After a huge success of our 1st MRCEM batch we are pleased to announce our 2nd batch for non trainee doctors of Pakistan. On this special occasion we would like to share what LGEM and its First batch trainees have achieved in last 8 months.
LGEM has spread like a wild fire all across Pakistan, we now have our trainees in more than 200 hospitals LGEM has signed partnership MOU/ Agreement with 5 prestigious health institutes of Pakistan, name of these institutes are:
1. Abbottabad International Medical Institute
2. South City Hospital Karachi
3. Evercare Hospital Lahore
4. KMDC Karachi Medical & Dental College Alumni Association.
5. Pakistan Airforce Fazaiya Ruth Pfau Medical College Karachi
LGEM has delivered more than 140 hours of live interactive teaching from UK to more than 200 of its trainees all across Pakistan. We also conducted, 100 Emergency Medicine Procedures Workshop in Karachi and Lahore which was attended by more than 100 GEM trainees.
Last but not the least, LGEM team made special arrangements to conduct Level 1 EM ultrasound workshop in Karachi and Lahore , here it’s important to mention that as per RCEM guidelines Level 1 EM ultrasound competencies are mandatory to be acquired by EM trainees in UK and it was the first time Level 1 EM US workshop took place in Pakistan, more than 60 GEM trainees learnt EM Ultrasound skills from NHS UK consultants as per RCEM guidelines.
The biggest success of LGEM is more than 80% doctors who attempted FRCEM Primary exam from Pakistan have passed this tough exam in very first attempt , we now have more than 25 LGEM trainees who have passed FRCEM primary and same number will be appearing in MRCEM Intermediate exam in April 2023.
We are now inviting , committed and passionate non trainee doctors to apply for this unique programme and progress further in third careers under direct supervision of Dr Ash (Director London GEM Programme)
A brief overview of London Global Emergency Medicine MRCEM BATCH 2 Programme from our Director - Dr Ash (Consultant Emergency Medicine, Acute Medicine & Geriatric Medicine NHS UK)
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, so far a number of qualified EM physicians in Pakistan is less than 20 and demand is 30,000+, means Pakistan hasn’t produced even less than 1 % of what is needed.
This is the reason why Dr Ashfaque Sorathia (Director of London Global EM Programme) has initiated this project.
About The Director of London Global EM Programme.
Dr Ashfaque Sorathia (Dr Ash) is among the few leading EM consultants in the UK who has taught and trained over 1000 EM physicians in the UK, he is a very passionate EM physician with a vast academic and teaching background, he is actively involved in teaching MRCEM, FRCEM and EBEEM Courses. He is the director of London Clinical Courses and a Founder of Pakistan Emergency Medicine Association.
Dr Ash has worked at Leading NHS UK hospital trusts, including Barts London NHS, The Royal London Hospital, Guys and St Thomas Hospital London, Queen Hospital London, and Newham Hospital London.
He has conducted numerous teaching sessions in UAE, Dubai, Saudi Arabia, Egypt, and Brussels Belgium.
He is the pioneer of MRCEM /FRCEM courses In Dubai and Medina.
All he wants now is to change Emergency Medicine in Pakistan.
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
- 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 or completion of House job by the end of June 2023. 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 by June 2023.
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.
- 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 clinical competences
Integrating clinical practise and patient safety
Legal and ethical aspects of care
Standards of care and education
Management and NHS structure
Intensive Care Medicine
CMP 2 Cardiorespiratory Arrest
CMP3 Major Trauma
CMP4 Sepsis Patient
CMP5 Shocked Patient
CMP6 Unconscious Patient
CAP1 (S) Abdominal pain including loin
CAP2 Abdominal swelling, mass and constipation
CAP3 Acute back pain
CAP4 Aggressive/disturbed behaviour
CAP7 Chest pain
CAP8 Confusion, acute/delirium
CAP12 Dizziness and vertigo
CAP16 Haematemesis & Melaena
CAP18 Head injury
CAP20 Limb pain & swelling - atraumatic
CAP21 Neck pain
CAP22 Oliguric patient
CAP23 Pain management
CAP24 Painful ear
CAP26 Pelvic pain
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
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)
A1a Preoperative assessment - History taking
A1b Preoperative assessment - Clinical examination
A1c Preoperative assessment - Specific anaesthetic evaluation
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
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
CT/ST3 Paediatric Emergency Medicine
Major presentations (in children
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
PAP7 Dehydration secondary to diarrhoea and vomiting
PAP9 (M) Fever in all age groups
PAP10 Floppy child
PAP11 Gastro-intestinal bleeding
PAP13 Neonatal presentations
PAP15 (M) Pain in children
PAP16 Painful limbs - atraumatic
PAP17 (M) Painful limbs - traumatic
PAP18 Rashes in children
PAP19 Sore throat
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
20) Arterial Blood Gases
21) Insertion of Arterial Line
22) Obtaining Intraosseus access
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
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
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
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