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Subspecialization in emergency medicine: where do we go from here?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Sinclair, Douglas C. |
| Copyright Year | 2005 |
| Abstract | As emergency physicians, our principal mission is evaluating, managing, treating and preventing unexpected illness and injury. In contrast to most subspecialties, which developed to serve patients with discrete, single-system problems, the specialty of emergency medicine (EM) grew out of the premise that high quality medical care should be available to the public 24 hours a day, and that the broad range of injuries and undifferentiated illnesses that can pose immediate life and limb threats require the skills of a generalist physician. Emergency medicine bridges the gap between family physicians and subspecialty services and functions at the interface of community and hospital-based care. Emergency medicine also has an important role in health advocacy and health system reform. The rise of a new specialty is driven by patient need, a distinct body of knowledge and a unique field of research. Emergency medicine developed as the result of the increasing demand for around-the-clock primary and acute care, and through advances in cardiac resuscitation and trauma care. A collaborative group of organizations in the United States recently proposed a 3-dimensional matrix model of EM practice that includes a listing of clinical conditions based on presenting complaints, physician tasks and patient acuity frames. The striking finding from this analysis is the richness and variety of EM practice. The emergency physician roles vary from primary assessment of individual patients with undifferentiated disease to multi-tasking and team management in a complex emergency department (ED) environment. During the last 20 years, EM has made dramatic advances in terms of acceptance as a specialty. A recent US analysis documented a significant increase in the number of academic EM departments and residency programs between 1991 and 2001. At the same time, the International Federation of Emergency Medicine has grown from 4 founding members in 1984 to over 20 members in 2005, reflecting the international development of the specialty. Technological advance and the exponential growth of medical knowledge have spawned numerous new disciplines. The Royal College of Physicians and Surgeons of Canada now recognizes 60 specialties and subspecialties. The Royal College defines a specialty as a specific body of knowledge and skills used by a group of physicians and applicable in community and tertiary settings. The definition of a subspecialty is less clear, and the Royal College has addressed subspecialty development on a case-by-case basis, but the basic requirement is certification in an existing core specialty. As EM has matured as a specialty, many physicians have focused on discrete areas of practice and research. Some of these are shared with other specialties, and some are unique to EM. Some of these subspecialties are now recognized with certification examinations and certification in conjunction with other specialty groups. These areas of subspecialty interest include pediatric EM, sports medicine, toxicology and emergency medical services (EMS). Today, many emergency physicians hold dual certification in family medicine, anesthesia and, more recently, critical care medicine. |
| File Format | PDF HTM / HTML |
| DOI | 10.1017/S1481803500014585 |
| PubMed reference number | 17355698 |
| Journal | Medline |
| Volume Number | 7 |
| Issue Number | 5 |
| Alternate Webpage(s) | https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1481803500014585 |
| Alternate Webpage(s) | https://doi.org/10.1017/S1481803500014585 |
| Journal | CJEM |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
