Monday 17 July 2017

The Truth about what’s going on in the Indian EM arena- as I see it.

The truth about what’s going on in the Indian EM arena- as I see it.    
18/7/2017, Chennai

Emergency Medicine in India is hogging the lime light in print and social media out of the blue but sadly for the wrong reasons1-3

While it is very heartening to see many budding doctors taking an interest in the specialty of late, most do so for the right reasons of “ I love the adrenaline rush”, “ I am actually going to save lives”, “I sort them out as they come”, “ I will be the first to make a diagnosis and in most cases it sticks”, “ I want to help the sickest ones in my country and do my bit to erase the huge deficits in Acute and Emergent care in India” and “ Nothing is more gratifying than seeing a very sick patient rapidly get better in front of your eyes as you intervene positively”. 

Some of them misguidedly choose it for the wrong reasons too , common ones being  ” I will become a consultant sooner than my other colleagues”, “ I will earn more than the others”, “It is easier to go overseas if I do EM” and “ I don’t seem to be able to get into anything else” .

The true options in front of you which would ultimately make you a specialist in EM in India are only three- MD( EM), DNB( EM) and MRCEM and they’re the only registrable ones with MCI.
You could of course go overseas to countries where EM is established, train there and obtain CCTs( certificate of completion of training) having passed their respective exit exams( the likes of FRCEM, FACEM...) .  

I know there is a lot of dissent from those who are saying we started before the MD and DNB but that was fine at that juncture but not anymore. When the law of the land (MCI) says stop your MEMs, then it has to stop. Offering “Master degrees” in any specialty is certainly something that can only be done when MCI authorises your institution to. It is certainly very different from giving a certificate.
It is scandalous that good, enthusiastic budding doctors (From government and private medical colleges and FMGs) are being roped into these MEMs with the promise of a job which fetches them lakhs and will get them MRCEM etc...

In a recent article doing big rounds in the social media3, MEM is made out to be the key path to MRCEM.  This is clearly a ploy to sell MEMs after the recent dip in their credibility, being exposed naked by a recent article in a leading news paper1,2

It is no more a case of “ I want to help the specialty grow”. The paths are set. It is wrong to create blind-ends unless you want to waylay the unsuspecting traveller and rob them.
I have a request from all those who possess MRCEM/ FRCEM and practice in India. Please do not bring the reputation of these qualifications down.  We have worked very hard to get it. The efforts to link MEM with MRCEM is plain mischievous and is a surrogate way to sell something which shouldn’t be sold. The last time when there was a window open for lateral entry into DNB( EM), MRCEM was denied entry as the torch bearers of EM then coupled MRCEM with the other unregistrable qualifications.  Now they are at it again to save something they shouldn’t.

In simple terms MRCEM is a qualification you obtain after having undergone a stipulated (3 years) period of training in EM and allied specialties having passed the necessary components of the exams. Anyone who is doing DNB, MD or any unnamed training or residency for 3 years in EM could end up with MRCEM if you pass the various components of the exam contrary to what has been said in a recent guide to EM4 which doubts the eligibility for those doing DNB and MD.   

For all those wanting to appear for the MRCEM exams, a hearty welcome for it is a great qualification to have after clearing all the tall hurdles.

Emergency Medicine is a budding specialty in India and we should make all attempts to become academically better, establish local guidelines to deal with emergencies inherent to our terrain etc. Instead trying to offer degrees isn’t something we should be doing. We need to salvage the pride of EM. Let’s all get together and do it
Jai Hind

Disclaimer- This is my personal take on where I stand. The intention is not to offend or belittle anyone’s contribution to this great specialty.  
I am not a professor or an academic giant in EM by any stretch of imagination. In fact I just enjoy my work and I publish very little.  I am a qualified EM physician trying to practice evidence based EM and train enthusiastic candidates in EM. I am quite chuffed that I have created some good EM clinicians who are practising EM in India and elsewhere in the world.

Dhavapalani Alagappan, MS, FRCS, FRCS(A&E), FRCEM

 References :

The truth about what's going on in the Indian EM arena- as I see it.

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