Introduction

Emergency Medicine is a unique and emerging speciality all across the world, it has a great scope, wide broad-based curriculum and huge variety to offer to EM physicians, physicians can choose to work flexibly on days, weekends, nights or out of the hour, no other speciality offers that much flexibility, variety and scope what EM offers. This is the reason why Entry into EM training programmes in first world countries is very difficult, Its competitive and therefore very small number of doctors are lucky enough to be matched or offered national training programme number, on the contrary demand for EM physicians is huge and the majority of EM services are provided by non-trainee doctors, middle grades, trust grades, clinical fellows, SMO, EMO, CMOs who do not undergo any formal training, therefore, don’t have a vast understanding of acute medical and surgical illnesses.

Sadly, Pakistan is among one of the few countries where Emergency Medicine is still in its infancy, Pakistan started EM as a separate speciality almost 2 decades ago but still striving to produce adequate numbers of qualified EM physicians.

This is the reason why Dr Ashfaque Sorathia (Director of London Global EM Programme) has initiated this project.

Aims And Objectives of London Global EM Programme for Pakistan

This programme is the first of its kind and is an intellectual asset of Dr Ash and is unique in many ways, no country, no institute, organisation, or hospital has ever tried anything like this before. it’s addressing the needs of non-trainee doctors which is the major workforce for any hospital and is specifically designed to provide necessary skills and knowledge so that they can then step up as specialists and consultants. 

This programme will break all barriers for doctors who wish to do post graduations, but their family or personal circumstances didn’t allow them to join the National Training programme.

This programme is flexible, live, online instructor-led, interactive from the UK. There will be 2 classes per week which will be taken by senior EM clinicians of the UK.

The main aims of this project are as follows

• To own Non-trainee doctors, supervise them, train them, and bring the best out of them, so they can improve the quality of EM services across Pakistan.
• To produce 5000 EM physicians in Pakistan in the shortest possible time who can then serve confidently all over Pakistan
• To address the need of our nation, educate and train those EM physicians who are somehow left out and are in the middle of nowhere
• To Standardized EM care across Pakistan
• To make Pakistan EM Physicians shine globally on the international EM stage

Eligibility Criteria

• Primary Medical Qualification 
• MBBS/ MD/ Equivalent 
• House Job/ Foundation training or equivalent
• Must have completed House job or completion of House job by June 2023
• Must be working in a reputable Hospital  
• Accident and Emergency Department/ Medical Department department with adequate senior supervision by Either
•  Member or Fellow of any Royal Colleges or equivalent i.e., FCPS/MS/MD or under CMO/SMO who has at least 5 years of Post Graduate Experience
• Must have a valid license to practice medicine in the country of practice.
• Candidate must have a thorough understanding of Royal College Examinations, their parts, expenses, and courses they wish to take in the future.

You don’t Need FCPS1/FRCEM Primary or any other qualifications to join this programme. All you need is MBBS, Completed House job. The doctor must be working in A&E/Medical ward, intensive care, or acute medical departments in any reputable govt or private hospital of Pakistan. Doctors who are currently not working may apply for this programme but they must agree to take the clinical post within 3 months after starting the programme.

What candidate gets after 2 years of London Global EMT Programme. 

• A comprehensive EM learning with world-renowned EM physicians of the UK. 
• Complete the MRCEM Exam by the end of this course. 
• Comprehensive preparation for MRCEM /FRCEM exam
• You will be ready to take the European Board of EM exam if you have 3 Years of EM experience.
• You will get a logbook that will cover all competencies outlined by the Royal College of EM required for the MRCEM exam and ACCS EM training.
• Comprehensive letter of Recommendation and reference from UK NHS Faculty which will be very helpful in getting jobs in NHS UK

What would be your worth after completion of the MRCEM and 2 years Programme?

• MRCEM Is now a world-renowned Qualification in Emergency Medicine, with MRCEM you will have the following options:
• Stay Where you are and improve the quality of service in your department.
• You can move to Gulf and Mid East countries with a higher salary package. The current salary package in UAE/Gulf /KSA countries for MRCEM qualified doctors is ranging between 18,000 - 30,000 AED/months.
•  With MRCEM you can get an A&E Registrar job in UK without IELTS.
• You may also apply for UK higher speciality EM training programme at the ST4 level
• You can also join as a consultant in charge at any reputable hospital in Pakistan

In short, this programme will be a life-changer for you.

Extra Benefits, In addition to above

• This programme will prepare you for ACCS/St3/St4 UK interviews as well
• You will get a reference /Letter of Recommendation from a UK consultant who will be your supervisor/trainer.
• This programme will teach you more than 100 EM practical procedures with supervised hands-on practice, extra certificate will be given confirming that doctor has learnt these procedures.
• This programme will provide you with all the necessary EM skills which a trainee gets in the National training programme. so essentially, we will make sure that there remain no gaps between EM trainees and non-trainees.
• You will be a part of a structured EM education programme, which will give you a feeling of self-worth and career progression

How this programme will be delivered

This programme is 60% online and 40% Practical face to face, we will deliver a total of 220 hours of teaching over 2 years, out of which 140 hours will be online and 80 hours will be onsite practical sessions in the form of practical workshops.

• One hour live online lecture from the UK twice a week.
• First, 10 minutes Candidates will do case presentations as per RCEM published curriculum and tutor will then thoroughly teach each case, highlighting all relevant investigations and management plans as per UK guidelines
• There will be case-based discussions and logbooks will be maintained.
• After the session reference resources will be provided for further learning.
• All sessions will be recorded so candidates will be able to watch missed lectures flexibly and be able to keep a record.
• Every six months we will arrange a practical hands-on workshop to help candidates acquire necessary practical skills.
• There will be full long day conferences, seminars, and exam workshops to help candidate boost their preparation for EM exams.

Note: This is not just the MRCEM/FRCEM Exam Preparation programme, it’s much more than that, this programme will provide comprehensive EM learning with adequate supervision, it will enable candidates to map the entire Royal College of EM Curriculum into their clinical practice and be able to compete and take registrar post in the UK.

Candidate Responsibilities

• Must-Attend all lectures, lectures will be recorded and be available to catch up later in case the candidate misses any, but candidate must catch up by the end of the same week. 
• At the end of 6 months, candidates should aim to attempt the FRCEM primary Exam or latest by End of the First-year candidate must attempt FRCEM Primary Exam, the plan should be in place.
• By the end of 12 months or latest by 18 months candidates must aim to attempt FRCEM Intermediate SBA
• By the end of 18 months or latest by 24 months candidates must register themselves for the MRCEM OSCE Exam. 
• Candidate must attend 4 days “100 Emergency Medicine Procedure workshop “which will be conducted in Karachi/ Lahore / Islamabad over 2 years, the worth of this workshop is £800 but the candidate who is registered in this programme will get it for free. 
• The AM/EM content is presented as 6 major presentations and 38 acute presentations. These should be covered over the typical 12-18 months periods. (Details Of Major and Acute Medical Presentations listed in the curriculum below)
• RCEM has listed 45 items under practical procedures that trainees should aim to cover over the first 2years. (RCEM Guide requires 45 Procedures, but We will teach 100 procedures which will cover all procedures required by RCEM)
• Candidate must actively participate in case presentation, each candidate will be allocated time to present their cases, at the start of lecture candidate will be given 10 minutes to present their case comprehensively, which will then be followed by a consultant, active feedback will be given, and all candidates had to write learning reflection. 
• The candidate must do at least one e-learning module a week from RCEM recommended resources, this will be guided by our team.
• The candidate must remain honest throughout the course and follow GMC good medical practice guidelines.

Optional Recommendations for candidates

• Participate in departmental audit 
• Initiate Quality Improvement Projects
• Read Journals of EM 
• Active participation in teaching at own Hospital and Departments 
• Attend EM local, regional, and international EM Conferences, seminars, and Webinars 

Responsibilities of GEM Faculty

We have lined up top-notched EM consultants of the UK who will be joining us as a tutor, our faculty members are currently working in London’s most reputable hospitals including St Thomas, The Royal London and London Barts NHS hospital trust, Role of our faculty will be

• To Provide quality EM Education
• To supervise, Mentor and Train individual candidates.
• To participate in Clinical Case Base discussion and provide feedback 
• To address the individual needs of a candidates 
• To cover the entire ACCS EM curriculum comprehensively, keep records and sign off required competencies 
• To provide guidance and help candidates to prepare for MRCEM Exam. 
• To conduct 6 monthly FRCEM courses for candidates who register themselves for the Exam.
• To provide references and recommendations to all successful candidates who wish to work in UK or abroad.
• To help candidates find a job in UK after completing MRCEM. 
• To help candidates to get into the training programme of the UK by helping with portfolio and ACCS/ST4 interview preparations. 

What we aim to deliver in 2 years

We will aim to complete the entire ACCS EM curriculum in 2 years as per RCEM guidelines.

Also, list of 100 Emergency Medicine Procedures which will be taught by the LCC team and Dr. Ash himself.

We will conduct a practical face to face 4 days workshop in Karachi, Lahore, Abbottabad and Islamabad, in this workshop we will teach 100 Emergency Medicine procedures with full hands-on practice and under the direct supervision of Dr. Ash.

Detailed Programme Outline:

Basic Competencies

Common Competencies

Basic clinical competences

Integrating clinical practise and patient safety

Communication

Legal and ethical aspects of care

Standards of care and education

Personal behaviour

Management and NHS structure

Clinical Competencies

Clinical Curriculum 

Major presentations

Acute presentations

Procedural Competences

Anaesthetic Competences

Intensive Care Medicine

Major Presentations

CMP1 Anaphylaxis

CMP 2 Cardiorespiratory Arrest

CMP3 Major Trauma 

CMP4 Sepsis Patient

CMP5 Shocked Patient 

CMP6 Unconscious Patient 

Acute Presentations

CAP1 (S) Abdominal pain including loin

CAP2 Abdominal swelling, mass and constipation

CAP3 Acute back pain

CAP4 Aggressive/disturbed behaviour

CAP5 Blackout/collapse

CAP6 Breathlessness

CAP7 Chest pain

CAP8 Confusion, acute/delirium

CAP9 Cough

CAP10 Cyanosis

CAP11 Diarrhoea

CAP12 Dizziness and vertigo

CAP13 Falls

CAP14 Fever

CAP15 Fits/Seizure

CAP16 Haematemesis & Melaena

CAP17 Headache

CAP18 Head injury

CAP19 Jaundice

CAP20 Limb pain & swelling - atraumatic

CAP21 Neck pain

CAP22 Oliguric patient

CAP23 Pain management

CAP24 Painful ear

CAP25 Palpitations

CAP26 Pelvic pain

CAP27 Poisoning

CAP28 Rash

CAP29 Red eye

CAP30 Mental health

CAP31 Sore throat

CAP32 Syncope and pre-syncope

CAP33 Traumatic limb and joint injuries

CAP34 Vaginal bleeding

CAP35 Ventilatory support

CAP36 Vomiting and nausea

CAP37 Weakness and paralysis

CAP38 Wound assessment and management

Procedural Competencies

PP1 Arterial cannulation

PP2 Peripheral venous cannulation

PP3 Central venous cannulation

PP4 Arterial blood gas sampling

PP5 Lumbar puncture

PP6 Pleural tap and aspiration

PP7 Intercostal drain - Seldinger

PP8 Intercostal drain - Open

PP9 Ascitic tap

PP10 Abdominal paracentesis

PP11 Airway protection

PP12 Basic and advanced life support

PP13 DC Cardioversion

PP14 Knee aspiration

PP15 Temporary pacing 

PP16 Reduction of dislocation/fracture

PP17 Large joint examination

PP18 Wound management

PP19 Trauma primary survey

PP20 Initial assessment of the acutely unwell (in ICU)

PP21 Secondary assessment of the acutely unwell

PP22 Connection to a mechanical ventilator

PP23 Safe use of drugs to facilitate mechanical ventilation

PP24 Managing the patient fighting the ventilator

PP25 Monitoring respiratory function

PP26 Deliver a fluid challenge safely to an acutely unwell patient

PP27 Describe actions required for accidental displacement of tracheal tube or tracheostomy

PP28 Preoperative assessment

P29 Management of spontaneously breathing patient

PP30 Administer anaesthesia for laparotomy

PP31 Demonstrate RSI

PP32 Recover patient from anaesthesia

PP33 Demonstrate function of the anaesthetic machine

PP34 Transfer of patient to the operating table

PP35 Demonstrate CPR resuscitation on a manikin

PP36 Technique of scrubbing up and donning gown and gloves

PP37 Basic competencies for pain management

PP38 Patient identification

PP41 Choice of muscle relaxants and induction agents

PP42 Post op analgesia

PP43 Post-op oxygen therapy

PP44 Emergency surgery

PP45 The routine for dealing with failed intubation

Safe use of vasoactive drugs and electrolytes (2010)

Anaesthetic Competence

A1a Preoperative assessment - History taking

A1b Preoperative assessment - Clinical examination

A1c Preoperative assessment - Specific anaesthetic evaluation

A2 Premedication

A3 Induction of general anaesthesia

A4 Intra-operative care

A5 Post-operative and recovery room care

A6 Management of respiratory and cardiac arrest

A7 Control of Infection

A8 Introduction to anaesthesia for emergency surgery

Airway management

Procedural sedation

Transfer medicine

Critical incidents

Aspects of regional anaesthesia (2010)

Intensive Care Medicine

ICM1 Demonstrate aseptic peripheral venous cannulation

ICM2 Demonstrate aseptic arterial cannulation (+ local anaesthetic

ICM3 Obtain an arterial blood gas sample safely, interpret results correctly

ICM4 Demonstrate aseptic placement of the central venous catheter

ICM5 Connect mechanical ventilator and select initial settings

ICM6 Describe safe use of drugs to facilitate mechanical ventilation

ICM7 Describe principle of monitoring respiratory function

ICM8 Describe the assessment of the patient with poor compliance during ventilatory support (fighting the ventilator)

ICM9 Prescribe safe use of vasoactive drugs and electrolytes

ICM10 Deliver a fluid challenge safely to an acutely unwell patient

ICM11 Describe actions required for accidental displacement of tracheal tube or tracheostomy

Paeds EM

CT/ST3 Paediatric Emergency Medicine

Major presentations (in children

PMP1 Anaphylaxis

PMP2 Apnoea, stridor and airway obstruction

PMP3 Cardio-respiratory arrest

PMP4 Major trauma in children

PMP5 The shocked child

PMP6 The unconscious child

Acute presentations (in children

PAP1 Abdominal pain

Covered by PAP1 Testicular pain

PAP2 Accidental poisoning, poisoning and self-harm

PAP3 Acute life-threatening event (ALTE)

PAP4 Blood disorders

PAP5 (M) Breathing difficulties - recognise the critically ill and those who will need intubation and ventilation

PAP6 Concerning presentations

PMP6 Fits/Seizure

PAP7 Dehydration secondary to diarrhoea and vomiting

PAP8 ENT

PAP9 (M) Fever in all age groups

PAP10 Floppy child

PAP11 Gastro-intestinal bleeding

PAP12 Headache

PAP13 Neonatal presentations

PAP14 Ophthalmology

PAP15 (M) Pain in children

PAP16 Painful limbs - atraumatic

PAP17 (M) Painful limbs - traumatic

PAP18 Rashes in children

PAP19 Sore throat

Paediatric procedure

PEMP1 Primary survey in a child (M)

PEMP2 Airway assessment and maintenance (M

PEMP8 Venous access in children

PEMP24 Paediatric equipment and guidelines in the resuscitation room (M)

PEMP3 Choking child (S)

PEMP4 Orotracheal intubation (S)

PEMP6 Needle thoracocentesis

PEMP7 Tube thoracostomy 

PEMP9 Intraosseus line insertion (S)

PEMP10 Direct current electrical cardioversion defibrillation (S)

PEMP13 Oro/nasogastric tube replacement

PEMP15 Infiltration of local anaesthetic

PEMP16 Incision and drainage of abscesses

PEMP17 Incision and drainage of paronychia

PEMP18 Evacuation of subungual haematoma

PEMP19 Wound exploration and irrigation

PEMP20 Wound repair with glue, adhesive strips and sutures

PEMP21 Immobilisation techniques

PEMP23 Fracture/dislocation reduction techniques

PEMP24 Plaster technique

List of 100 Emergency Medicine Procedures which will be taught by the LCC team and Dr. Ash himself.

Day 1 - 100 EM Procedures

1) Airway Manoeuvres

2) Use of Basic airway adjuncts ( OPG/NPG)

3) Use of Bag Valve mask and basic ventilation

4) Use of Advance Airways I Gel, LMA

5) Endo Tracheal Intubation

6) Surgical Airway Cricothyroidotomy/ Tracheostomy

7) Removal of foreign body from upper airway

8) Abdominal Thrust to remove airway foreign body in Adults

9) Needle Cricothyroidotomy

10) Surgical Cricothyroidotomy

11) Percutaneous Tracheostomy

12) Neck Immobilization and Intubation

13) Open surgical chest drain

14) Eletrical DC Cardiovesion

15) Tension Pneumothorax Needle Decompression

16) Aspiration Pneumothorax

17) Sildenger Chest drain

18) I/V cannulation

19) Venupuncture

20) Arterial Blood Gases

21) Insertion of Arterial Line

22) Obtaining Intraosseus access

23) Valsalva

24) Modified Valsalva Manouvre

25) Chemical Cardio Version

Day 2 - 100 EM Procedures

26) Cervical spine immobilization and protection

27) Log Roll

28) Shoulder Dislocation and Manipulation Technique (one)

29) Elbow Dislocation and Manipulation Technique      

30) Reduction and manipulation of Distal Radius Fracture (Colles Fracture)

31)Reduction and Management Phalangeal Dislocation

32)Application of slings Collar and cuff slings , Broad arm slings

33)Application of below elbow back slab/PoP( Sling POP)

34)Use of various splints in hand/ finger Neighbour strapping

35) Application of Sager/Donnoway/Thomas Splint ( need)

36) Fundoscopy ( Done)

37) Otoscopy ( Done)

38) How to Check Eye PH ( PH strip)

39) Eye Irrigation in Chemical injuries to eye ( Morgan lense)

40) Removal of Foreign body from eye and application of Eye patch

41) Management of Anterior Epistaxis , Anterior Nasal Packing

42) Use of Rhinopad to control Anterior and post Epistaxis ( Rapid Rhino)

43) Cauterization for Anterior Epistaxis ( Silver Nitrite Sticks)

44) Removal of Foreign body from Ear ( Mosquito Forceps)

45) Removal of Foreign Body from Nose ( Nasal Probe)

46) Technique and Principles of Quinsy Drainage ( Orange/Gray cannula)

47) Incision and Drainage of Abscess ( Scalpal and wound pack)

48) Drainage of Subungal hematoma 

49) Nail bed injuries à Repair and Rimplantation

50) Wound Closure/Suturing

Day 3 - 100 EM Procedures

51) Urethral Catheterization

52) Bimanual PV Examination

53) Cuscos Spaculum Examination

54) High Vaginal Swab /Cervical Sampling /Pap Smear

55) Removal Of Foreign Body from Vagina ( lost tampon/Condom removal) on mannequin.

56) P/R and Prostate Examination on Manneqquin

57) Breast Examination on Mannequin

58) CVS ( SVT Chemical Cardioversion

59) VT chemical Cardioversion

60) Ankle Relocation

61) wound suture flap

62) ring removal with silk thread and soap

63 64)BLS Paeds

65)Primary Survey

66) Secondary survey

67) patellar relocation

68) Above knee back slab

69) Ulnar gutter splint

70) Scaphoid cast

71) procedure sedation

72) safe transfer

73) removal of patient from scoop

74) Safe transfer from bed to bed ( Pat slide)

75) Intubation in patient with head and neck trauma BLS Adult

DAY 4 - 100 EM Procedures

76) Removal of helmet in Head injured patient

77) femoral stab

78) FAST scan

79) aorta scan

80) echo in life support

81) Dental Block ( Dental Syringe)

82) Volar Slab

83) Transcutaneous pacing

84) Pericardiocentesis

85) Radial Head Sublaxation

86) fish hook removal

87) Lumbar Puncture

88) Suprapubic bladder 

89) Priapism Management

90) Digital globe massage

91) How to apply thumb spica cast

92) Antenatal examination of Full-term pregnant lady in ER

93) Laryngoscopy

94) Foreign Body helminch manouver

95) FB back blows

96) FB Abdominal thrust

97) TMJ Dislocation /Relocation

98) Intramuscular Injections

99) deroofing of Burns blisters

100) fasciotomy