Emergency Medicine Training in LDCs

aka Postcards from the Edge 009

This ‘Postcard from the Edge’ highlights a talk given by Dr Chris Curry at ACEM2011 conference in Sydney. Chris discusses the development of emergency medicine training in LDCs (Least Developed Countries), using the examples of Papua-New Guinea and Nepal, and takes a look west to Botswana and Africa.


The need for capacity to respond to acute illness and injury is greatest in least developed countries (LDCs), where resources are extremely limited and infrastructure for the delivery of health care is fragile.

The development of specialisation is following the developed world, with the traditional leaders of surgery and internal medicine dominant. The younger specialties of the developed world are only just being considered in some of the 48 LDCs, and emergency medicine (EM) is one of these.

The building of EM needs to be shaped to the peculiarities of the environment. Postgraduate medical training is managed variously. In PNG the Postgraduate Committee of the School of Medicine and Health Sciences in the University of PNG has control of all postgraduate training. In Nepal several institutions are involved in postgraduate training, with differences between them. While an EM curriculum can have a shared foundation, such as that promulgated by the IFEM, local variations and areas of emphasis are important. The pathway by which a trainee can be exposed to learning is dependent upon services available and local ways of managing training and service. An initial absence of EM trained faculty requires resourcefulness from local trainers, who can benefit from the input of EPs who have experience of the beginnings of development elsewhere.

The particulars of resources, infrastructure, and position of EM within the totality of health care delivery, have a profound impact on the delivery of training and have to be considered in determining levels of performance for a new specialist. These factors impinge on assessment and examination.

An EP contributing from a more developed EM system may have more to learn than to teach.


The slides for the talk are shown below. The slides are best viewed on slideshare.net so you can view the speaker notes as you flick from slide to slide (click on the ‘Speaker Notes on Slide x’ tab under the slideshow).

Postcards from the edge LITFL 700


from the edge

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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