In Europe the specialty of EM has made remarkable progress during the last twenty years and many countries now have emergency medicine as a specialty or supraspecialty. The European Directive 2006/100/EC outlines the expectations for freedom of movement of persons by recognition of professional medical qualifications, and for Emergency Medicine requires a 5 year training programme in the specialty to be in place in the country to be listed in the directive.
In 2001, the Directive included only the UK and Ireland as recognising the specialty; more recent Directives (European Directives 2005/36/EC and 2006/100/EC) list nine EU nations under the heading of ‘Accident and Emergency Medicine’, and in January 2019 a further European Commission Delegated Decision (EU) 2019/608 amended Annex V recognising 16 European countries with Emergency Medicine (called Accident and Emergency in the directive) with a training programme of 5 years. You can find the text here of the Decision.
There are another 17 countries in Europe who recognise emergency medicine as a specialty in their national system but where the training is not five years or is a supra=specialty programme. Find the overview here.
Professional representation in Europe
European medical specialties are represented in Brussels by the Union Européenne des Médecins Spécialistes (UEMS), a non-governmental organisation promoting quality and standards of training with the purpose of harmonising care and promoting free movement of doctors within the EU. Emergency Medicine is represented in the UEMS by a Section and Board for Emergency Medicine (UEMS S&B EM), made up of emergency medicine representatives, nominated by the National Medical Associations of all European Union countries. The Section and Board are independent, equal members of the UEMS and work with all other specialties on ensuring high quality care is delivered within the EU.
Education and assessment
The UEMS publishes standards for professional examinations and curriculum within Europe and through the UEMS S&B for Emergency Medicine these standards have been applied to develop a European Training Requirement (ETR) for emergency medicine. A European Training Requirement sets out what must be learnt, where it will be learnt and how learnt, as well as the standards for the trainers and the training departments. In partnership with EUSEM, a European Board Examination in Emergency Medicine (For more information go to EBEEM) was developed in 2014, following the guidance published by UEMS relating to structure and examiner standards.
The original Core Curriculum for EM was published in the European Journal of Emergency Medicine December 2002. Further iterations of this document were undertaken to reflect developments in the specialty and recent educational principles, initially through a task force in 2006 chaired by Roberta Petrino and more latterly a group chaired by Gregor Prosen and Eric Dryver in 2017.
Following the publication of standards for European Training Requirements, a further review of the curriculum has been developed by a small working group of UEMS and EUSEM members and a new ETR for Emergency Medicine was presented to the UEMS Council in April 2024 and unanimously approved (link to document).
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The main objective of the ETR/Curriculum is to serve as a guide and a standard for all European countries seeking to train future emergency physicians. Whilst countries may have their own national curriculum, the ETR represents the commonality of all emergency care systems across Europe and defines the aspirational standards for the knowledge, behaviours and capabilities of both the learners and the trainers.
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Key aspects of the new ETR (2024)
The new ETR is structured around the competences required to care for patients including triage and resuscitation, assessment, diagnostics, clinical reasoning and management including procedural competence. It includes the professional competences required to lead a team, to educate others and to bring academic scholarship to clinical care as well as management of services. It emphasises the importance of understanding the context of the patient and their illness and the social situation they are living in. the ETR emphasises that development of a emergency physician is a lifelong activity and that supervision and mentorship is key to developing skills. Within the document are suggestions for assessments that can be conducted locally as well as guidance on supporting trainers in the workplace.
