Penn State University, College of Medicine, Hershey, PennsylvaniaUSA.
Department of Emergency Medicine, WellSpan York Hospital, York, PennsylvaniaUSA.
Prehosp Disaster Med. 2024 Apr;39(2):218-223. doi: 10.1017/S1049023X24000165. Epub 2024 Mar 11.
Disaster medicine (DM) is a unique field that has undergone significant development as disaster events become increasingly complicated to respond to. However, DM is not recognized by the American Board of Medical Specialties (ABMS) or Accreditation Committee of Graduate Medical Education (ACGME), and therefore lacks board certification. Furthermore, prior studies have shown that there is unique body of DM knowledge not being addressed in emergency medicine (EM) residency or Emergency Medical Services (EMS) fellowship, resulting in fundamental DM topics not being covered amongst graduate medical education (GME) programs most prepared to produce DM physicians. A recently published DM core curriculum addresses this knowledge gap and seeks to promote standardization of DM training.
The objective of this study is to analyze EM residency and EMS fellowship curricula for the inclusion of DM major curriculum topics and subtopics, using the most recently published DM core curriculum as a control.
Both EM residency and EMS fellowship curricula were analyzed for inclusion of DM curriculum topics and subtopics, using the DM curriculum recommendations published by Wexler, et al as a control. A major curriculum topic was deemed covered if at least one related subtopic was described in the curricula. The included and excluded DM topics and subtopics were analyzed using descriptive statistics.
While all the DM major curriculum topics were covered by either EM residency or EMS fellowship, EMS fellowship covered more major curriculum topics (14/15; 93%) than EM residency (12/15; 80%) and EMS fellowship covered more DM curriculum subtopics (58/153; 38%) than EM residency (24/153; 16%). Combined, EM residency and EMS fellowship covered 65 out of 153 (42%) of the DM curriculum subtopics.
Although this study finds that all the DM major curriculum topics will be covered in EM residency followed by EMS fellowship, over one-half of the subtopics are not covered by either program (16% and 38%, respectively) or both programs combined (42%). Increasingly relevant subtopics, such as climate change, droughts, and flooding, are amongst those not covered by either curriculum. Even amongst the DM topics included in GME curricula, an emphasis on themes such as mass treatment, preparedness, and mitigation is likely under-represented. Accreditation from ACGME for DM fellowship would further promote uniform implementation of the updated core curriculum and ensure optimal training of disaster-ready physicians.
灾难医学（DM）是一个独特的领域，随着灾难事件的应对变得越来越复杂，它已经有了显著的发展。然而，DM 并未得到美国医学专业委员会（ABMS）或研究生医学教育认证委员会（ACGME）的认可，因此缺乏专科认证。此外，先前的研究表明，在急诊医学（EM）住院医师培训或急诊医疗服务（EMS）专科培训中，存在着独特的 DM 知识体系，这导致在大多数最适合培养 DM 医生的研究生医学教育（GME）项目中，并未涵盖基本的 DM 主题。最近发布的 DM 核心课程解决了这一知识差距，并旨在促进 DM 培训的标准化。
本研究旨在分析急诊住院医师培训和 EMS 专科培训课程中是否包含 DM 主要课程主题和子主题，并将最近发布的 DM 核心课程作为对照。
使用 Wexler 等人发布的 DM 课程建议作为对照，分析急诊住院医师培训和 EMS 专科培训课程中是否包含 DM 课程主题和子主题。如果课程中描述了至少一个相关子主题，则认为涵盖了主要课程主题。使用描述性统计方法分析纳入和排除的 DM 主题和子主题。
虽然所有的 DM 主要课程主题都被急诊住院医师培训或 EMS 专科培训所涵盖，但 EMS 专科培训涵盖了更多的主要课程主题（14/15；93%），而急诊住院医师培训涵盖了较少的主要课程主题（12/15；80%），并且 EMS 专科培训涵盖了更多的 DM 课程子主题（58/153；38%），而急诊住院医师培训仅涵盖了较少的 DM 课程子主题（24/153；16%）。急诊住院医师培训和 EMS 专科培训共涵盖了 153 个 DM 课程子主题中的 65 个（42%）。
尽管本研究发现所有的 DM 主要课程主题都将在急诊住院医师培训后由 EMS 专科培训涵盖，但仍有一半以上的子主题未被任何一个项目（分别为 16%和 38%）或两个项目的组合（42%）涵盖。越来越相关的子主题，如气候变化、干旱和洪水等，都不在这两个课程涵盖的范围之内。即使在 GME 课程中包含的 DM 主题中，对大规模治疗、准备和缓解等主题的强调也可能被低估了。ACGME 对 DM 专科培训的认证将进一步推动更新后的核心课程的统一实施，并确保对灾难准备医生进行最佳培训。
