Editorial August 2009
Academic Emergency Medicine in India

With the first hospital based training program in emergency medicine for doctors starting in 1997, we have come a long way. It will be a rollercoaster ride in emergency medicine academics from now on. An MBBS graduate now has a wide choice of EM training programs available in India.

From a cheap 6 month online certificate course in Accident & Emergency Medicine to a 3 year post graduate program costing 18lakh, there are a multitude of 1year, 2 year & 3 year EM residency programs. It is quite obvious that every single of these academic trainings are occurring in private institutes as of today. EmergencyMedicine.in conducted a survey of established Indian emergency departments in April 2009, which showed that there are more than 212 doctors undergoing training in the field of emergency medicine, in private institutes. This number is even higher now.

As mentioned in a number of recent articles, the Medical Council of India (MCI) has still not recognized emergency medicine as a specialty in India. Judging from the activity at www.indusem.com, it seems that AIIMS is all set to start a formal MD in emergency medicine and push this down to all other medical colleges across India. Faculty training is already under way. As per their recent newsletter, the faculty for training new EM physicians will be drawn from other specialties until EM postgraduates in training exit and take over the departments, which has been estimated to take about 25 years!

In sharp contrast, private hospitals started certification programs in emergency medicine way back in the late 90s. The teaching, restructuring & faculty evolution over the past few years has improved emergency care to such a level that the EM resident training at some Indian private institutes & corporate hospitals today is far superior, if not at par, to that available in any other pioneering country in the world. Both clinical & academic emergency medicine is highly dependent on active EMS networks, well organized emergency departments, advanced high end investigations, specialty-superspecialty care, information technology, and most importantly, presence of teaching faculty trained purely in emergency medicine. And this is what makes the private sector more attractive for the ideal EM learning experience.

But still, it is the government hospitals which will be caring for the majority of our sick population and those who have taken the onus of either establishing or learning the specialty of emergency medicine in this segment will certainly have a tough time on the casualty floors even if it has been a cake walk on paper!

Dr. Imron Subhan
Administrator
EmergencyMedicine.in
.

EmergencyMedicine.in FEATURED PERSONALITIES brings to our readers, the voices, minds & hearts of the most enthusiastic people contributing to emergency medicine in India.

Emergency Medicine in India is in the stage of evolution and this is an opportunity of learning for everyone working in EM. We try to show you the interviews with contributers to Indian emergency medicine, both novices as well as veterans. In a country as diverse as ours, the experience of the current emergency physicians & allied individuals can never be overlooked. We believe that the replication of the best practices implemented by these personalities, in addition to those from the West, will facilitate the setup of new Indian emergency departments in a faster & more standardized manner.

__________________________________________

DR. ANUNAYA JAIN
Fellow in Emergency Medicine Research, University of Rochester, USA
Managing Editor, International Journal of Emergency Medicine
__________________________________________

He is one of the emergency physicians recently trained in India who chose emergency medicine research as a career goal. The path he has taken is loaded with information which we feel will benefit not only budding researchers in Indian emergency medicine, but also the those who are responsible for its promotion here. CLICK HERE TO READ MORE

EmergencyMedicine.in FEATURED EMERGENCY DEPARTMENTS takes our readers up and close into the most active and happening emergency departments in India. Lets look at what is there, instead of highlighting what is not there.

Emergency Medicine in India is in the stage of evolution and this is an opportunity of learning for everyone working in EM. We try to show you facilities, staffing patterns, training, academics, equipment and also interviews with few of the staff members. In a country as diverse as ours, the experience of the current emergency departments can never be overlooked. We believe that the replication of the best practices found in these featured EDs, in addition to those from the West, will facilitate the setup of new Indian emergency departments in a faster & more standardized manner.

__________________________________________

APOLLO MEDICAL CENTER
Passenger Terminal Level B, Rajiv Gandhi International Airport, Shamshabad, Hyderabad, INDIA
Level II Emergency Service, Level III Trauma Center
__________________________________________

We chose our first contender, the Apollo Medical Center (AMC) at Rajiv Gandhi International Airport, Shamshabad - Hyderabad, because of its uniqueness. And with our website operations based in Hyderabad, we had no issues reaching the facility. It was a 37km ride to the airport which took exactly... CLICK HERE TO READ MORE

Apollo Health City, Hyderabad, India and the College of Emergency Medicine (CEM), United Kingdom conducted the 2009 graduation ceremony for the doctors who went through the 3 year emergency medicine residency program and passed the MCEM examinations last year. The graduation ceremony was held at Novotel, Hi Tech City, Hyderabad on 10th June 2009 and was attended by doctors & staff of Apollo Health City along with family & friends of the MCEM recipients. Local media had a heavy presence.

The College of Emergency Medicine conferred its honorary Fellowship (FCEM) to Dr. Hariprasad, CEO of Apollo Hospitals, Hyderabad for his extraordinary contribution to the specialty of emergency medicine in India. He is the first physician outside United Kingdom to receive an honorary FCEM and also the first to recieve after the College was incorporated into the Royal Charter.

This EmergencyMedicine.in video shows Dr. Gautam Bodiwala, President of International Federation of Emergency Medicine (IFEM) addressing the audience followed by Dr. Hariprasad, CEO of Apollo Hospitals, Hyderabad recieving the honorary FCEM from Dr. Ed Glucksman, Vice President of College of Emergency Medicine (UK).

Dr. Hariprasad was one of the founders of the Society of Emergency Medicine in India (SEMI) which was formed in 1999. He organized the first Indian conference in EM in the same year (EMCON 1999) and also the first International Conference in EM in 2002 (INTEM 2002), both hosted by Apollo Hospitals, Hyderabad. Switching over to EM from anesthesia, Dr. Prasad was responsible for starting the 1 year structured training program in EM known as Fellowship in EM at Apollo Hyderabad in 2000 which was subsequently affiliated to the Royal College of General Practitioners, UK.

In 2005, he launched the MCEM emergency medicine residency training program in collaboration with CEM, UK at Apollo Hyderabad. This 3 year post graduate training program for doctors is now available at 5 other Apollo Hospitals in the country i.e at Apollo Hospitals Bangalore, Chennai, Delhi, Ahmedabad & Kolkota. There are more than 55 doctors currently in the MCEM program. Dr. Hariprasad was also responsible for starting one of the first EMS systems in the country known as National Network of Emergency Services with the universal emergency number 1066, in the year 2001.

The College also conferred its membership by examination (MCEM) to 6 young physicians who had passed the MCEM Part B & C exit exams in 2008. The certificates were handed by Dr. Ed Glucksman who is the Vice President of College of Emergency Medicine (Academic & International).

Dr. Gautam Bodiwala, President of the International Federation of Emergency Medicine (IFEM) and also the CEM International Representative, felicitated the occasion. The Registrar of CEM examinations & Chair of Court of Examiners, Dr. Ruth Brown along with the Chief Examiner for London & Chair of the Higher Training Committee for London, Dr. Helen Cugnoni were also present during the ceremony. They were here for the conduct & supervision of the June 2009 diet of MCEM Part A, B & C exams at Apollo Hyderabad.

LEFT Dr. Mahesh Joshi, Head of Emergency Medicine, Apollo Health City, Hyderabad and CEO of National Network of Emergency Services, gives the welcome address to the audience. RIGHT Dr. A.N.Venkatesh recieves his MCEM certificate from Dr. Ed Glucksman, Vice President of College of Emergency Medicine, UK


Standing (L to R)
Dr. Mahesh Joshi - Head of Emergency Medicine Apollo Hyderabad, Dr. P. E. R. Subrahmanayam , Dr. Indraneel Dasgupta, Dr. A. N. Venkatesh, Dr. Nina Laxmikanth, Dr. Satinder Kaur, Dr. Pooja Jain and Dr. Hariprasad - CEO Apollo Hospitals, Hyderabad.

Sitting (L to R)
Dr. Ed Glucksman - Vice President of CEM, Dr. Gautam Bodiwala - President of IFEM, Dr. Ruth Brown - Registrar of CEM Examinations and Dr. Helen - Senior Examiner in CEM.




LEFT Dr. Pooja Jain is congratulated by her father on her MCEM certification and for being one of the first credentialed emergency physicians from India. RIGHT Apollo Emergency Medicine Faculty. Left to Right Dr. Imron - Apollo Hyderabad, Dr. Venkatesh - HOD Apollo Bangalore, Dr. Mahesh Joshi - HOD Apollo Hyderabad, Dr. Ketan Patel - HOD Apollo Ahmedabad, Dr. Priya - HOD Apollo Delhi and Dr. Dhavapalani - HOD Apollo Chennai.

This gathering was one of the most important events in emergency medicine in India and points to many conclusions.
One, the absence of recognition of emergency medicine specialty by the Medical Council of India has not prevented the development & maturation of EM postgraduate residency training, examination & certification; which is recognized internationally.
Two, the tendency of MCEM qualified candidates to occupy EM departments at various other hospitals within Apollo Group coupled with Joint Commission International (JCI) accreditation of these facilities, is establishing high quality emergency medicine in this private sector.
Three, interactions with the heads of EM departments of various Apollo Hospitals are indicating an unprecedented level of cooperation at a national level to carry clinical & academic EM across the entire spectrum of Apollo facilities numbering more than 44 hospitals, with Apollo Hyderabad being the center of the hub.

EmergencyMedicine.in salutes Apollo Group for the recognition and the continued contribution to the field of emergency medicine in India, since more than a decade!
.

Dr. Suresh David, Professor & Head of Dept of Accident & Emergency Medicine, Christian Medical College (CMC), Vellore, India, is the senior most emergency physician in India with more than 18 years of EM experience and one of the pioneers for the development of emergency medicine in India. He is a honorary recipient of the Fellowship of Australian College of Emergency Medicine (FACEM) in 2006.

CMC Vellore has the distinction of having developed the first independent emergency medicine department in the country, in 1994. The 44 bed ED, with an annual flow of more than 45000 patients, has been conducting structured training in emergency medicine & emergency nursing since 1997.

The department faculty team presented various CME lectures in toxicology at Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India on 7th June 2009. Dr. David presented a talk on Emergency Medicine in India - Past, Present & the Future

He said that EM is not yet officially recognized as a specialty in India and the main reason was due to the non-existence of EM postgraduate training by the Medical Council of India (MCI). The obstacles for EMs genesis in India included the inertia of policy makers i.e. MCI, who were unfamiliar to the concept of EM, unconvinced of its relevance in the practice of medicine and they believe that EM is still taught by respective specialties.

The pitfalls in the existing system were ineffective emergency departments or casualties, incompetent staffing and poor networking. He also said that EM training opportunities were only available at a small number of private institutes which included CMC, Vellore.

Dr. David also pointed out that the National Board of Examinations (which is another independent body responsible for postgradute education in India) was ready to recognize EM postgraduate specialty training but was hesitant to do it without MCI recognition. The previously available post MS fellowship was a poor substitute for basic specialty training and had a low uptake among specialists due to poor job opportunities.

He said that the main steps which would be needed are recognition of EM as a specialty by the MCI, implementation of PG training program and inclusion of EM training into the undergraduate curriculum. He also said that emergency physicians in India were a loose collection of clinicians with a common interest, most of them were half cooked and working in ineffective EDs.

The future cannot be predicted but EM popularity will rise when the PG program is on the horizon
- Suresh S David, 2009

Dr. Suresh David also informed that work was underway for a comprehensive textbook in emergency medicine which will focus on EM from the Indian perspective.
.