Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
Duke University, Department of Emergency Medicine, Durham, North Carolina.
West J Emerg Med. 2020 Oct 28;21(6):284-290. doi: 10.5811/westjem.2020.8.47694.
Emergency medicine (EM) was recognized as a specialty in Ecuador in 1993. Currently, there are two four-year EM residency programs and an estimated 300 residency-trained emergency physicians countrywide. This study describes the current challenges in EM in Ecuador.
We conducted 25 semi-structured, in-person interviews with residency-trained emergency physicians, general practitioners, public health specialists, prehospital personnel, and physicians from other specialties. The interviewer asked about challenges in the areas of emergency care, working conditions of emergency physicians, EM residency education, EM leadership, and prehospital care. We analyzed data for challenges and registered the number of interviewees who mentioned each challenge.
Interviewees worked in the three largest cities in the country: Quito (60%); Guayaquil (20%); and Cuenca (20%). Interviewees included 16 (64%) residency-trained emergency physicians; six (24%) residency-trained physicians from other specialties working in or closely associated with the emergency department (ED); one (4%) general practitioner working in the ED; one (4%) specialist in disasters; and one (4%) paramedic. Shortage of medical supplies, need for better medico-legal protection, lack of EM residencies outside of Quito, and desire for more bedside teaching were the challenges mentioned with the highest frequency (each 44%). The next most frequently mentioned challenges (each 38%) were the need for better access to ultrasound equipment and the low presence of EM outside the capital city. Other challenges mentioned included the low demand for emergency physicians in private institutions, the lack of differential pay for night and weekends, need for more training in administration and leadership, need for a more effective EM national society, and lack of resources and experience in EM research.
Emergency medicine has a three-decade history in Ecuador, reaching important milestones such as the establishment of two EM residencies and a national EM society. Challenges remain in medical care, working conditions, residency education, leadership, and prehospital care. Stronger collaboration and advocacy among emergency physicians can help strengthen the specialty and improve emergency care.
1993 年，急诊医学（EM）在厄瓜多尔被认定为一门专业。目前，全国有两个为期四年的 EM 住院医师培训项目，估计有 300 名接受过住院医师培训的急诊医生。本研究描述了厄瓜多尔急诊医学目前面临的挑战。
我们对接受过住院医师培训的急诊医生、全科医生、公共卫生专家、院前人员和其他专科医生进行了 25 次半结构化的面对面访谈。访谈者询问了急诊护理、急诊医生工作条件、急诊住院医师教育、急诊领导和院前护理方面的挑战。我们对数据进行了分析，记录了每位受访者提到的每个挑战的次数。
受访者在该国三个最大的城市工作：基多（60%）；瓜亚基尔（20%）；和昆卡（20%）。受访者包括 16 名（64%）接受过住院医师培训的急诊医生；六名（24%）来自其他专科的接受过住院医师培训的医生在急诊部工作或与急诊部密切相关；一名（4%）在急诊部工作的全科医生；一名（4%）灾难专家；和一名（4%）护理人员。医疗用品短缺、需要更好的医疗法律保护、基多以外缺乏急诊住院医师培训以及希望增加床边教学是受访者提到的最频繁的挑战（各 44%）。其次提到的挑战（各 38%）是需要更好地获得超声设备和在首都以外地区急诊医学的低参与度。其他提到的挑战包括私立机构对急诊医生的需求低、夜间和周末无差别薪酬、需要更多的管理和领导培训、需要一个更有效的急诊全国协会以及缺乏急诊医学研究资源和经验。
急诊医学在厄瓜多尔已有三十年的历史，在建立两个急诊住院医师培训项目和一个全国急诊医学协会方面取得了重要的里程碑。在医疗保健、工作条件、住院医师教育、领导和院前护理方面仍存在挑战。急诊医生之间更紧密的合作和宣传可以帮助加强该专业并改善急诊护理。
