The European Union of Medical Specialties (UEMS) promotes the development of unifying documents relating to training in all recognised specialties across Europe. These European Training Requirements (ETRs) take the form of a structured document describing the specialty, the competences required, how the competences will be acquired and assessed and the requirements for the institution and the training programme including educator capability.
The Section and Board for Emergency Medicine within UEMS, together with the Education committee of the European Society for Emergency Medicine (EUSEM) reviewed the ETR that was originally published in 2019, and updated it in line with current clinical practice and educational models. The document, after consultation with Emergency Medicine colleagues across Europe, and the Advisory Board and Council of UEMS, was approved as the ETR for Emergency Medicine in April 2024.
The new ETR utilises the concepts of key competences or capabilities of the emergency physician, based on the pathway that a patient will follow within a clinical encounter. These include;
>the recognition and management of time critical conditions within the triage and resuscitation setting,
>assessment of signs and symptoms,
>procedural capability,
>utility and interpretation of investigations
>clinical reasoning to determine management plans focused on individual patients.
The ETR also emphasises the professional competences required for emergency medicine (based on CANMEDS) including communication, collaboration, leadership, safety and quality improvement, health promotion, education and research and professional behaviours.
Within the ETR, the concept of the development of capability from novice to expert is defined, introducing the principles of growing independence as the practitioner evolves to a specialist level.
These two complementary principles of capability and independence provide a structure to support the learner in developing across the breadth of the clinical syllabus, which has been entirely reviewed and edited. New to the syllabus for example are the explicit descriptions of capability around the use of ultrasound in the emergency department, inclusion and reference to the UEMS adolescent framework and a focus on quality and safety elements suggested by EUSEM Q&S committee. Other areas have been refined and some elements removed from the syllabus. The syllabus is presented to reflect the competences/capabilities and includes both symptoms, signs and diagnoses as well as specific procedures investigations and clinical situations.
In addition to the content described above – the ETR describe the organisation of training including a recommended training pathway (five years is recommended), suggestions for assessment including template workplace based assessment forms and outline of educational governance for a training programme. The authors have described the requirements for a trainer including core competences for trainers and the training requirements for institutions.
By redefining both the clinical syllabus and competences/capabilities of an emergency physician and also the structure and support needed to enable training, the ETR defines a unified standard for Emergency Medicine in Europe. The document recognises that the systems for delivery of emergency care vary across the European countries and therefore some countries may be unable or not need to meet these standards particularly in the breadth of the clinical syllabus. Whilst not all countries in Europe will meet the standards described (and some will exceed these standards), it is hoped that many countries will adopt this standard to enable high quality care to be delivered by appropriately trained physicians. Countries with their own curriculum in place may also wish to demonstrate how the European ETR is reflected in their own curriculum.
The unanimous support for the ETR from all specialties in UEMS and from all UEMS Board members reflects the maturation of the specialty in Europe and the recognition of the significant contribution EM makes to the healthcare systems in European countries and to their people. The ETR will set the standard for emergency physician capability – it will naturally require to be reviewed within 5 years as the specialty continues to grow and responds to challenges and clinical innovation.
Ruth Brown on behalf of the ETR revision group 2024
