The Building Our Future Summit
On 30 August 2023, emergency medicine leaders from across Australia and Aotearoa New Zealand came together for the Emergency Medicine – Building Our Future Summit.
As a centrepiece of the College’s 40th anniversary year, the summit was convened as the start of internal conversations on the role and scope of the specialty, in acknowledgment of the major evolutions that have occurred in emergency medicine practice – and the skills required of its practitioners – over four decades.
Hundreds of passionate people, working at the clinical heart of emergency medicine, joined experts with a range of advanced skills in areas like research, Global Emergency Care, education, climate change advocacy and leadership, in person in Melbourne, and-online.
Over a day of lively, inspiring and at-times confronting discussions, participants considered the identity of emergency physicians, the collective culture of emergency medicine, achievements to date, and current and future challenges.
““The summit is about us. Today is about what we do, what we think our scope and our role is, and getting our own house in order.””
ACEM President Dr Clare Skinner with summit facilitator Professor Sally Redman AO
Opening Session: Changes to emergency medicine practice and training
Chair: President, Dr Clare Skinner
““If you consider emergency medicine, and what is fundamental to emergency medicine, then you consider First Nations health equity to be fundamental, and you consider cultural safety to be fundamental. So, these two things inform every aspect of the care that we deliver.””
The day commenced with an acknowledgment of country, and formal welcomes.
The co-chairs of ACEM’s Indigenous Health Committee Dr Glenn Harrison and Dr Max Raos, then emphasised the importance of improving health equity for Indigenous peoples, and the crucial role of cultural safety in driving better health experiences and outcomes.
““We know that if trainees don’t feel culturally safe, they will actually leave. We leave without having and developing our Aboriginal and Torres Strait Islander workforce.” ”
Dr Glenn Harrison (left), Dr Max Raos, Dr Kimberly Humphrey, and Dr Kate Field.
““I passionately believe that an emergency physician isn’t defined by the emergency department. They are defined by his or her skills, culture, and their way of dealing with patients, and seeing problems.””
In his video presentation, Associate Professor Didier Palmer, Chair of the Council of Advocacy, Practice and Partnerships (CAPP), outlined changes he has observed in the way emergency medicine is practised, and how the specialty might develop.
Dr Kimberly Humphrey, Deputy Chair of CAPP, then considered what skills are fundamental in the provision of excellent care.
““What do we need to be excellent at to be able to treat every patient who walks through the door in a way that they deserve, to get the highest quality care that they can?””
Dr Kate Field, ACEM’s Censor-in-Chief and Chair of the Council of Education (COE), described how ACEM trains specialist emergency physicians, the broader specialist medical education context, and identified gaps in current systems and structures.
““There is a giant, gaping, black hole in our training program. I don’t believe that we are routinely teaching our learners how to think, or how to understand themselves in their professional context. How to lead a team outside of a resus bay – whether that be on shift in a hospital, or within a jurisdiction, or even at a systems level.””
Panel from the opening session.
““I really think that the social determinants of health and advocating for that level of care is core business for emergency departments. We need to be in that space.””
Dr Stephen Gourley, ACEM President-Elect, discussed current and future directions in rural emergency care. He outlined socio-economic inequities that follow geographic lines, and the impacts of inequities on access to healthcare.
A full house during discussions.
Panel Session: Changing processes and models-of-care
Chair: Deputy Censor-in-Chief, Dr Anoushka Perera
This panel focused on how emergency doctors ‘actually do their job’, the rapidly changing ways emergency care is delivered, and impacts on the scope of practice required by emergency physicians.
““I think, with the best of intentions, we’ve really created lots of processes and systems to deal with an increasingly overwhelmed system. But, in turn, have we succumbed to the ‘If you build it, they will come’ principle?””
Panel session underway
Associate Professor Stefan Mazur, Chair of the Pre-Hospital and Retrieval Medicine Curriculum Expert Reference Group, spoke to his topic, Clinical Procedures and Resuscitation.
““Our specialty came about because of the requirement for a multi-system undifferentiated resuscitationist; the person who could look after the true undifferentiated emergency. When we don’t really know what’s going on, or when the patient is ‘big sick’, and others only look after ‘medium sick’, then that’s where our role comes into place.””
““I really think it’s time that emergency physicians took on being the face of trauma. Injury is really our lane.””
Deputy Chair of the Trauma Emergency Medicine Network, Dr Andy Buck, summarised changes to trauma care delivery, outlining the evolution of trauma systems which divert patients with major injuries to specialist trauma hospitals, impacting skill and confidence managing trauma in some other hospitals.
Associate Professor Stefan Mazur (left) and Dr Andy Buck
Dr Nadi Pandithage, Chair of the Emergency Department Ultrasound Committee, described what she calls “the PoCUS (Point of Care Ultrasound) dilemma”.
““Recommendations and benchmarks are not being met but PoCUS continues to be utilised every shift. How do we convince FACEMs who have been practising competently without PoCUS for decades to skill up in this new modality?””
Dr Andy Buck (left), Dr Nadi Pandithage and Dr Niall Small
Dr Niall Small, Chair of the Regional, Rural and Remote (RRR) Committee, explored the rise of observational emergency medicine, and the wide variation in models and functions of short stay units.
““Short stay wards cannot be used as strictly a clock stopping initiative to meet time-based targets. They should only value-add to patient care. I’m sure we’ve all heard the ‘Just admit them to short stay’ comment from some of our inpatient colleagues. It’s on us to push back when it’s not clinically appropriate.””
Chair of the Emergency Telehealth Network, Dr Justin Bowra, outlined established and emerging roles for virtual care, and how to ensure telehealth is used safely and embedded in effective systems, especially in critical care scenarios.
““Every time a GP rings me up and I’m an ED admitting officer, I’m doing telemedicine. And every time I’ve got a patient in the resus room and I ring up my toxicologist mate to get some help, that’s telemedicine too. I reckon everyone in this room, and online, has been practising telemedicine anyway. The challenge is how to integrate that safely and make it core business and recognise what it is.””
Dr Andy Buck (left), Dr Nadi Pandithage, Dr Niall Small, and Dr Justin Bowra.
Panel Session: Changing peoples and populations
Chair: Aotearoa New Zealand Faculty Chair, Dr Kate Allan
Dr Allan addressed the changing demography of people seeking emergency care, and the resulting effects on emergency department case mix.
““Our populations and our environments are changing rapidly. Our demographics have changed, and our health and social systems are struggling to keep up. The question for us, today, is how can we support the new FACEM to ensure that they have the skills and training they need to work in this changing world?””
Dr Shantha Raghwan (left), Dr Kate Allan and Professor Sally Redman AO
Dr Graham Jay, Chair of the Committee for Joint College Training in Paediatric Emergency Medicine, asked three key questions regarding emergency care of children.
““What is expected of us by our communities? How should we be best prepared? What should our future be?””
Dr Ellen Burkett, Chair of the Geriatric Emergency Medicine Network, presented data about the ageing population, and implored emergency departments and clinicians to be better prepared to deliver effective geriatric emergency care.
““Invest in, and undertake, improved high quality care for older persons. This must be core business for all of us. Because if we don’t do it well, all of the things that we imagine are core business will be irrelevant, because our acute healthcare system will no longer be sustainable.””
Panel from the second session.
““There is no doubt that our role should really be part of a matrix of care.””
Dr Simon Judkins, Chair of the Mental Health Working Group, outlined recent ACEM work to drive improved mental health care, and the challenge of defining the role for emergency medicine and measuring outcomes.
““There is a growing appetite for toxicology training, but it’s hampered by a lack of specific training pathways and capacity.””
Dr Kerry Hoggett, representing the Toxicology and Poisons Network Australia (TAPNA) in her role as Chair of the TAPNA Education Sub-Committee, described how presentations related to poisoning are changing, and the growing role of expert toxicologists and centralised poisons centre advice.
Dr Shantha Raghwan, Chair of the Advancing Women in Emergency Network, talked about how to provide more equitable and trauma-informed emergency care to people who are socially disadvantaged and vulnerable.
““It’s amazing that we all recognise that the marginalised peoples coming into our departments are the core business. They’re the community that we need to be working really hard to be able to service, to the standard that they deserve.””
A view of the room for the next session
Panel Session: Changing roles and contexts
Chair: President-Elect, Dr Stephen Gourley
Dr Gourley explored some of the broader roles now performed by emergency physicians across health services and systems.
““We’ve come a long way in the last 40 years, and there’s been new tech, communication strategies, investigations, treatments, models-of-care, resources, community expectations. Emergency medicine has also grown, in both breadth and complexity.””
Dr Stephen Gourley.
Dr Lai Heng Foong, Chair of the Public Health and Disaster Committee, proposed that there are two modes for emergency care are two modes for emergency care - acute clinical care, and social or preventive care – both of which are core business for emergency medicine. Dr Foong implored all emergency doctors to take urgent action to mitigate the climate emergency.
““Every day we work at a hospital and emergency department that’s at a hundred percent occupancy rate, and we are seeing more frequent, more severe disasters that will bring patients to our door, whether we like it or not.””
Dr Lai Heng Foong.
““There is much more work to be done. And so the question we have been thinking about is how can we do more? How can we scale our work? But importantly, how can we make sure that what we do is ethical, is sustainable and maximally impactful?” ”
Dr Rob Mitchell, Chair of ACEM’s Global Emergency Care Committee discussed healthcare delivery in low and middle income countries and persisting inequity in health resourcing and outcomes. He explained opportunities for the College to work with governments to improve emergency care across the Indo-Pacific region.
Dr Lai Heng Foong (left), Dr Rob Mitchell, and Professor Diana Egerton-Warburton.
““It becomes obvious from our discussions today that without research and data, we cannot have a training program that’s helpful.””
Professor Diana Egerton-Warburton, Acting Chair of the Clinical Trials Network, outlined the critical role of research in ensuring health care is as effective as possible. She also highlighted the lack of a binational ED outcomes and evaluation database to drive emergency care quality and safety improvements.
It is necessary, said Prof Egerton-Warburton, to build and develop research capacity at the College and across the emergency medicine workforce.
““We’re kind of like the Swiss Army knife of the medical world. We kind of can do anything, but it doesn’t necessarily mean that we should. The big question for us is, What are the core skills that every FACEM should have?””
Dr Shamus Shepherd, Chair of the Continuing Professional Development (CPD) Committee, spoke about emergency physicians delivering medical education.
He said that the implementation of CPD homes in Australia, presented an opportunity for the College to deliver lifelong learning through improved CPD content and wayfinding.
““We need to influence. We need to impart some of our knowledge, to enlighten those that make decisions for us. Because if we don’t do it, nobody else is going to do it for us.””
Dr André Cromhout, ACEM Aotearoa New Zealand Faculty Deputy Chair, discussed the role of emergency physicians in driving health system improvements through leadership roles. This includes in emergency departments, hospitals, and across the broader health system.
Question time during the session
Closing Session: Future challenges and opportunities
Chair: President, Dr Clare Skinner
““It’s about us all working together at really creating something special. You, as a specialty, have done this for 40 years. To be part of that future is pretty exciting.””
ACEM CEO Emily Wooden outlined the College’s strategic intentions, and explained how governance and financial structures are being strengthened to ensure they are accountable, transparent and able to best support members to lead impactful work.
Olly Jones, Chief Operating Officer and Deputy Chief Executive, spoke about the regulatory context of the College. He said ACEM is well-regarded and ideally positioned to lead important improvements.
““We’ve talked about leadership development today. We’ve talked about growth and change. So maybe we’re not training people. We’re actually investing and growing leadership competencies and skills that meet the ever-changing community needs.””
““It’s really important that we have a unified and strong message.””
Dr Robert Lee, Executive Director of Policy, Research and Partnerships, discussed the recent advocacy survey and advocacy priorities. Dr Lee explained how College work plans are developed based on data and member feedback, and observed that the summit had included robust discussion from an advocacy standpoint.
Emily Wooden (left), Olly Jones and Dr Robert Lee.
““I think the opportunity for FACEMs, and senior trainees, is to really deepen that relationship with the trainee, and to empower them to make a clinical decision without [unnecessary] recourse to advanced imaging.””
Dr Laksmi Sakura Govindasamy, Chair of the Trainee Committee, and Dr Tom van Dantzig, Trainee Member of the ACEM Board also addressed the final session.
Dr van Dantzig explored the pitfalls of practising “defensive medicine” and the creep towards over-investigation, emphasising the importance of good clinical decision-making and thoughtful resource stewardship.
Dr Govindasamy stressed the importance of not focusing only on challenges faced by emergency medicine, but also the many strengths of the specialty.
““I think there’s a real power, and empowerment, in being able to celebrate what we do well, whether that’s being a proceduralist in the sense of a resuscitation, or a proceduralist in the sense of having a complex family discussion around palliation.””
Dr Tom van Dantzig (left) and Dr Laksmi Sakura Govindasamy
In the final address of the summit, Dr Skinner reflected on the day’s discussions and deliberations.
““Today we have had some difficult conversations. We can influence a system, we’re enormously powerful, but we can only do that well and effectively if we have clarity of purpose, which I hope today has started to establish.””
““We are the College for emergency medicine. Emergency medicine came about to help people and communities. So, in the end, this isn’t actually about us. It’s about the people who need and seek emergency care, and we must always remember that.””
She emphasised that the ACEM exists to support and drive excellence in emergency medicine, and that the College would continue to have a lead role in supporting members, trainees, communities and the specialty into the future.
Next steps
ACEM recognises the immense contributions of members and trainees to the specialty, acknowledges your experiences, and value your insights. We are grateful to all who were able to participate in this critical conversation.
For anybody unable to attend – or wishing to revisit proceedings – a full recording of the day’s sessions, as well as recommended reading and other information is now available online via the ACEM Portal using your ACEM login.
Discussions from the summit, including questions and comments submitted online, will be used to inform future reviews of training curriculum and CPD content, as well as assist the College Board and Councils with strategic priority-setting and planning.
To assist in this important work, a post-summit survey is available on the Portal page. All members and trainees who participated in the summit, or have viewed the summit recordings, are invited to complete this survey which will help inform the College’s next steps.
