Global EM 7 Global Emergency Medicine Partnerships

Global EM Partnerships

Emergency Medicine has seen remarkable growth over the past fifty years, evolving from being recognized in just four countries to now offering specialist residency training programs across all six inhabited continents. As it adapts to emerging healthcare challenges, EM has become the primary point of care for many patients worldwide. Despite its vital role as a societal safety net, the field faces significant challenges today, including workforce attrition, increasing resource constraints, and the need for ongoing innovation. These issues demand that EM continuously reinvents itself to meet the evolving needs of global healthcare systems.

Once region-specific, the challenges facing EM are now global, prompting the need for international collaboration to address shared issues. These partnerships emphasize bilateralism and mutually beneficial projects. While large consortia, such as the International Federation of Emergency Medicine (IFEM), are often associated with these efforts, smaller collaborations have also achieved notable success. 

Establishing a Global EM Partnership: Twinning Partnerships for Improvement (TPI) model

The World Health Organization has created a partnership guideline entitled the Twinning Partnerships for Improvement (TPI) model. This is a six-step model that emphasizes shared learning and capacity building, and it provides a structured approach to forming sustainable collaborations (Figure 1).

The first step is establishing a collaborative environment through dialogue and mutual understanding between two national EM societies. This is formalized with a Memorandum of Understanding (MOU), which outlines the shared vision of the partnership in terms of scope, timeframes, and accountability measures for the partnership. Each society undergoes its own needs assessment and gap analysis to identify strengths and areas of improvement. These findings serve as the foundation for joint projects that address critical needs and areas where best practices can be learned. Collaborative projects are often tailored to the specific gaps identified in both societies and emphasize mutual learning, regardless of differences in healthcare systems, cultural contexts, or socioeconomic factors.

Ultimately, these partnerships are more than technical exchanges; they foster global solidarity in improving emergency medicine as a specialty, with both parties contributing and benefiting from the collaboration. This approach helps EM societies not only strengthen their systems but also enhance global health outcomes.

Examples of Global EM Partnerships

Several examples illustrate the different models and outcomes of global EM partnerships. Each partnership is tailored to the specific needs of the partner countries but often follows the principles outlined in the WHO TPI model.

1. Canada-Switzerland Partnership: The collaboration between the Canadian Association of Emergency Physicians (CAEP) and the Swiss Society of Emergency and Rescue Medicine (SSERM) is an example of a bilateral partnership that focuses on learning from each society and bettering the field of emergency medicine. Although EM culture and settings vary somewhat between the two countries—most notably, Switzerland does not yet have an established EM specialty—both nations, as resource-rich Western countries, share many medical opportunities and challenges.

From the outset, three key projects have been the focus of this collaboration:

• Exchange best practices on Physician Wellness and Burnout
• Exchanging and creating educational courses, research, and articles benefiting both societies 
• Partnering in helping emergency doctors during humanitarian crises

The partnership led to Switzerland’s first study on EM physician burnout, conducted in collaboration with Canadian researchers. An annual Wellness in EM online symposium has also been established, featuring Canadian experts who share their insights and experiences. Additionally, the two societies have initiated national grand rounds collaborations, fostering ongoing dialogue and knowledge sharing. 

Currently, a 10-paper series focused on emergency medicine reform and specialty improvement is in the works, further strengthening the partnership’s impact.

Reciprocal visits to annual emergency medicine conferences have enriched both societies, allowing members to present and discuss various topics in each other’s countries. These interactions not only promote professional learning but also foster lasting friendships, creating a strong network in the global emergency medicine community.

2. Toronto-Addis Ababa Academic Collaboration (TAAAC): This partnership between the University of Toronto and Addis Ababa University focuses on training emergency medicine specialists and multiple other specialties in Ethiopia. Canadian physicians provide training in person training and supervision of residents during month long teaching trips thrice annually in Addis Ababa, while Ethiopian healthcare professionals gain the skills needed to develop their own EM programs, making this partnership a strong example of capacity building and knowledge transfer.
3. The Calgary-Mbarara Emergency Medicine Collaboration (CMEM), founded in 2019, is a partnership between the University of Calgary and Mbarara University of Science and Technology (MUST) in Uganda. It aims to develop emergency medicine at Mbarara through faculty development, trainee support, and exchange programs between Calgary and Mbarara. 

Each of these partnerships has a shared goal: to improve emergency care through collaboration, research, and the exchange of expertise.

4. CAEP and Denmark: The collaboration between the Canadian Association of Emergency Physicians (CAEP) and the Danish Society for Emergency Medicine (DASEM) represents a productive partnership aimed at advancing emergency medicine. While Denmark’s specialty is newly established, both countries share similar opportunities and challenges in publicly funded healthcare.

From the outset, the partnership has focused on exchanging knowledge and best practices, highlighted by presentations at national conferences in Denmark. A key achievement was the observership of a Danish resident at a major Canadian teaching centre, who returned inspired to implement full academic days for residents in their own hospital.

Additionally, a Canadian-trained emergency physician with work experience in Danish emergency medicine has provided valuable insights into the similarities and differences between the two systems, inspiring Danish emergency doctors. With collaborative and mentorship support through CAEP, this physician also served as an external reviewer for the Danish Position Statement on Emergency Medicine

Plans are underway to launch a series of webinars to facilitate ongoing knowledge sharing and dialogue. These initiatives enhance professional learning and foster lasting friendships, strengthening the global emergency medicine community.

Establishing global EM partnerships is not an easy feat. It requires a dedicated MOU, action plans, accountability indicators, and a dedicated staff to maintain sustainability. With a successful global EM partnership, the two parties can learn from one another’s best practices, cultural differences and continue to propel the field of emergency medicine forwards through establishing collective solutions to common EM issues. 

Dr. Nour Khatib is an emergency physician in Toronto working at Markham Stouffville Hospital, rural sites across Ontario, and remote Northern communities in the Northwest Territories and Nunavut. Before her career in medicine, she was a financial analyst for Pratt & Whitney Canada and has a background in Finance and an MBA. Dr Khatib has a passion for medical education and global health partnerships. She is the Swiss Champion for CAEP’s International EM partnerships. 

Dr. Eric Heymann is an Emergency Physician based in Neuchâtel, Switzerland. Board certified in Internal Medicine, Emergency Medicine and in Rescue and Retrieval Medicine, his clinical interests lie in critical care and airway management, both in- and out-of-hospital, with a career spanning from Australia, to Singapore, South Africa, the United Kingdom, and Switzerland. In addition to an academic tenure at the University of Bern, with a focus on Clinician Wellbeing, Dr Heymann also works for the Swiss Humanitarian Aid Unit and the Swiss Rescue Chain (USAR).

Dr. Valerie Romann is an internist and emergency physician from Bern, Switzerland. Currently, she works in anaesthesiology and as a preclinical emergency physician. She studied Medicine in Bern and Lausanne in German and French, and has spent a high school exchange year in North-Western Ontario.

Dr. Kim Desouza is an emergency physician at the University Health Network in Toronto, Canada, with a focus on medical education, global health, and understanding how people experience and receive healthcare. She has four years of experience working in emergency medicine in Denmark and serves as the champion for CAEP’s International Partnership with Denmark.