• 
  • Archives
• 
• 
• 
  • Forum
  • Audio / Visual
• 
  • Five Questions
  • Affiliate Spotlight
  • Briefcase
  • Around Harvard

View Archives:

-Select an issue- Sep / Oct 2008 July / Aug 2008 Mar / Apr 2008 Jan / Feb 2008 Nov / Dec 2007 Sep / Oct 2007 July / Aug 2007 May / June 2007 Mar / Apr 2007 Jan / Feb 2007 Nov / Dec 2006 Sep / Oct 2006 July / Aug 2006 May / June 2006 Mar / Apr 2006 Jan / Feb 2006 Nov / Dec 2005 Sep / Oct 2005 July / Aug 2005 May / June 2005 Mar / Apr 2005 Jan / Feb 2005 Nov / Dec 2004 Sep / Oct 2004 July / Aug 2004 May / June 2004 Mar / Apr 2004 Jan / Feb 2004 Nov / Dec 2003 Sep / Oct 2003 July / Aug 2003 May / June 2003 Mar / Apr 2003 Jan / Feb 2003

Welcome

• FRONT PAGE
• ABOUT HMI WORLD
• ARCHIVES
• SUBSCRIBE
• CONTACT US
• LINKS
• HMI MAIN

Feature Stories

Four-year collaboration enhances emergency medicine training for Italian physicians

Since 2003, hundreds of physicians from hospitals throughout the region of Tuscany have completed a newly created emergency medicine training program that provides physicians in the region with the first standardized training in this specialty. The program is part of a nationwide effort to develop emergency medicine into a recognized medical specialty, and in doing so, enhance emergency medical care delivery in both hospital emergency departments and in the region’s emergency response system.

The terrorist attacks of September 2001 prompted health authorities around the world to look closely at their system’s disaster management and emergency response capabilities. As Italy had no system of national or regional accreditation for emergency care, and no standardized training in this specialty, variability in care delivery was the norm, not only between hospitals but within individual emergency departments.

“From a political perspective, we believe the master’s program helped demonstrate the value of dedicated, detailed emergency medical education and advanced the emergency medicine agenda on a broader level.” -- Kevin Ban, MD

Thus the Tuscan Ministry of Health supported the development of the Tuscan Emergency Medicine Initiative, with the goal of helping to spur the growth and development of emergency medicine as a recognized specialty. The first step was to establish a standardized training program that would form a baseline for education in emergency medicine. A group comprised of members of the Department of Emergency Medicine at Beth Israel Deaconess Medical Center (BIDMC), regional health authorities, and faculty from HMI developed the structure and curriculum of the training program.

The training curriculum had three goals:

1. Establish and implement a train-the-trainer program that would produce a select group of emergency physicians that would become future educators in the program;
2. Develop an abbreviated training program and criterion-based examination that would be used to qualify all of the physicians working in regional emergency departments and in the out-of-hospital emergency response system; and
3. Launch a regional university master’s degree program in emergency medicine that would form the foundation for the future development of emergency medicine residency specialty training. (In 2006, the Italian National Ministry of Health passed a law allowing residency training in emergency medicine.)

• The program was piloted at the Careggi Medical Center, an affiliate of the University of Florence. There 24 physicians from Careggi and six other hospitals in the greater Florentine area completed the nine-month train-the-trainer program. Shortly after, the regional qualification program for 51 physicians working in regional emergency departments and in the out-of-hospital system began. During the course, the physicians attended monthly lectures (including lectures given by the 24 graduates of the train-the-trainer program), spent more than 300 hours in clinical rotations, and participated in clinical workshops led by faculty from Careggi and BIDMC. The first emergency medicine master’s degree program in Italy was launched at Careggi in September 2004, with five physicians selected for the first class.

Once tested and refined, the elements of the Tuscan Emergency Medicine Initiative were rolled out in the Tuscan sub-regions of Pisa and Siena. Now 81 physicians have completed the train-the-trainer program, and they are the driving force behind the regional qualifying process. The qualification course was offered in Florence, Pisa, and Siena, and it is estimated that by June 2008, more than 625 physicians will have participated. In December 2005, 30 new physicians enrolled in the second class of the regional master’s program, bringing the total number of master’s candidates to 35.  

Kevin Ban, MD, an emergency physician at BIDMC who has helped lead the project, said, “From a political perspective, we believe the master’s program helped demonstrate the value of dedicated, detailed emergency medical education and advanced the emergency medicine agenda on a broader level.”

Graduates of the training program have been working with their colleagues in their own Emergency Departments (in Pisa, Versilia, and Lucca) to improve the care of their patients and to implement strategies for maximizing patient safety. Among the topics of these quality improvement projects are patient transfer from emergency to intensive care, management of admission and discharge, and improving emergency triage. These projects, which were presented at the Fourth Mediterranean Emergency Medicine Conference held in September, grew out of a series of two-day training courses on quality and patient safety delivered by Sharon Kleefield, PhD, HMI Director of Health Care Quality, and Senior Consultant John Helfrick, DDS, MS, FACD, FICD. One of the projects—on the impact of the introduction of a new pneumatic system for blood sample delivery on laboratory turn-around time—was awarded top marks at the conference. Kleefield, together with Dr. Paolo di Martino in Tuscany, has been working with each of the teams to facilitate their progress.

For more information

For more background on this project, read this article from the September-October 2003 issue of HMI WORLD. Dr. Kevin Ban and colleagues from BIDMC and Tuscany have written a comprehensive overview of the Tuscan Emergency Medicine Initiative, for the Annals of Emergency Medicine.