In 2011, the Ministry of Health in Sri Lanka granted emergency medicine the recognition of a medical specialty. This came less than 10 years after the devastating aftermath of the Indian Ocean tsunami in 2004, which drove the development of a proper emergency health care system along with a formal training system for clinicians to become specialized in emergency medicine.
Before starting their postgraduate EM training, registrars complete their undergraduate medical school training with an MBBS degree as physicians. After graduating as physicians, they undergo one year of postgraduate training as house officers in general medicine specialties (intern year) followed by a minimum of one year working as a post-intern medical officer. Then, they take the Part 1 entrance exam to enter into the Sri Lanka EM registrar training program.
The postgraduate Doctor of Medicine (MD) in Emergency Medicine registrar training program is delivered under the guidance of the Post Graduate Institute of Medicine (PGIM), University of Colombo, Sri Lanka. The first group of 17 EM registrars started their training program in November 2013. This initial group of registrars is finishing up their training to become the first EM consultants in the history of Sri Lanka in 2019. New batches of EM trainees ranging from 15–25 registrars per class start every November. The EM registrar training program itself is a minimum five-year course. Currently, there are 136 registrars within the program spread out across the years. The first three years are spent in clinical rotations across a variety of specialties relevant to EM along with lecture-based didactics on a regular basis.
Resources for training the EM registrars are incredibly limited. The registrars are limited to roughly one to two conference days per month due to a lack of EM consultants. A virtual grand rounds project is underway to allow EM-trained physicians from around the world to deliver EM conference didactic lectures with the registrars. Asynchronous, self-directed learning plays a crucial role for the EM registrars, and Rosh Review helps support this, as registrars can solidify their individual knowledge base via self-study efforts.
Following the third year of EM registrar training, the registrars take the Part 2 examination, which completes their MD in Emergency Medicine training program. After completing the MD in EM at year three, the EM registrars undergo an additional two years of clinical training. The fourth year of EM registrar training is spent abroad in a mature EM system. Most registrars have spent this year in Australia, but several have traveled to the UK and other places. Some registrars elect to spend an additional year abroad honing their EM knowledge base and skills before returning to Sri Lanka. Upon their return to Sri Lanka, registrars serve as a senior registrar in EM for one year. At this point, completing the EM training program requirements will allow the registrars to become board-certified consultants in emergency medicine.
After completing their training and becoming board certified EM consultants in Sri Lanka, graduates will work as consultants in Ministry of Health public hospital emergency departments around the country as well as private hospitals. The first cohort of EM registrars that started in 2013 will soon become the first board-certified EM consultants in the history of Sri Lanka in 2019. To meet the tremendous shortage of emergency physicians staffing EDs around the country, the goal is to train a large number of emergency physicians to meet the demand.
Prior to this, there had been no EM trained faculty in Sri Lanka. A virtual EM residency training effort has been organized over the past few years by several consultants from the US, UK, Singapore, and Australia. With the first EM consultants gradually starting in Sri Lanka, they will assume the crucial role of educating and training future generations of emergency physicians in Sri Lanka.
Thank you to Dr. Lenora for the program summary and the inspiring story of how EM is developing in Sri Lanka.
“On an individual level, it is in these first three years of the EM training program where Rosh Review has had the biggest impact. As registrars study the EM core curriculum from textbooks such as Tintinalli and Peter Cameron, they need a high-yield method for retrieval practice to solidify their learning in EM. Registrars using Rosh Review attested to how much it helped them in their study process for their Part 2 examination, which completes their training program to become EM physicians in Sri Lanka. Rosh Review has also been integral for helping registrars pass the MRCEM and the European Board Examination in Emergency Medicine. Additionally, Rosh Review has helped Sri Lankan EM registrars measure their progress with contemporaries across the world.
On a broader level, the Rosh Review dashboard allows EM curriculum organizers to see how individual registrars are progressing and where their strengths and weaknesses are with respect to the curriculum. The program is also in the process of implementing the Foundations of EM curriculum for the conference didactics, and Rosh Review will play an essential complement to this effort as well via pre-test, post-test, and summary evaluation of registrars completing the Foundations modules.”
– Dr Nilantha Lenora