Had the honour of being invited to join an ACEM 2023 panel to discuss #EmergencyMedicine education & training experiences + challenges across Asia, alongside esteemed peers, colleagues, and mentors. Was not able to fly to Manila due to exams and clerkships but tuned in remotely and learned lots from fellow panelists, moderators, and participants.
Emergency Medicine is a relatively young area of medicine in many countries, including Singapore. It is not just less developed regions that do not recognise this specialty / have not developed specific training programs — Germany, for instance, also currently does not have EM training as an independent primary medical specialty. These places still have many Emergency Departments, run by clinicians from various backgrounds (I visited one where an orthopaedic surgeon was in charge).
One of the challenges lies in defining EM’s boundaries. Breadth does not have to come at the expense of depth, but that is bandwidth dependent for each individual. I personally love being in the Emergency Department because that is the one place in the hospital where you can see truly undifferentiated patients. From neonatal to geriatric, surgical to psychiatric, pharmacological to procedural, resuscitative to palliative— the more knowledge and skills you have and are adept in, the better the care you can provide for patients, including helping them understand downstream care. The ED is also the bridge between pre-hospital and hospital services, making it an excellent platform for analysing systems.
It does not matter if your country or hospital recognises an independent EM specialty — creating and seizing opportunities to learn broadly and deeply in the wonderful art and science of medicine is, to me, all that matters. As someone who delights in learning and problem solving across mricro to macro, there are no boundaries, no templates, and no checklists when it comes to what I can and want to learn. And the ED is a place where you can employ as many skills as you are competent in and trusted to perform, as long as they are in the best interest of patient care and supported by your department. Yes there can be fundamental essentials, but the more you know and can do well, the better prepared you are for the medical mystery walking through your ED doors.
Every corner of medicine holds learning opportunities for knowledge and skills that can be useful in not only the ED, but good doctoring and diagnositcs in general. Being well-prepared to sezie these opportunities and maximising hands-on teaching by mentors (medicine is, after all, an apprenticeship) continue to be pillars of my own medEd journey.