It is a recurring story in medicine. A field of study attempts to chisel out a niche, but has trouble gaining acceptance as a discrete field. Everyone has a different answer when asked what the field is, even though people have done it for years. Almost every specialty and subspecialty has gone through the same story arc, just most of them happened in the early era of modern medicine.
Wilderness medicine is at the point in medical education where it is trying to define itself. Sure, people have practiced it for a long time, arguably since the advent of first aid. But when you try to pin down what the field encompasses, you have trouble doing just that. Sure, there are journals, and research articles specific to the field, but there is no formal accreditation body. There are wilderness fellowships, but they have historically had somewhat diverse curricula, and the oldest is only 11 years old.
This article fires a salvo towards fixing the lack of definition. The authors were a group of like-minded wilderness emergency physicians who were selected to be on a task force trying to standardize the core content for wilderness medicine fellowships. The task force itself reads like a who’s who of wilderness medicine. They took 4 years to come up with a list of the topics and skills that would make up the minimum requirements. As a testimony to the breadth of wilderness medicine, the first draft of the list of topics was 27 pages long.
What they finally honed it down to was 4 areas that pertain to academic skills, i.e. teaching future learners, and 15 topics (with multiple subtopics each) on wilderness medicine skills and knowledge. Those topics, in general, run from mountaintops to undersea, and all flora and fauna in between. Survival, EMS, and search and rescue are also included, as they are a significant part of wilderness medicine. Training duration has been defined as 12-24 months, and they place emphasis on experiential learning instead of classroom.
Now, this is the first step in a long journey towards ACGME accreditation. The authors acknowledge the need to for a certifying exam to be created, and getting the curriculum into ACGME format before it can be reviewed. This will likely take years, so don’t hold your breath on this happening in the near future. It is an exciting time for anyone involved in wilderness medicine though, as now there is a an effort towards standardization of the subspecialty. There will be time to blaze your own trails after you’re done, but the minimum requirements to be a competent wilderness provider are now at least partly defined.
Lipman GS et al. Core content for wilderness medicine fellowship training of emergency medicine graduates. Acad Emerg Med. 2014 Feb;21(2):204-7 [PMID 24438590]
EBM Gone Wild