Carl SumminsIn September of 2007, I had the fortunate opportunity to be the first resident to rotate and establish a residency exchange program between the EM residents at UUMC and Rajavithi Hospital in Bangkok, Thailand.  Emergency Medicine is in its infancy in Thailand, having just graduated its first class of emergency physicians in June of this year.  There are now just thirty-two board certified emergency physicians in all of Thailand.  Rajavithi Hospital is a government run tertiary-care teaching hospital in the center of Bangkok.  With over 1600 inpatient beds and more than 70,000 emergency department visits per year, there is ample opportunity for the Utah emergency resident to gain valuable medical experience.  Both residency programs are similar in size and length of training.

Thailand - CumminsThe three week elective is available to second and third year emergency medicine residents in good standing from either program.  Both hospitals offer unique opportunities for residents that rotate.  Bangkok residents will be exposed to rapid sequence intubation and bedside ultrasound which will soon become available in their country. Utah residents receive training in public health concepts, establishment of a national EMS program, and exposure to the diagnosis and treatment of tropical disease.  We hope to soon create a live monthly case conference for teaching between the two programs.  We look forward to the opportunity for a stronger bond between these two programs and for our EM residents to gain international experience and a global perspective on emergency medicine as a specialty. -By Jen Gordon, MD

Words from our Visiting Faculty from Thailand

From April-July of 2008 I have had the fabulous opportunity to be a visiting faculty member in an exchange program between the UUHC and Rajavithi hospital in Bangkok, Thailand.  This is now an international exchange program of EM residencies, which residents Jen Gordon and Zach Sturges participated in last year.

In Thailand, the emergency medicine specialty is in its beginning stages.  In 2004, we started training programs in thirteen institutes that are government run tertiary-care centers and University hospitals.  In 2005, we added two more University hospitals.  After training, we had 32 board certified emergency physicians who went back to work in hospitals all over Thailand.  The next group of 48 physicians being trained will take the national board exam this June.

With cooperation from Tan Tock Seng Hospital in Singapore all of the third year residents will have an opportunity to visit and experience the Advanced Trauma Life Support (ATLS) course under the Singapore-Thailand Civil Service Exchange Program.  The residents will also have networking opportunities through the TTSH ED, and the opportunity to attend the Annual Scientific Meeting of the Society of Emergency Medicine for Singapore (SEMS).

From February-May of 2007, sixteen of the EM residents going to work for the training institutes after graduation, visited the Royal Melbourne Hospital in Australia as a part of an exchange program.  The participants are now working as faculty in the training centers in Thailand.

Along with all of those activities, the Thai Assoc. for EM (TAEM) also had the opportunity to have one of our emergency physicians participate, as invited faculty, at the 2008 International Conference on EM in San Francisco held by the International Federation for EM (IFEM).  This conference is conducted bi-annually with the intent of knowledge sharing from around the world.

Thailand - NalinasCurrently, I am having a wonderful experience here at UUHC. I am attending academic activities, observing in the ED and doing ride-alongs with AirMed.  Also, we are working on a trial model of teleconference between Rajavithi hospital and University of Utah.

I found that emergency medicine is quite similar in many places around the world.  We have very active, enthusiastic, and nice people.  Even the problems of over-crowding in the ED are similar.  Each institute from each country has tremendous ideas to develop their own solutions that will be most compatible to their local culture.  The attempt to build a global knowledge sharing will be a strong part of a growing specialty like ours.  We look forward to expanding and achieving partnerships of expertise and vision with others, and sharing these forward movements.

Thailand - NalinasFinally, I would like to sincerely thank Dr. Erik Barton, Dr. Susan Stroud and all of the UUHC EM faculty and residents for the fantastic time here.  Also, I thank my supervisor Dr. Somchai Kanchanasut, Director of Rajavithi EM, and Dr. Pairoj Khruekanchana, the assistant director, for the excellent experience.  - By Nalinas Khunkhlai, MD

Four months ago, int he Spring of 2008, while I was working as an attending in the emergency department at Rajavithi Hospital in Bangkok, Thailand I imagined being in another place, far away from home, for four months.  In this place, everything would be different from what I am used to.  I thought it was going to be really hard, but after being here for three months it has turned out to be easier than I thought.  The warm welcome I received and the nice people here made me feel comfortable and at home.

One question I get asked frequently is about the differences and similarities between here and Thailand.  I have to say that there are some things that are different and some things that are the same.  In Thailand, we see many patients who come in with different complaints than here, but the problems of the emergency department are similar.  Working under stressful situations, and dealing with patients and their family's high expectations at the same time are what every emergency physician deals with every day.  ED overcrowding, unavailable inpatient beds, and ambulance diversions are common problems of many emergency departments in the world.  The difference is in the way these problems are dealt with.  There's not just one solution for every ED.  The solution that most suits your ED depends on what resources you have.

While here I have learned about the EMS system and pre-hospital management.  EMS in Thailand has been developing for 14 years.  Before 1995, there were only volunteers in emergency rescue who provided the services to transport patients to the hospital at no charge.  At that time, there was no formal training or any equipment.  These volunteers relied solely on donations of both funds and equipment.  The EMS pilot project was started at Rajavithi's Hospital in 1995.  A hospital-based ambulance service was established and expanded to the entire country in 1997.  Now we have hundreds of EMS personnel, an emergency phone number (1669), a developed dispatch system, guidelines, and protocols.  Although, unlike the United States, there are still many places in Thailand developing their EMS systems and the new Thai EM physicians will play important roles in developing these systems in their communities.

These days you can find the newest practices and the latest drugs and therapies in just one-click on the internet.  So, what makes emergency physicians so sexy, smart and different from others is not only being an expert in the clinical field but knowing how to manage things and taking responsibility in emergency situations as well.

In conclusion, I want to say that I'm very grateful to Dr. Barton, Dr. Stroud, and all of the UUHC EM faculty and residents who gave me and our residents a warm welcome and such a great experience while here.  Besides learning and gaining knowledge of emergency medicine practices and procedures there were also many other things we learned.  Because emergency medicine in Thailand was just recognized as a specialty and started training in 2004, the role of the emergency physician is still unclear. We still do not have enough emergency physicians for every province.  What we've seen here is a good example of a well-organized ED. It helps us to better understand our future roles and learn better ways to develop our emergency department.  We look forward to an ever expanding partnership and continued knowledge sharing  in the future.  -By Nathida Sumetchotimaytha, MD


Thai EM Residents and Faculty Visiting Utah



Only a few years ago, the presence of an emergency medicine residency in Utah was still just a dream. In 2005 that dream became a reality, and in June of 2008 we graduated our first class of emergency medicine residents.

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Christine Carlson
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