Training in Emergency Medicine

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 edition of the Guide to Emergency Medicine Training in Ireland (5th Edition) was published in October 2011.

As part of current Medical Council obligations, all doctors not on recognised Training Schemes must be part of a recognised Professional Competence Scheme. Click for details of the PCS for Emergency Medicine.

Emergency Medicine (EM) training in Ireland is divided into two components, both of which are overseen by the Irish Committee on Emergency Medicine Training (ICEMT):

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

Basic Specialist Training in Emergency Medicine (BSTEM)

Basic training in EM 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 EM. A further 12 months must be in specialties relevant to EM e.g. acute general medicine/geriatrics, paediatric emergency medicine or general paediatrics, general surgery, trauma & orthopaedic surgery, anaesthesia and critical care medicine.

Whereas previously, most basic trainees will have gained the relevant experience through a combination of stand alone posts, a minority will have been part of "employer driven" basic EM schemes e.g. St. James's Hospital, St. Vincent's University Hospital schemes. Since July 2011, a national Basic Specialist Training in Emergency Medicine (BSTEM) Scheme is in place which has incorporated those posts currently part of "employer driven" schemes. The scheme is of 3 years duration and incorporates training in EM, paediatric EM, acute medicine, anaesthesia & critical care and musculoskeletal EM/trauma & orthopaedic surgery/plastic surgery. There will be up to 26 posts available annually with a total of 78 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)

The following EDs are currently recognised for HSTEM:

• Beaumont Hospital
• Children's University Hospital, Temple St, Dublin
• Connolly Hospital, Blanchardstown
• Cork University Hospital
• Mater Misericordiae University Hospital
• Midland Regional Hospital, Tullamore
• Our Lady's Children's Hospital, Crumlin
• Our Lady of Lourdes Hospital, Drogheda
• Sligo Regional Hospital
• St. James's Hospital
• St Vincent's University Hospital
• Tallaght Hospital
• University Hospital, Galway
• University Hospital (formerly Mid Western Regional Hospital), Limerick
• 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 HSTEM. While this may reduce the overall duration of HSTEM, the minimum requirement is that trainees spend four years on the HSTEM programme working in general EDs.

Subspecialty Training in Emergency Medicine

For further detail on subspecialty/fellowship training in EM, please see the Guide to EM Training in Ireland.

IAEM and ICEMT have recently published a guidance document on the subspecialty of Paediatric Emergency Medicine, which contains essential information about training pathways in PEM.