Talk:International emergency medicine

Fellowships
Moved to talk because no references and likely incomplete. RJFJR (talk) 14:54, 21 July 2010 (UTC)

Fellowships are provided at the following universities:

Duke Medical Center

Stanford University Medical Center

Alameda County Medical Center - Highland Hospital

Loma Linda University

Keck School of Medicine at the University of Southern California

George Washington University

Emory University

Medical College of Georgia

Rush University/ Cook County Hospital

University of Illinois at Chicago

The Johns Hopkins University

University of Maryland

Columbia University/New York Presbyterian Hospital

Long Island Jewish Medical Center

University of Rochester Medical Center

University of Pittsburgh

Vanderbilt University

Rhode Island Hospital- Brown University

International emergency medicine page (expansion and revisions)
Hello, my name is Matthew, and I'm an undergraduate student from Rice University. I'm intending on expanding and rewriting this article for a class project. Currently there isn't much more than a definition and description of the International Conference on Emergency Medicine. I'd like to create more of a focus on the establishment/improvement of emergency medicine in developing countries. There is actually a fairly extensive literature on international emergency medicine in some of the emergency medicine journals so there is a lot of scope to add information about the state of emergency medicine in the developing world and initiatives that are underway to improve it. I'm still trying to figure out how to strike a balance between a broad overview of the topic and examples from specific countries. My plan is reorganize what is already there and to create sections like "Overview of international emergency medicine", "Institutions involved", "Role in the overall health system", "Initiatives to expand emergency medicine", and "Challenges." I would be glad to hear if anyone had ideas on other sources I could use as most of my intended sources are from medical journals. Any suggestions for the best way to go about this project? Mjs15 (talk) 15:45, 3 October 2012 (UTC)


 * Welcome. Toil away. If you have any queries on anything, ask at WT:MED, where you introduced yourself earlier. I know a bit about the editing policies so feel free to ask anything on my talk page. --Anthonyhcole (talk) 15:52, 3 October 2012 (UTC)

Global perspective
Hi, nice work on a complicated topic. I think the article, ironically, needs a little bit more 'global perspective'. A basic example to illustrate what I mean is the reference to "practicing abroad", which means different things depending on where you are. Similar problem with "emergency medicine in other countries" being a key part of the definition. Other than what? Is "international medicine" actually, specifically, the practice First world emergency medicine in Third World countries? I don't like these terms, but to be honest I prefer them to developed/developing, which IMO are actually more loaded.

Are there cultural practices outside of the global capitalist monoculture that could be considered "emergency medicine"? If so, are these part of "international emergency medicine" when they are used in, for example, the United States? Or is "international emergency medicine" a unidirectional transfer from Us to Them? (With Anglo-American and Franco-German the only choices. Which actually makes me wonder, even within the first world, about the state of Soviet international emergency medicine...)

None of which is to trash your hard work or even suggest we need to remove anything, but I do think some expansion and reframing is necessary. Salaam, groupuscule (talk) 19:40, 26 October 2012 (UTC)

Thanks for the c/e and feedback. This is just my first draft of the article, so I'll try to address some of your concerns when I go back to rewrite and expand it.

I see what you mean about trying to write from a more global perspective and I'll try to incorporate that into my edits. However, I think that developing and developed are probably the clearest terms for discussing countries in international emergency medicine, as well as being the ones used in the literature. Of course, they are not ideal either, especially as some otherwise fairly developed countries lacked emergency medical systems until recently. I'll give the issue some more thought.

I don't know much about "cultural practices outside of the global capitalist monoculture" but international emergency medicine is certainly about more than just transfers from us to them. Research and best practices should flow both ways. I'll try to emphasize that more in my edits. Mjs15 (talk) 01:03, 28 October 2012 (UTC)

Peer Input
Hi Matt! I think this article is a really good and well-written. I have a few suggestions which you can feel free to take or ignore. I think under the importance section the final sentence in the third paragraph needs to either be rephrased or cited so that it won't be perceived as a factual claim without any proof. Also, I think in general it would be good to be cognizant of the fact that this is an encyclopedic entry so the language needs to be neutral. So one sentence in particular that I think needs to be rewritten or cited is under the importance section also and it says "Emergency departments are excellent locations to train health care providers and to collect data due to the density of patients". Also, some of the transitions seem a little too colloquial for an encyclopedic article such as of course and as would be expected so I think it'd be helpful if you changed that. Best, Lgriffin92 (talk) 02:46, 30 November 2012 (UTC)

The changes already made during the GA Review
I'll take on the changes recommended in the GA review. Seeing as the article wasn't promoted at that time and is not currently under review, I can get this article up to GA status at my own pace. AmericanLemming (talk) 21:35, 17 June 2013 (UTC)


 * possible useful links: public health, developing world, white paper, critically ill, cost-benefit study, variable, curriculum, travel medicine, field medicine, infection control, disease burden
 * ✅ Changed by Mjs15 on 30 January 2013


 * the lead is currently a bit US-Centric; is IEM offered as a fellowship in non-US programs as well?
 * "it was the high number of traffic and other accident fatalities in the 1960s that spurred by a white paper from the National Academy of Sciences that exposed the inadequacy of the current emergency medical system and led to" something's wrong with the grammar in this sentence
 * ✅ Changed by Mjs15 on 15 February 2013


 * "These are conditions that potentially threaten the lives of those who are afflicted by them and yet adequate and/or timely treatment may not be available for much of the world's population." Source for this statement? If it's the same as the previous sentence, it needs to be placed at the end.
 * ✅ Changed by Mjs15 on 3 February 2013


 * "For instance, a 2008 study of Zambia published by" It wasn't a study of Zambia, rather, it was a study of its "current status of anesthesia and its allied disciplines (intensive care medicine, emergency medicine, and pain therapy)". I'm worried that a primary source is being used to advance a position; has this study been cited in any reviews?
 * Arnold (1999) is the most frequently cited paper in this article, but it's now 14 years old. WP:MEDRS (particularly, WP:MEDDATE) advises us to "Look for reviews published in the last five years or so, preferably in the last two or three years." Have there not been any review papers that cover the same material published since then? Any textbooks? Any dedicated chapters in more general textbooks on Emergency medicine?
 * "EMS" is used as a shorthand starting in the "Models of emergency care" section, but is not defined anywhere
 * ✅ Changed by Mjs15 on 3 February 2013


 * Hauswald and Yeoh is a primary study from 1997, and so not particularly MEDRS-compliant; can the cost-benefit argument be supported with a secondary source?
 * "In developing counties international emergency medicine is one among many initiatives" the subheader right above indicated this subsection is called "Developed countries"; should the underlined be "developed"?
 * ✅ Changed by Mjs15 on 15 February 2013


 * "…international emergency medicine is one among many initiatives underway to shape the future of the specialty." Confused, isn't international emergency medicine the specialty?
 * ✅ Changed by Mjs15 on 15 February 2013


 * "Its authors argue that attempting to cover all of those areas may be unrealistic and that a more targeted focus on acquiring necessary skills might be more productive." this sentence needs a citation
 * ✅ Changed by Mjs15 on 15 February 2013


 * "Given the relatively young nature of emergency medicine as a specialty in the world as a whole there are" can we trim the underlined without sacrificing meaning?
 * ✅ Changed by Mjs15 on 3 February 2013


 * "a far greater number of nations (50+) are in the process of developing those systems." this statement will become dated (see WP:DATED), so an template could be useful here
 * "Preventive care is clearly a crucial part of healthcare"
 * ✅ Changed by Mjs15 on 3 February 2013


 * "Some money may be available from wealthier nations or international organizations but careful decisions still need to be made. Regardless of the amount of preventive care available, though, health problems requiring immediate attention will still occur and emergency medical programs could increase access to care." source?
 * Hobgood et al. (2009) isn't marked by Pubmed as a review, but the similar-sounding Singer et al. (2009) is; could you check if the latter source can be substituted?
 * "It is targeted towards all medical students in order to produce a minimum competency in emergency care for all physicians, regardless of their specialty." citation please
 * ✅ Changed by Mjs15 on 15 February 2013


 * " As would be expected, countries that have" the underlined sounds like editorializing and should be trimmed
 * ✅ Changed by Mjs15 on 15 February 2013


 * several dated statements: "The most recent conference took place in Dublin, Ireland on the 27 - 30 June, 2012."; "Up until now the conference has rotated"; "new members have been accepted in recent years"
 * "An important step for the advancement of emergency medical care" who says this is important? The authors of the primary source cited at the end of the paragraph? I can't find this article indexed in Pubmed, and it seems the entire paragraph is based on a possibly dubious source.
 * "An alternate route is providing additional training" an alternate route of what?
 * ✅ Changed by Mjs15 on 15 February 2013


 * "This has the benefit being more rapid to implement as physicians already trained in other areascan add the necessary emergency skills to their repertory." fix grammar
 * ✅ Changed by Mjs15 on 15 February 2013


 * "Educational opportunities in emergency medicine are simply not available"; "Botswana just opened its first medical school in 2009"
 * ✅ Changed by Mjs15 on 15 February 2013


 * there is no need to define acronyms (eg. CEM(SA), EMSSA) if they aren't used later
 * "An important notion present in emergency medical systems development" Again, I'm not comfortable with how the article often tries to tell the reader what's important (especially when sourced to a primary study); please rephrase
 * "Despite the intuitive appeal of the thought that increasing availability to emergency medicine will improve patient outcomes" The suggestion that the thought has intuitive appeal sounds like editorializing; also the phrase "More to the point" soon after
 * the final two paragraphs need end-of-paragraph citations
 * please include pubmed id's to all of the the cited sources; it makes it easier for the reader to read the abstract and otherwise follow-up on sources (the template is an easy way to implement this)

The changes remaining to be made from the GA Review
These are the things that I'll be changing. AmericanLemming (talk) 22:21, 17 June 2013 (UTC)


 * the lead is currently a bit US-Centric; is IEM offered as a fellowship in non-US programs as well?
 * ❌ As far as I can tell, IEM is only offered as a fellowship in US programs. I don't have a source that says that, but that's my understanding. AmericanLemming (talk) 19:42, 19 June 2013 (UTC)


 * "For instance, a 2008 study of Zambia published by" It wasn't a study of Zambia, rather, it was a study of its "current status of anesthesia and its allied disciplines (intensive care medicine, emergency medicine, and pain therapy)". I'm worried that a primary source is being used to advance a position; has this study been cited in any reviews?
 * ✅ I've reworded the phrase to better represent the nature of the study. And yes, the study has been cited in one review, "Clinical review: International comparisons in critical care - lessons learned," (see "Priorities for future international research" section near the end). The PubMed ID is 22546146. AmericanLemming (talk) 19:32, 19 June 2013 (UTC)


 * Arnold (1999) is the most frequently cited paper in this article, but it's now 14 years old. WP:MEDRS (particularly, WP:MEDDATE) advises us to "Look for reviews published in the last five years or so, preferably in the last two or three years." Have there not been any review papers that cover the same material published since then? Any textbooks? Any dedicated chapters in more general textbooks on Emergency medicine?
 * ❌ There are a few review papers on IEM that are more recent, but the two I found were more focused on the specifics of the literature from a particular year than on defining what exactly IEM is, like Arnold (1999) does. Anyway, the two reviews I found are as follows:
 * International Emergency Medicine: A Review of the Literature from 2010
 * International Emergency Medicine: A Review of the Literature from 2009


 * Hauswald and Yeoh is a primary study from 1997, and so not particularly MEDRS-compliant; can the cost-benefit argument be supported with a secondary source?
 * ❌ I'm afraid not; no other source that I know of mentions the cost-effectiveness of adapting Western EMS standards to developing countries. AmericanLemming (talk) 19:42, 19 June 2013 (UTC)


 * "a far greater number of nations (50+) are in the process of developing those systems." this statement will become dated (see WP:DATED), so an template could be useful here


 * "Some money may be available from wealthier nations or international organizations but careful decisions still need to be made. Regardless of the amount of preventive care available, though, health problems requiring immediate attention will still occur and emergency medical programs could increase access to care." source?


 * Hobgood et al. (2009) isn't marked by Pubmed as a review, but the similar-sounding Singer et al. (2009) is; could you check if the latter source can be substituted?


 * several dated statements: "The most recent conference took place in Dublin, Ireland on the 27 - 30 June, 2012."; "Up until now the conference has rotated"; "new members have been accepted in recent years"


 * "An important step for the advancement of emergency medical care" who says this is important? The authors of the primary source cited at the end of the paragraph? I can't find this article indexed in Pubmed, and it seems the entire paragraph is based on a possibly dubious source.


 * there is no need to define acronyms (eg. CEM(SA), EMSSA) if they aren't used later

✅
 * "An important notion present in emergency medical systems development" Again, I'm not comfortable with how the article often tries to tell the reader what's important (especially when sourced to a primary study); please rephrase
 * "Despite the intuitive appeal of the thought that increasing availability to emergency medicine will improve patient outcomes" The suggestion that the thought has intuitive appeal sounds like editorializing; also the phrase "More to the point" soon after


 * the final two paragraphs need end-of-paragraph citations


 * please include pubmed id's to all of the the cited sources; it makes it easier for the reader to read the abstract and otherwise follow-up on sources (the template is an easy way to implement this)

Picky comments
I'm not an expert on FA, so take all my comments below with a grain of salt. I've tried to be picky to give you as much as possible to work with. I also made some changes as I went, which you should feel free to revert any (or even all) of.

My first impression is that this looks quite good, and I'm very grateful for your work on it. This was a topic that I wasn't familiar with, and I learned a lot reading this article. The difference between Anglo and Franco health care models was particularly interesting.

The biggest issue for me (as you'll gather from my comments below, made as I went) is that I felt much of the analysis this article presents should be more directly attributed in-text; many statements that seemed to verge on opinion or interpretation are presented in Wikipedia's voice as established fact. None seemed terribly egregious, but it wouldn't be a hard issue to fix; just change more of the prose to "Weiner et al. state that a key factor in international emergency medicine", etc.

A secondary issue was that I was unclear what debates or controversies might exist in this specialty. (There's the debate over the definition, but I found it difficult to understand what the second group of authors saw as oxymoronic, or what their disagreement meant in practical terms.) Some discussion clarifying different approaches/schools of thought, and critiques of those approaches, would be useful, if this exists.

I hope some of this is helpful! Thanks again for your work on this one, it's really terrific how far you've brought it. -- Khazar2 (talk) 02:56, 19 August 2013 (UTC)

Comments

 * "However, this definition has been criticized as oxymoronic, given the international nature of medicine and the number of physicians working internationally." -- wouldn't this make it redundant, rather than an oxymoron? I'm not sure I follow this part.
 * Truth be told, I'm not exactly sure either. I didn't write that sentence. MJs15 did. But, seeing as he is somewhat occupied at the moment, take a look at the relevant paragraph from the source in question at the bottom of the talk page. AmericanLemming (talk) 06:59, 20 August 2013 (UTC)


 * "although these countries' EMSs did not become fully mature until the early 1990s" -- this seems like an opinion that might be attributed to someone. It seems likely that the field will continue to develop in both developed and developing nations, whereas this paragraph implies that some countries are finished with that process.
 * The relevant sentence from the source is "With maturation of EM as a specialty in these countries, a number of EM practitioners in the early 1990s started to turn their attention to developing the specialty in other countries." That same article notes that the precise years in which EM started and became mature in these countries are debatable. AmericanLemming (talk) 03:49, 20 August 2013 (UTC)


 * How does "improved healthcare" lead to more interest in emergency medicine?
 * To quote the relevant section of the source directly, "There are also a number of reasons for recent increasing interest in developing EM within other countries. These include the general overall medical system improvement in most countries." As the quality of healthcare improves, it raises public expectations for healthcare, as the public begins to expect further improvements (Or at least that's what I'm inferring.) Also, as some aspects of a healthcare system are "brought up to speed," it makes both policy-makers and the public more aware of other aspects that need to improve (Again, I'm reading between the lines.) As a disclaimer, none of my explanation here is directly supported by the source. AmericanLemming (talk) 06:36, 20 August 2013 (UTC)


 * I feel that the lead may be more detailed than necessary. For example, I was surprised that the discussion of whether the definition is oxymoronic rests entirely on a three-page article; perhaps there's just very little written about this topic, but that seems like a minor blip to make it into the lead.
 * Well, the FA reviewer thought that the lead was way too short and didn't cover everything in the article, so I greatly expanded it. I stand by the lead as a whole, but it is true that the alternative view mentioned in the lead is a minority view. I guess it's a question of whether it's significant enough to be mentioned. On one hand, we want to avoid giving undue weight, but on the other hand, we don't want to imply that everyone is in agreement on the definition. AmericanLemming (talk) 02:01, 20 August 2013 (UTC)
 * I wonder if it would be possible to just write something like "but this definition has also been criticized"? Perhaps you're right that it's better to have detail, though. -- Khazar2 (talk) 02:13, 20 August 2013 (UTC)


 * " "increased public expectations...in many countries."" -- this seems like a quote that could simply be paraphrased; the exact wording doesn't seem terribly important
 * ✅ AmericanLemming (talk) 02:09, 20 August 2013 (UTC)


 * " thus showing a need to improve emergency medical care" -- I'd suggest attributing this analysis to its author in-text as well as in the citation.
 * ✅ AmericanLemming (talk) 02:11, 20 August 2013 (UTC)


 * As a broad note, I feel like the article includes many statements that seem to me borderline on whether they need in-text attribution. "Emergency departments are excellent locations to train health care providers and to collect data, because of the high number of patients" seems like a bit of opinion that shouldn't be in Wikipedia's voice; I wouldn't flag an individual statement like that, necessarily, but it seems to happen often.
 * ✅ I've attributed that entire paragraph to the authors of the source. As far as the article in general goes, if you think it would benefit from more such attribution, I'll put it in there, but that would take a while. AmericanLemming (talk) 07:12, 20 August 2013 (UTC)


 * "which relies on "bringing the patient to the hospital", and the Franco-German model, which operates through "bringing the hospital to the patient."" -- these quotations should be followed by an inline citation
 * ✅ AmericanLemming (talk) 02:15, 20 August 2013 (UTC)


 * "Within that understanding of emergency care models there is also an acknowledgement that current Western models may be totally inadequate in the context of developing nations." -- By "that understanding", do you mean Arnold and Holliman?
 * ✅ Yes. I have clarified that point. However, in the interest of full disclosure, ref 10 does not warn against Western models in general; it merely advises against adopting all aspects of the United States' EMS model, as some of those are nor suited to developing countries. AmericanLemming (talk) 06:47, 20 August 2013 (UTC)


 * "that current Western models may be totally inadequate in the context of developing nations" -- it seems like the Kuala Lumpur example demonstrates that Western models would not be cost-effective, but I'm not sure that's the same as "totally inadequate", which suggests to me a failure to provide care
 * ✅ I'm glad you pointed that out. I didn't realize that it could be confusing to some people. AmericanLemming (talk) 02:18, 20 August 2013 (UTC)


 * "In developed counties, international emergency medicine is one among many initiatives underway to shape the future of emergency medicine. " -- this phrasing seems like ad-speak--does it mean anything besides "international emergency medicine exists"?
 * ✅ It does not. I have removed the sentence. One subtle bias this article may have is its attitude toward EM and EMS; the editor who wrote most of it, Mjs15, is an EMT. AmericanLemming (talk) 04:04, 20 August 2013 (UTC)


 * "Such exchanges can be mutually beneficial. For instance, 23 to 28 percent of all physicians in Australia, the United States, the United Kingdom and Canada received their training at medical schools outside of the country in which they currently practice" -- does the source describe this as mutually beneficial? The article is titled "brain drain".
 * It does not. I think the idea is that while developing countries can benefit from short-term trips by physicians from developed countries, developed countries greatly benefit from physicians from developing countries who move there permanently. Obviously, developed countries benefit much more from this exchange than developing ones do, but I'm not sure if I can say that in the article without a ref to back me up. AmericanLemming (talk) 03:09, 20 August 2013 (UTC)


 * "Some money may be available from wealthier nations or international organizations, but careful decisions still need to be made" -- another moment where this seems to me to veer into analysis
 * ✅ I've removed the analysis, as I'm pretty sure the guy who added that sentence just put it in there, without a source to back him up. (Mjs15, the editor who expanded the article from a stub to a C- or B-class article, is my brother. He doesn't understand all of Wikipedia's nuances.) Also, I don't think removing the sentence changes the meaning of the paragraph at all. AmericanLemming (talk) 03:37, 20 August 2013 (UTC)


 * "Regardless of the amount of preventive care available, health problems requiring immediate attention will still occur and emergency medical programs could increase access to care, particularly if they focus on low-cost but effective treatments administered by first responders" -- another moment that should be attributed to an author, I think. The article at times appears to be assembling an argument for the importance of this discipline.
 * I've attributed the second part of that sentence, but I think the first part falls under analysis/original research, however self-evident it may seem. I don't think I can find a ref for the first part, either. AmericanLemming (talk) 06:54, 20 August 2013 (UTC)


 * "Africa is the continent most in need of developing emergency medical systems" -- is this universally agreed? Seems like another moment that could use "According to,"
 * ✅ I think it's pretty obvious that the caption is true, but I understand the need to give attribution and then let readers come to their own conclusions. AmericanLemming (talk) 03:43, 20 August 2013 (UTC)


 * "One key component in equipping nations to develop emergency medical systems is to identify the aspects of training that are essential for health care providers" -- attribute
 * ✅ AmericanLemming (talk) 02:55, 20 August 2013 (UTC)


 * "a standard curriculum is still useful for identifying core issues" -- attribute
 * ✅ AmericanLemming (talk) 02:55, 20 August 2013 (UTC)


 * "Scott Weiner suggests" -- should this be Scott Weiner et al.?
 * ✅ Yes, it should be. AmericanLemming (talk) 02:32, 20 August 2013 (UTC)


 * "Its application worldwide could lead to the boon of sharing best practices between emergency medicine practitioners in various countries, thus advancing the current standard of emergency care." -- attribute
 * ✅ AmericanLemming (talk) 02:36, 20 August 2013 (UTC)


 * "Educational opportunities in emergency medicine are not available in many countries, and even when present, they are often in their infancy" -- so if the goal of the specialty is to promote EMS knowledge and training in other countries, how is lack of training in other countries a "challenge" to that? Shouldn't it be expected that the people you plan to train are not yet trained?
 * I would say that this is analogous to the proverb "Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime." It's impossible for EM practitioners from developed countries to teach the relevant skills to every individual in developing countries who needs to know these things. I think the idea is that it's easier to train people in the relevant skills than it is to train people to train people in the relevant skills, hence the challenge.
 * In short, it's easier in the short run to train people than it is to train them to train other people, but it's more sustainable in the long run to do the latter. If you find it confusing, it may need some rewording, but I'm not entirely sure how to go about doing that. AmericanLemming (talk) 02:46, 20 August 2013 (UTC)

Relevant paragraph from source 3: As medicine has become more global, opportunities to practice in other countries have expanded. Indeed, ‘‘international emergency medicine’’ is to some degree an oxymoron. Medicine is by definition international. Nigerian physicians working in Great Britain or Kenya are obviously working internationally. So are Dutch physicians working in the Netherlands after training in the United States. Indeed, some of us have become transnational. This raises a definitional problem: if IEM is defined only as ‘‘... the area of emergency medicine concerned with the development of emergency medicine in other countries," this will have limited applica- bility to most international jobs.

Controversies
I do have a source that would seem to lists some controversies about IEM: Challenges in international medicine: ethical dilemmas, unanticipated consequences, and accepting limitations.

On a separate note, I am starting to think that the article isn't comprehensive enough for FA status. It doesn't mention international pediatric emergency medicine at all (a sub-subspecialty of EM), growth in the number of EM journals around the world; or any controversies about IEM. I probably should withdraw it from the FAN list, as I really don't have time to fix any of those gaps, either. AmericanLemming (talk) 07:35, 20 August 2013 (UTC)
 * I'm hesitant to try to judge as a non-expert, but from what you say those do sound like areas that should be included. Perhaps you should pull and try to fill those gaps, and then go for a peer review before taking this to FA again? I think you've done a good job addressing my concerns above, so I'm not sure I can make any further suggestions myself, but PR is a stop for many editors pre-FA; hopefully you could get some good further feedback there. In either case, though, I wish you the best of luck with this important topic! -- Khazar2 (talk) 00:25, 23 August 2013 (UTC)

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