How to train emergency docs

I agree with Russell MacDonald's emphasis on integrating the academic knowledge of emergency medicine with a humanistic approach to patient care, and our research has confirmed the value of this approach.1 However, I disagree with his proposal for achieving this goal. It is family physicians who are providing emergency care outside urban centres, and the humanistic education provided by family medicine programs must be supplemented by adequate acute care training, as through the CCFP-EM program. The concept of merging the 2 training streams has been debated in the past. However, accreditation is the purview of the 2 national colleges and to my knowledge they are not considering integration. Furthermore, a merger would also reduce the total number of emergency medicine training positions (because of the formula for provincial allocation of funds for postgraduate training positions in family medicine and specialties). Emergency medicine is already short of training slots, and such a loss of positions would be disastrous. The solution to the issues raised by MacDonald is to improve the existing educational tracks.

The Commentary format of my article2 precluded discussion of the topics that Alan Drummond has raised. Indeed, the quality of emergency care in Canada is negatively affected by all of the factors he describes. I would welcome a comprehensive strategy that would alleviate these problems. I also maintain that the quality of emergency medicine training is a crucial issue. The credibility of the specialty is based on our ability to advocate for patients and on our capacity to develop high-quality clinicians, educators, researchers and administrators.

Ivan Steiner Professor and Director Studies in Medical Organizations Department of Family Medicine and Division of Emergency Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton, Alta.