Penn State University College of Medicine, Hershey, PennsylvaniaUSA.
Department of Emergency Medicine, WellSpan York Hospital, York, PennsylvaniaUSA.
Prehosp Disaster Med. 2023 Jun;38(3):378-383. doi: 10.1017/S1049023X23000407. Epub 2023 Apr 3.
Disaster Medicine (DM) is defined by Koenig and Shultz as the "disciplines and organizations involved with governmental public health, public and private medical delivery including Emergency Medical Services (EMS), and governmental emergency management." The Accreditation Council for Graduate Medical Education (ACGME) sets curriculum requirements and standards for Emergency Medicine (EM) residencies and EMS fellowships, which include a limited portion of the DM curriculum topics recommended by the Society of Academic Emergency Medicine (SAEM). The ACGME does not currently approve DM fellowships, as DM is not recognized as a subspecialty by the American Board of Medical Specialties (ABMS). This lack of nationally standardized guidelines for DM training leads to variability in disaster-related knowledge and skills, even among physicians trained by ACGME-accredited programs.
The objective of this study is to analyze the DM components covered in EM residency and EMS fellowship in the United States and compare those to SAEM DM fellowship curriculum guidelines.
The DM curriculum components of EM residencies and EMS fellowships were evaluated, using the SAEM DM curriculum as a control. Overlapping topics, as well as gaps between the programs, were analyzed using descriptive statistics.
Of the DM curriculum components developed by SAEM, EMS fellowship covered 15 of 19 (79%) major curriculum components and 38 of 99 (38%) subtopics, while EM residency covered seven of 19 major curriculum components (37%) and 16 of 99 (16%) subtopics. Together, EM residency and EMS fellowship cover 16 of 19 (84%) major curriculum components and 40 of 99 (40%) subtopics.
While EMS fellowship covers a large portion of the DM major curriculum components recommended by SAEM, there are several important DM subtopics that are not covered either in EM residency or EMS fellowship. Furthermore, there is no standardization for the depth and manner that DM topics are addressed in either curriculum. Time constraints in EM residency and EMS fellowship may also prevent extensive review of important DM topics. Disaster Medicine covers a distinct body of knowledge, represented in the curriculum subtopics, that are not covered in either EM residency or EMS fellowship. The development of an ACGME-accredited DM fellowship and recognition of DM as a distinct subspecialty could allow for more effective DM graduate medical education.
灾难医学（DM）由 Koenig 和 Shultz 定义为“涉及政府公共卫生、公共和私人医疗服务（包括紧急医疗服务（EMS））以及政府应急管理的学科和组织”。毕业后医学教育认证委员会（ACGME）为急诊医学（EM）住院医师培训和 EMS 奖学金制定课程要求和标准，其中包括学术急诊医学协会（SAEM）推荐的 DM 课程主题的有限部分。ACGME 目前不批准 DM 奖学金，因为 DM 尚未被医学专业委员会（ABMS）认可为一个亚专科。这种 DM 培训缺乏全国标准化指南导致了与灾害相关的知识和技能的差异，即使是在接受 ACGME 认证项目培训的医生中也是如此。
本研究旨在分析美国 EM 住院医师培训和 EMS 奖学金中的 DM 组成部分，并将其与 SAEM DM 奖学金课程指南进行比较。
使用 SAEM DM 课程作为对照，评估 EM 住院医师培训和 EMS 奖学金的 DM 课程组成部分。使用描述性统计分析分析方案之间的重叠主题和差距。
在 SAEM 制定的 DM 课程组成部分中，EMS 奖学金涵盖了 19 个主要课程组成部分中的 15 个（79%）和 99 个子主题中的 38 个（38%），而 EM 住院医师培训涵盖了 19 个主要课程组成部分中的 7 个（37%）和 99 个子主题中的 16 个（16%）。EM 住院医师培训和 EMS 奖学金共同涵盖了 19 个主要课程组成部分中的 16 个（84%）和 99 个子主题中的 40 个（40%）。
尽管 EMS 奖学金涵盖了 SAEM 推荐的大部分 DM 主要课程组成部分，但仍有几个重要的 DM 子主题既不在 EM 住院医师培训中也不在 EMS 奖学金中涵盖。此外，这两个课程都没有为 DM 主题的深度和方式制定标准化的标准。EM 住院医师培训和 EMS 奖学金中的时间限制也可能阻止对重要 DM 主题进行广泛审查。灾难医学涵盖了一个独特的知识体系，体现在课程子主题中，而这在 EM 住院医师培训或 EMS 奖学金中都没有涵盖。ACGME 认可的 DM 奖学金的发展以及将 DM 确认为一个独特的亚专科可以使 DM 研究生医学教育更加有效。
