ACEM in midlife: Lessons from the emergency medicine building our future summit

In 2023, the Australasian College for Emergency Medicine (ACEM) turned 40. For many, midlife is an important time to reflect on the past, take stock of identity, examine values and set priorities for the next season – and ACEM is not exempt from this period of soul-searching.

The practice of emergency medicine today is significantly different from when ACEM was founded in 1983, and there are vital questions to be answered. How is the scope of the specialty, and the role of emergency physicians, changing? What are the skills and training necessary to deliver effective and compassionate emergency care in increasingly complex healthcare contexts? What is needed to create sustainable and satisfying careers in emergency medicine?

On 30 August 2023, ACEM hosted the Emergency Medicine – Building our Future Summit to begin this conversation. The summit was attended in-person by leaders from ACEM's Councils, Committees and Networks, and ACEM members and trainees were invited to participate online. Rapid-fire presentations about key topics, representing the specialty's ‘growing pains’, were delivered, generating rich discussion. Afterwards, a survey was circulated to seek feedback on the issues raised, and information from the summit and survey was collated and examined.

Reflecting the wide participation of contributors, and the broad church of the ACEM community, input was varied, but key themes, experiences and observations emerged.

Although the practice of emergency medicine has adapted and diversified over time, the majority of emergency physicians share commitment to the acute, generalist, clinical core of the specialty.

Participants indicated a strong dedication to community, and a willingness to adapt to changing pressures over time, to learn new skills, and to adopt expanded clinical and professional scopes to meet the increasingly complex needs of people who seek emergency care.

Emergency medicine is now practised well beyond emergency departments, and the breadth of career options is vast. Many emergency physicians augment clinical work with activities such as research, policy, international development and medical administration, or develop clinical expertise in areas of special interest – such as toxicology, paediatrics, retrieval or aged care.

Increasing diversification, as well as the growing trend for emergency physicians to assume clinical or system-wide leadership positions, demonstrates the maturity of emergency medicine as a specialty, and reflects confidence in our critical position within health systems.

Versatility also brings new tensions and challenges. Emergency medicine sits at the intersection between primary and hospital-based care and occupies a special position in healthcare systems. Emergency departments become a safety net when other services fail.

The scope of emergency medicine practice is heavily shaped by external forces, including political. This has created many opportunities, and emergency physicians are often proud of our ingenuity and flexibility under pressure. However, this change has challenged ACEM education and training processes. It was asked: has the breadth of practice diluted our capabilities to effectively perform core clinical skills?

Contributors agreed that ACEM's training programs must deliver effective skill development and maintenance to support the provision of excellent emergency care to patients and communities. Three areas were identified as needing core focus: resuscitation, decision-making, and leadership.

There was strong support for ACEM to continue to advocate for the systems, structures and resources required for emergency physicians to provide high-quality, humanistic care that patients and carers need.

As ACEM settles into middle age, the time has come to set clearer organisational priorities. This must be done cautiously, based on member and community feedback. A careful balance must be found, to ensure the health needs of patients and carers are met, while also recognising the professional needs of emergency physicians, including their capacity to learn, synthesise and maintain competence across a broad range of skills – and enjoy interesting and meaningful careers.

To achieve this, ACEM must expand its educational focus beyond the FACEM training program to support lifelong learning across the full trajectory of member careers.

Through the ACEM CPD program, it will work with Committees and Networks to better define and deliver content to help members foster their core skills, and to design extended skills pathways for emergency physicians to achieve mastery and recognition in their areas of special interest.

Information from the summit, and the survey, will guide ACEM's advocacy strategy, the 2025–2027 strategic plan, and the next review of the FACEM training program curriculum, which is due to commence in late 2024.

ACEM will continue to listen, and evolve, to meet the growing and increasingly complex needs of communities, and to support emergency physicians, trainees and other people delivering emergency healthcare, to enjoy diverse and sustainable careers.