Training in Emergency Medicine in Ireland

Emergency Medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders (International Federation of Emergency Medicine). It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.

The most recent (3rd Edition) of the Guide to Emergency Medicine Training in Ireland was published in March 2010.

Emergency Medicine (EM) training in Ireland is divided into two components:

• Basic Specialist Training (BSTEM) and
  
• Higher Specialist Training (HSTEM).

Basic Specialist Training in Emergency Medicine (BSTEM)

Basic training in Emergency Medicine consists of a series of relevant posts at Non Consultant Hospital Doctor (NCHD) level that lay the professional groundwork for subsequent specialisation. During this time, doctors obtain a wide range of experience in a variety of specialties, of which a minimum of 12 months must be spent in Emergency Medicine (EM). A further 12 months must be in specialties relevant to EM – acute general medicine/geriatrics, paediatric emergency medicine or general paediatrics, general surgery, trauma/orthopaedic surgery, anaesthesia and intensive care medicine.

Previously, most basic trainees will have gained the relevant experience through a combination of ‘stand alone’ posts, while a minority will have been part of an ‘employer driven’ basic EM scheme e.g. St. James’s Hospital, St. Vincent’s University Hospital schemes.

A national Basic Specialist Training in Emergency Medicine (BSTEM) Scheme organised and overseen by the Advisory Committee on Emergency Medicine Training (ACEMT) will be launched in 2011 and will incorporate those posts currently part of the aforementioned ‘employer driven’ schemes. While the finalised structure of the BSTEM programme is near completion, the scheme will be of 3 years duration and incorporate training in EM, paediatric EM, acute medicine, anaesthesia and intensive care, and musculoskeletal EM/orthopaedics. There will be up to 30 posts available annually with up to 90 trainees on the national programme at any one time.

BSTEM will culminate in eligibility to sit the Membership of the College of Emergency Medicine (MCEM). Success in this examination combined with certified completion of BSTEM confers eligibility to apply for HST.

Higher Specialist Training in Emergency Medicine (HSTEM)

HSTEM is currently organised and overseen by the Advisory Committee on Emergency Medicine Training (ACEMT) based at the Royal College of Surgeons in Ireland.

The following EDs are currently recognised for HST in Ireland:

• Adelaide and Meath incorporating National Children’s Hospital, Tallaght
• Beaumont Hospital
• Children's University Hospital, Temple St, Dublin
• Connolly Hospital, Blanchardstown
• Cork University Hospital
• Mater Misericordiae University Hospital
• Midland Regional Hospital, Tullamore
• Mid Western Regional Hospital, Limerick
• Our Lady’s Children’s Hospital, Crumlin
• Sligo General Hospital
• St. James’s Hospital
• St Vincent’s University Hospital
• University Hospital, Galway
• Waterford Regional Hospital

The duration of HSTEM is five years. During this time trainees spend time working in a minimum of three EDs (at least six months in a dedicated paediatric ED) and up to six months in the essential secondment of anaesthesia/ICU. Some retrospective recognition may be granted for experience in EM and in certain secondment specialties prior to entering HST. While this may reduce the overall duration of HST, the minimum requirement is that trainees spend four years on the HST program working in general EDs.