Table 4.

Program components from the selected manuscripts on broad EM programs.

First Author	Goals and Objectives	Certification/Recognition	Curriculum Outline/Content	Methods of Assessment	Funding	Logistics	Educational Resources	Outcomes	Challenges
Aggarwal	To provide guidelines for EM curricula in India – residency and medical student	Formal residency training	Core topics and required procedures for residents outlined; off-service rotations (minimum two weeks); medical student rotation (one month); no specific academic activities for medical students; required Casualty (two weeks) or EM (four weeks) posting during internship; no specific academic activities for interns; academic activities are department-wide	Thesis requirement; end-of-rotation assessment; log book; final examination with theory and practical components with short-answer questions, short cases, procedural skills (simulated), and OSCEs	Not discussed	Three-year training program; institutional requirements for ED resources and capacity and EM instructors defined	Calls for re-organization/re-structuring of existing resources; lists commonly used books and journals; reports essential list for departmental library	Clear requirements for institutions for the practice of and training in EM	Ongoing conflict and confusion with other specialty degrees such as trauma and surgery and critical care
Hammerstedt	To deliver emergency care through non-physician providers (Emergency Care Practitioners, or ECPs) in rural, low-resource settings	Emergency Care Practitioner certification	Graduated clinical and educational responsibilities; research and quality improvement requirements; weekly conferences comprised of didactic lectures, simulation, and procedural skill laboratories First year (Junior ECP) – 40 hours per week in beside learning; three hours of conference per week Second year (Senior ECP) – lead the junior-level conferences; present morbidity and mortality lectures; bimonthly CME classes on topics such as teaching	Intermittent quizzes and final written and oral examinations; procedure and patient follow-up logs; regular feedback with program director; oral case-based remediation test if needed; regular evaluation by visiting emergency physicians	Non-profit organization (Global Emergency Care)	Two-year program, train-the-trainer model	Core competencies from Uganda’s Medical Education for Equitable Services to All Ugandans and the US’s Accreditation Council for Graduate Medical Education Outcome Project; content developed by global emergency care physicians, the hospital medical superintendent, and faculty from Mbarara University and the Ministry of Health	Emergency care practitioners trained; plans to monitor patient outcomes and to expand to other sites	Tracking outcomes; expansion to other sites; funding; continued international faculty support
Keyes	To develop EM as a specialty in Costa Rica	Certificate for the Faculty Preparation Course; formal residency training	Faculty Preparation Course: review of core EM topics and instruction in teaching techniques – two hours on case review and journal club and four hours of lectures as well as clinical rotations (200 hours) and workshops; two-thirds of lectures in flipped classroom format Residency: overlap with the Faculty Preparation Course as well as a preceptor program and weekly grand rounds	Written and oral examinations monthly	Project HOPE, People-to-people Health Foundation and USAID	Faculty Preparation Course on-site by international faculty (one year) followed by the residency program (three years) supported by the first faculty for at least five years; learners included foreign physicians	ACLS, ATLS, PALS; US residency materials adapted to the local setting	14 graduates from the residency as of 1999	Attrition; payment for/status of physicians after graduation
Lim	To determine the acceptability of small-group learning in EM training	Formal residency training	Initially a lecture-based format in 2010 and redesigned to include small-group learning (40% of the curriculum) in 2014 including case-based seminars, procedure labs, and resuscitation simulations	Described elsewhere – written, oral and practical examinations; quantitative and qualitative survey	Described elsewhere – Abbott Fund Tanzania along with a departmental business plan for financial sustainability	Small groups done weekly (seminars) or 1–2 times per month (procedure labs, simulations) with an instructor-learner ratio of 4-6:1	Described elsewhere – African Federation for Emergency Medicine; International Federation for Emergency Medicine	Small groups more effective at improving clinical practice and preferred for enjoyment of learning and peer- and instructor-relationship building; preferred by learners with more experience	Novel type of learning; some sessions remain too “lecture-like”; relationship building may be difficult across learner levels
Meshkat	To develop and deliver comprehensive EM residency training; specific objectives outlined in the manuscript	Formal residency training	Clinical, Clinical Epidemiology, and EM Administration streams; didactics (separated into blocks), beside teaching, simulation, procedural sessions, and journal club; three half days a week for three months of the year; off-service rotations; formal faculty-resident mentorship program; monthly video conferencing	Session and rotation evaluations; written and practical examinations	University-based funding; Grand Challenges Canada; International Development Research Centre; hospital-based funding	Three-year program with annually repeating junior lecture series and bi-annually repeating senior series; three one-month teaching trips by visiting faculty/senior residents; briefings for visiting faculty; curriculum co-director oversight	Core content based on facility assessment, learner needs assessment, and evaluation of disease burden; free and open-access EM-specific materials listed; University of Toronto postgraduate medical education documents used to develop evaluation methods	The program is in its seventh year as of 2018 with 34 graduates, 20 working in EDs throughout Ethiopia, and 25 modules published online	Development of content by outside experts leads to discordance with local practice and resources; the program was time and resource-intensive in first three years; gaps in visiting faculty led to low morale; internet connection with teleconferencing occasionally poor
Mahadevan	To determine differences in knowledge acquisition between online and classroom-based teaching on EM concepts	None	20 modules; 10–15-minute videos or in-person teaching; case-based	Multiple choice and free-response questions	University-based grant	The online course was offered during 10 weeks of the academic year and the classroom-based course was completed over one week during the school break	Novel course developed by Stanford physicians; clips from the show ER	Both groups improved their scores on the post-test with no significant difference overall between the two groups	High numbers of late enrollees and attrition, especially in online course; the online group post-test was delayed by three months
Niyogi	To increase knowledge and to allow for task-shifting in the delivery of emergency care by teaching physician assistants (PAs) to identify and stabilize patients with acute conditions; focus on ABCs	In-service training in the Ghana Health Service	Didactic lectures, problem- and case-based small group sessions, skill stations, simulations, laminated algorithms, and a tabletop mass casualty incident exercise; initial training of trainers and supervision of initial trainings by international faculty	Written testing; observation of learners; case review; simulations	Not described	Nine-day trainer training with a refresher six months later; five-day in-service trainings led by trainers in groups of 2–3	ABCCC approach from the Integrated Management of Adolescent and Adult Illnesses and the Integrated Management of Childhood Illnesses; Ghana Standard Treatment Guidelines	All post-test scores improved from pre-test scores; the trainer refresher pre-test scores fell nearly to initial pre-test levels, but regional pre-test refresher scores stayed relatively high; 22 initial senior trainers, 39 enrolled in initial regional courses	Decay in knowledge over time; minimal differences in knowledge between trainers and trainees; resource limitations at non-training sites; scope of practice limitations for PAs; lack of familiarity with leading/facilitating case-based methodologies and simulation; refresher courses delayed too long; inability for trainees to leave clinical requirements for the training
Pean	To increase knowledge and confidence in emergency response skills using a near-peer model	BLS certification	BLS (three days); EM Module – lectures and skills sessions (two days)	Written examination and observed practical skills examination; fund of knowledge tests and self-efficacy surveys; one-year follow up survey	Self-funded and/or sponsored by private donations as well as Doctor’s Hospital at Renaissance in Edinburg, Texas, and the Icahn School of Medicine at Mount Sinai in New York, New York	One week annually for two years; student to instructor ratio 3:1; follow up survey given during the second year; lectures in the morning followed by skills sessions in the afternoon	BLS resources supplied by the Regional Emergency Medical Services Council of New York City; STRAKER Translations for translating written material; EM Module from the introductory course at Icahn School of Medicine at Mount Sinai	Improvements in fund of knowledge and self-efficacy test scores	Unexpected scheduling changes; language barrier; difficulty with maintaining continuity and connection among cohorts; high levels of non-completion and absenteeism; difficulties in communicating expectations; limited access to electricity
Reynolds	To provide multiple levels of training to provide emergency care	Formal residency training – Master of Medicine track	International faculty with transition to local faculty; competency-based; half of the time is spent on rotations in other specialties	Written multiple choice questions and essay exam; oral case-based exam; observed clinical exam (OSCE) with case presentation; professional performance audits	Abbott Fund Tanzania along with a departmental business plan for financial sustainability	10-module nursing curriculum; 1-year registrar program; 3-year residency program	African Federation for Emergency Medicine; International Federation for Emergency Medicine	90% of nurses have completed the program; residency graduates since 2013; credentialed registrars	Differences in scope of practice in low-resource settings – curricula and off-service rotations must be modified accordingly; culture of practice slow to change
Rouhani	To address a gap in human resources and knowledge in EM until more physicians are able to complete formal residency programs	Formal certificate with the Ministry of Health and National Medical School	Didactic lectures, simulation, journal club, morbidity and mortality conference, skill sessions clinical supervision, and development and delivery of one lecture; learners comprised of physicians from multiple hospitals; international and national faculty	Attendance of 75%, 180 supervised clinical hours, written pre- and post-test, completed case and procedure log	Course free of charge; participants retained full salary; non-local participants provided food and housing; subsidized in-country expenses for visiting faculty	6-month course; 96-hour didactic program conducted every other week; eight visiting faculty volunteering 3–4 weeks	Use of established residency resources; ACLS and PALS resources	11/14 graduates still working in Emergency Departments one year later; average improvement of 15 points between pre- and post-test scores	Frequent turn-over of clinical supervisors; resource limitations at non-training sites; views of staff/culture of institution; lack of curriculum flexibility; varied baseline knowledge; language barrier
Stanley	To improve competence in assessment and management of emergent conditions	None	Scenario-based drills/training with whiteboard and reference cards; focus on ABCDE	Observed scenarios (OSCE) and feedback form; pre-assessment; 1–2-week post-assessment and 8-week assessment	Not described	Three sites; four days at each site (pre-assessment, training, post-assessment, 8-week assessment) with two identical sessions daily	Previously used local training tools and instructor experience	Assessment scores and self-reported confidence scores all improved after the intervention	Attendance low