Emergency Medicine as an Academic Discipline: Giants strides along an Endless Path

Abstract

For many years, emergency care had been abandoned and left in the hands of practitioners whose main interest was not working in the not-so-much respected “emergency room (ER)”. They were usually obliged to serve the first years of their career in the ER, where senior colleagues did not want to be bothered with, before they were allowed to focus on their ultimate goals. This fact had led to delivery of a fragmented, suboptimal care to the patients who were seeking care for the most urgent threats to their health. Not only were these emergency physicians’ novice and inexperienced, but they also suffered from an inevitable tunnel vision rooted in their primary specialty, which adversely affected their practice by causing inability to take care of the often undifferentiated ER patients. Another issue, which resulted from this model of emergency care, was that some areas of emergency care did not fit well into the realms of the existing specialties and so had remained under-developed for many years. These included but were not limited to topics such as pre-hospital and disaster medicine, environmental and wilderness medicine. Last but not least on the list of problems that emergency care faced was the problem of stewardship and leadership, something that the emergency room urgently needed. With people considering the ER as a platform for their next move in their career, or as a marshland they were stuck in, one could not expect a long-term visionary, strategic plan.  Being faced with these challenges, the community of medicine resigned itself to giving birth to a new specialty: “emergency medicine”.  It was then that the now-called “emergency departments (ED)” were staffed by professionals whose first and ultimate work arena was the ED; their main interest and focus was to deliver high quality care to the critically ill and injured people who were brought to the EDs. Moreover, their training and experience were also related to the emergent situations and their broad vision and multi-tasking capabilities made them very suitable for work in the hectic environment of the ED. With increasing utilization of the EDs and diversity of the services provided, the role of these physicians in the healthcare system became more pronounced.

Although first created with an intention of service delivery in mind, this new specialty has experienced tremendous advancements; changes that not only have resulted in its further establishment, but also have transformed it into an “academic discipline”. Like any other academic discipline, emergency medicine incorporates elements such as expertise, people, communities, and research areas. Formation of communities such as American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), and International Federation for Emergency Medicine (IFEM) as well as the scientific bodies such as American Board of Emergency Medicine (ABEM) endorsed this position and emergency medicine successfully introduced itself to the academia. Emergency medicine residency programs flourished throughout the United States and around the world and new fellowships and subspecialties emerged. Emergency medicine programs were active and vigorous and contributed a lot to the field of medical education. Research activities were also part of this movement and led to the compilation of an enormous amount of evidence pertaining to the practice of emergency medicine. These pieces of evidence have found their way into the guidelines and protocols developed by well-known scientific organizations. This added to the reputation of emergency medicine among other disciplines.

In Iran, since the establishment of this specialty in the country about 25 years ago, a more or less similar path has been followed. Beginning with only one program, there are now 25 emergency medicine residency programs around the country with around 350 medical graduates entering these programs. The national board is well established and the Iranian Society of Emergency Medicine functions as a member of IFEM. Emergency medicine trained specialists are working in tandem with the most recent advances in emergency and critical care in highest volume emergency departments, which are now much better equipped than in the past. Emergency medicine has become an integral part of the medical curriculum at undergraduate level and now several other specialties also ask their residents to do a clinical rotation in the emergency department under the supervision of emergency medicine attending physicians. In addition to these achievements, one should not forget the huge share of this discipline in the research products. While there is still a long way ahead, many cutting-edge research projects have been accomplished and the results have been published in prestigious emergency medicine journals. However, the presence of a platform for dissemination of the results of these scholarly activities at a national level is an urgent need. Many researches are of interest to a national or local readership and not necessarily for a wider population around the world. Furthermore, many manuscripts are facing difficulty getting published due to non-academic reasons such as the problems with paying the publication fees or the reluctance of the journals to be in contact with scholars from Iran for political reasons (or excuses), including sanctions.

With the successful experience of the first Iranian emergency medicine journal, the emergency department of Tehran University of Medical Sciences decided to launch a journal that matches the high standards of this old and outstanding university. We hope that this endeavor will provide the scholars of the emergency medicine discipline as well as other investigators with an opportunity to publish their manuscripts and benefit from the input of other colleagues. We also hope to promote the position of this journal to a well-known academic journal in the region. In doing so, the editorial board will eagerly wait for the constructive feedback of our esteemed audience.