Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 3 2023 09 30 Pulmonary hydatid cyst in pregnancy e31 e31 Mustafa Eid Department of Emergency Medicine, Tawam Hospital, Al Ain, UAE Alaa Al-Zubaidi College of Medicine, University of Diyala, Baqubah, Iraq 2023 03 26 2023 08 29 A 26-year-old pregnant lady was referred from a private hospital to the emergency department with a cough, shortness of breath, decreased oxygen saturation, and repeated vomiting. She went to the private hospital for obstetrics and gynecology follow-up for her pregnancy. The patient is 21 weeks pregnant with no known comorbidities. She is gravida three and para two. The patient claimed that since 3 days, the shortness of breath (SOB) and cough have been worsening, and she has been inducing herself to vomit more frequently, however, there is no associated dysphagia. She denied fever, headache, dizziness, abdominal pain, or a change in bowel habits. https://fem.tums.ac.ir/index.php/fem/article/view/1187 https://fem.tums.ac.ir/index.php/fem/article/download/1187/452
and the authorities in the Ministry of Health and Medical Education (MOHME) are trying to solve the problem by “supplemental offer”, in the hope of recruiting applicants for unclaimed spots. However, besides these temporizing measures, it is imperative to deep dive into the factors contributing to this unprecedented national trend in order to shed light on the factors behind it and the solutions ahead of us. The problem is multifaceted and influenced by a myriad of interconnected factors. It is partly driven by the current landscape of the healthcare system and the changes to specialty preferences by students (3) in general. Moreover, the trend seems to be present in other parts of the world as well (3). Yet, there are aspects that are unique or more significant for EM in Iran: As a specialty driven by the needs of the society, its existence requires constant support and recognition by the society (mainly represented in the health sector by MOHME). It seems that the current authorities have forgotten what the emergency rooms were like in the era before EM, and have taken the current situation of emergency healthcare for granted. This is represented not only in their speeches and statements, but also in their decisions regarding regulations for compensation. Establishment of EM as a specialty was a fundamental action toward improving emergency care (4,5), but it was too optimistic to think that it can solve the entire problem. More actions were needed including training other related providers and ancillary staff, restructuring the design of the departments, and changing the employment structure of ED healthcare providers. Eluded by the drastic changes created just by the introduction of competent and energetic EM physicians, the authorities neglected many of these crucial actions. In an effort to solve quickly a problem that existed for a long time, MOHME created a surge in EM positions, jeopardizing the quality of EM training programs and ignoring the supply-demand dynamics of the discipline. They even failed to consider the advice of the National Board of Emergency Medicine, who repeatedly warned them against the dangers of expanding the number of residency programs and training sites without enough quality assurance system in place. This mass production of emergency physicians with inconsistent qualities, considered by many as the main trigger of the shift in the situation of EM, require a detailed exploration in its own right. Surprisingly, the number of EM residency positions has increased in recent years, while the number of applicants continued to decline. High levels of burnout (resulting from poor compensation and financial reward mechanisms, high prevalence of violence (6,7), overcrowding of the EDs with extended boarding of the patients, and exacerbated by the COVID pandemic) has disappointed many EM practitioners who selected this specialty with great enthusiasm. Some of these people role model burnout explicitly during their shifts and fail to interact positively with medical students, who are potential applicants of EM residency. This atmosphere of despair reassure the hesitant applicants not to opt this field as the future of their carriers. As emergency physicians, we are accustomed to dealing with unanticipated, unfavorable events and we have been trained to handle these conditions calmly and efficiently. In this case, too, we must take this situation as an opportunity to shape the future of our specialty. Convincing those who are responsible for healthcare workforce planning to work in tandem with the authorities in charge of graduate medical training in order to find logical and feasible solutions including an organized approach to a balanced workforce is a first step. This requires diplomacy and tactfulness of the EM community, and perhaps more importantly, an open mind and a listening ear on the administration side.  https://fem.tums.ac.ir/index.php/fem/article/view/1282 https://fem.tums.ac.ir/index.php/fem/article/download/1282/454