly participate in care delivery in a n active e m e r g e n c y department. This would be p r i m a r i l y in the a r e a designated for care of critical illness and injury. S u p e r v i s i o n should be constant. S k i l l list objectives should be defined and monitored.
Summary A n o r d e r l y c u r r i c u l u m h a s been p r e s e n t e d t h a t advances from a g e n e r a l i n t r o d u c t i o n to life-support systems to clinical experiences designed to b u i l d competence and confidence in critical skills. By this progression, the s t u d e n t will become proficient in life-support methodology. Volume 5 Number 5 Page 377
Recommended Undergraduate Medical School Curriculum for Emergency Medicine and Services A Joint ACEP and UA/EMS Position Paper The U n d e r g r a d u a t e E d u c a t i o n C o m m i t t e e of t h e American College of E m e r g e n c y Physicians, in conjunction with the Medical Education C o m m i t t e e of the University Association for E m e r g e n c y Medical Services, has formulated the following r e c o m m e n d a t i o n s r e l a t i v e to a uniform c u r r i c u l u m for medical students in the U n i t e d States and C a n a d a as it applies to e m e r g e n c y medicine and e m e r g e n c y medical services. This c u r r i c u l u m constitutes a body of knowledge applicable to all p h y s i c i a n s in every specialty. It is recommended t h a t one faculty member be i d e n t i f i e d as r e s p o n s i b l e for t h e coordination and q u a l i t y of undergraduate e d u c a t i o n in e m e r gency medical care.
Freshman Year To ensure a basic level of competence for the medical s t u d e n t , a core c u r r i c u l u m s h o u l d b e g i n a t t h i s earliest level of formal t r a i n i n g . It is recommended t h a t the c u r r i c u l u m committee of the medical school include a compulsory didactic and practical course t h a t results in every s t u d e n t being tested and certified in t h a t s t a t e (according to its s t a n d a r d s ) as an E m e r g e n c y M e d i c a l Technician. This is not i n t e n d e d to extend to so called " p a r a m e d i c " or advanced life s u p p o r t s k i l l s t h a t require e x t e n s i v e clinical e x p e r i e n c e and s u p e r v i s i o n , but more to the c u r r e n t l y acknowledged or r e c o m m e n d e d basic experiences t h a t g e n e r a l l y require 60 to 80 hours. The i n t e n t of s e e k i n g EMT certification is to a s s u r e that the s t u d e n t s have proper confidence and competence in r e n d e r i n g i n i t i a l care when h a p p e n s t a n c e places t h e m in a s i t u a t i o n in which they m i g h t be looked to for primary assistance. W h e n t h e y r e n d e r such care, t h e y are recognized as a t l e a s t as c o m p e t e n t as t h e i r s t a t e ' s ~inimum standards.
Sophomore Year A course should be developed by the c u r r i c u l u m committee t h a t provides knowledge and a w a r e n e s s of EMS systems, to specifically include: t r i a g e methodology for raass c a s u a l t i e s and the "unscheduled" utilization of t h e emergency d e p a r t m e n t ; of concepts of e m e r g e n c y dePartment organization; communications (including biomedical t e l e m e t r y ; t h e role of t h e v a r i o u s p u b l i c services; first response and e v a c u a t i o n methods; d i s a s t e r planning and m a n a g e m e n t concepts; consumer education aad s y s t e m access and o t h e r r e l a t e d components. This
J~P
May 1976
p r o g r a m would e n t a i l 20 to 40 didactic hours. In addition, a field expermnce in p r e h o s p i t a l care is r e c o m m e n d e d to allow an a p p l i c a t i o n of the skills acquired by a n t e c e d e n t EMT certification. The student can t h e r e f o r e f u n c t i o n a b o v e t h e l e v e l o f a n observer a n d be p l a c e d in a p o s i t i o n of legally p a r t i c i p a t i n g in p r e h o s p i t a l care. This experience should not be framed to time components as much as to experience components. For example, a busy m e t r o p o l i t a n rescue service m i g h t provide sufficient field experiences in much less time t h a n would be r e q u i r e d to gain s i m i l a r exposure in a r e l a t i v e l y inactive setting.
Junior Year Experience in this study should e m p h a s i z e student involvement with p a t i e n t s p r e s e n t i n g with r e l a t i v e l y minor unscheduled problems, in c o n t r a d i s t i n c t i o n to major or critical unscheduled problems. Supervision under n o n e m e r g e n t or r e l a t i v e l y n o n u r g e n t conditions will provide a clinical introduction t h a t does not jeopardize pat i e n t service. This recognizes t h a t m a n y good clinical experiences in unscheduled care will be r e a d i l y available in the community. It is a s s u m e d t h a t these experiences will r a n g e from o b s e r v a t i o n to p a r t i c i p a t i o n in a c t u a l care u n d e r p r o p e r s u p e r v i s i o n . T h i s e x p e r i e n c e w i t h unscheduled o u t p a t i e n t s need not exceed four weeks since sufficient c u m u l a t i v e experience with scheduled outpat i e n t s will be afforded by o t h e r specialty rotations.
Senior Year For four to six weeks, the s t u d e n t should directly participate in care delivery in a n active e m e r g e n c y department. This would be p r i m a r i l y in the a r e a designated for care of critical illness and injury. S u p e r v i s i o n should be constant. S k i l l list objectives should be defined and monitored.
Summary A n o r d e r l y c u r r i c u l u m h a s been p r e s e n t e d t h a t advances from a g e n e r a l i n t r o d u c t i o n to life-support systems to clinical experiences designed to b u i l d competence and confidence in critical skills. By this progression, the s t u d e n t will become proficient in life-support methodology. Volume 5 Number 5 Page 377