How to train emergency docs
===========================

* Alan Drummond

I enjoyed reading the opinions of James Ducharme1 and Ivan Steiner,2 2 respected leaders within emergency medicine, even though I disagreed with the basic premise of these commentaries.

Human resources are indeed an important component of emergency care, but I believe the crucial question is not how to train the physicians who will staff our nation's emergency departments (EDs) but rather how to improve the quality of care given to individual patients presenting for emergency care. No matter how well trained our emergency physicians, they will ultimately be unable to have a sustained, meaningful impact on patient care if they find themselves unsupported, working in overcrowded emergency departments EDs and stressed to the point of burnout. Unfortunately, these 3 factors constitute the “new norm.”

There are currently no enforced performance standards for any ED in Canada. This means that many physicians find themselves working in departments with insufficient numbers of nurses, inadequate equipment, inaccessible diagnostic tools and limited consultant support. Overcrowding in EDs has perversely come to be accepted as routine. The problem has been reported in Canada since the mid-1980s3,4 and, despite a clear understanding of the causes and solutions,4,5,6 there appears to be no political will to solve this public health hazard. Finally, a lack of attention to the wellness of emergency physicians has contributed to the dreadful loss of many talented colleagues at the peak of their clinical, academic and administrative careers.

More than a debate on training, we need a comprehensive strategy to give Canadians the emergency care they deserve in their hour of greatest need. Leadership and vision we have in blessed abundance within the talented pool of our country's emergency physicians. What is required is an appropriate forum to develop such a strategy and sufficient political will to give substance to the ideas we share.

**Alan Drummond** Chair, Public Affairs Committee Canadian Association of Emergency Physicians Ottawa, Ont.

## References

1.  1. Ducharme J. Preparing emergency physicians for the future [editorial]. CMAJ 2003;168 (12): 1548-9.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTY4LzEyLzE1NDgiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY5LzUvMzg5LjQuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  2. Steiner IP. Emergency medicine practice and training in Canada [editorial]. CMAJ 2003;168 (12): 1549-50.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTY4LzEyLzE1NDkiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY5LzUvMzg5LjQuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  3. Dickinson G. Emergency department overcrowding [editorial]. CMAJ 1989;140(3):270-1.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=2914238&link_type=MED&atom=%2Fcmaj%2F169%2F5%2F389.4.atom) 

4.  4. Feferman I, Cornell C. How we solved the overcrowding problem in our emergency department. CMAJ 1989;140(3):273-6.
    
    [Abstract](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNDAvMy8yNzMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY5LzUvMzg5LjQuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

5.  5. Drummond AJ. No room at the inn: overcrowding in Ontario's emergency departments. Can J Emerg Med 2002;4(2):91-7.
    
    

6.  6. Canadian Association of Emergency Physicians, National Emergency Nurses Affiliation. Joint Position Statement on emergency department overcrowding. Can J Emerg Med 2001;3(2):82-4.