A 1‐year training program in emergency medicine for physicians in Karachi, Pakistan: Evaluation of learner and program outcomes

Abstract

Background Pakistan has an underdeveloped and overburdened emergency care system, with most Emergency Departments (EDs) staffed by physicians not formally trained in Emergency Medicine (EM). As of January 2020, only nine Pakistani institutes were providing formal EM specialty training; therefore, a training program of shorter duration is needed in the interim. Methods The Certification Program in Emergency Medicine (CPEM) is a one-year training program in EM consisting of two arms: CPEM-Clinical (CPEM-C), which includes physicians from The Indus Hospital (TIH) ED; and CPEM-Didactic (CPEM-D), including physicians from EDs across Karachi. Both groups participate in weekly conferences, including didactics, small group discussions, workshops, and journal clubs. CPEM-C learners also receive clinical mentorship from visiting international and TIH EM faculty. Both groups were assessed with pre-program, midterm, and final exams, as well as on clinical skills. Additionally, both groups provided regular feedback on program content and administration. Results Twenty-five of the 32 initially enrolled learners completed the program in June 2019. Scores on a matched set of 50 questions administered in the pre-test and final exam improved by an average of 15.1% (p<0.005) for CPEM-C learners and 8.5% (p<0.0005) for CPEM-D learners, with 93% of learners showing improvement. Clinical evaluations of CPEM-C and CPEM-D learners during the first and fourth quarters showed an average improvement of 1.1 out of 5 (p<0.05) and 1.2 out of 9 (p<0.0005) points, respectively. Learner evaluations of the program were overall positive. Conclusions CPEM demonstrated significant improvement in test scores and clinical evaluations in both program arms. Evaluations also suggested that the program was well-received. These data, along with CPEM’s ability to train physicians from multiple institutions using low-cost, innovative educational strategies suggest it may be an effective, transferable mechanism for the expedited development of EM in Pakistan and countries where EM is developing as a specialty.