Fit for the future? The relevance of <i><scp>E</scp>mergency <scp>M</scp>edicine <scp>A</scp>ustralasia</i> to current and prospective emergency medicine trainees

Emergency Medicine Australasia (EMA) is to be congratulated on its 25th anniversary. For a quarter of a century, the Journal has fulfilled an important role in publishing original research and facilitating discussion in academic emergency medicine (EM). At this milestone, it is timely to review the value of EMA to current and future Australasian College for Emergency Medicine (ACEM) trainees. This article reflects on trends in EM training, medical publishing and Web 2.0, and makes suggestions for further modernisation of the Journal. The EM workforce has expanded considerably in 25 years, with approximately 3500 ACEM fellows and trainees currently providing care in more than 115 hospitals in Australia and New Zealand.1-3 The College also offers Diploma and Certificate programmes for doctors wishing to pursue non-specialist qualifications in EM. As a result of this growth, demand for EM education is greater than ever before. In parallel with these developments, ACEM is renewing its curriculum, updating assessment tools and introducing a range of electronic educational resources.1 These include an online learning platform, Moodle™ (Perth, WA, Australia), and the Best of Web EM Project.4 Approaches to medical publishing have also evolved. Content is commonly published online ahead of print, and many journals are adopting ‘print short-online long’ models. Multimedia is increasingly used to communicate information to users, and open peer-review processes are slowly gaining favour. Business practices have also changed in response to demand for open access to biomedical literature, with increasing numbers of journals operating on an ‘author pays’ basis. Previous articles in EMA have reflected on the interplay between medical journals and Web 2.0.5-8 Much of this discussion has focussed on the role of social media (SM), defined as Internet-based applications that allow for the exchange of user-generated content.9 SM has an established place in EM education, with blog sites such as Life In The Fast Lane10 widely recognised as invaluable repositories of learning resources. The reach of these sites has been extended via Twitter™ (San Francisco, CA, USA), a microblogging application that allows users to categorise content using key words known as ‘hashtags’. A prominent example is #FOAMed (short for Free Open Access Medical Education), which is facilitating the collation of educational material on SM platforms.11 Unlike traditional models of medical publishing, SM's primary function is to facilitate real-time sharing and discussion of online resources. Although blog and podcast material are generally original, content often builds on information published elsewhere. Although SM has allowed a broader audience to engage with academic EM, the lack of formal peer-review processes has been a subject of debate.12 This is despite intrinsic mechanisms for quality assurance, including the provision for real-time comments and a reliance on user dissemination. In response to these concerns, selected blog sites are adopting post-publication, expert peer-review processes.13 Solutions to other challenges for FOAMed, including curriculum linkages and content deficiencies, are also being considered.14 These reforms are likely to enhance the quality of EM education delivered by SM. Owing to a lack of data, it is difficult to determine exactly what trainees want from a local EM journal. The extent to which they currently engage with EMA is also difficult to assess, given that proxy markers (such as the number of publications authored by trainees) do not reflect broader use of published material. A recent survey of EMA readers provides useful insights into perceptions of the Journal, although the trainee response rate of 8% limits interpretability. Overall, 60% of trainee respondents were ‘satisfied’ or ‘very satisfied’ with the hard copy format of the Journal. For the online version, 64% either did not respond or selected ‘not applicable’,15 which raises questions about the accessibility and functionality of this platform. Anecdotally, utilisation of EMA by trainees preparing for the Fellowship examination is variable. In addition, the Journal's appeal as a vehicle for trainee research publication will have suffered as a result of the introduction of the alternative pathway for the 4.10 requirement. EMA has many positive attributes, including relatively swift editorial response times and an advertising policy that precludes drug company advertising.8 Readers also appreciate that Journal content is responsive to local concerns.15 Many of EMA's weaknesses also apply to other journals, such as infrequent hard copy publication, limited use of multimedia and minimal open access content. The Journal has made moves to address these challenges by releasing papers early online via EarlyView, increasing the proportion of articles that are freely accessible in full text and establishing a Twitter™ account (@EMAJournal).7, 8, 16 An extensive appraisal of EMA occurred in September 2012, which incorporated a goal-oriented Strategic Planning Day. The review identified nine key objectives, including better engagement with the Australasian EM community and achievement of a better balance in educational and research material.8 The editorial team has indicated that the outcomes will help inform the Journal's future directions.8, 16 Current training reforms provide an ideal opportunity for EMA to establish a stronger foothold as an educational resource. This will require a strategic focus on trainee engagement and a commitment to meeting the needs of readers as well as authors. Resourcing arrangements might have to be reviewed as part of this process. Fiona Godlee, Editor of the British Medical Journal (BMJ), has said that medical journals suffer from being too boring, too pompous and too expensive.17 EMA's challenge is to rise above this characterisation and deliver an engaging resource that is relevant to all EM practitioners. Respondents to the survey of EMA readers have offered suggestions to this end,15 as have previous articles in this Journal.5, 6 Recent efforts by other Australasian medical journals to innovate might also be instructive.18, 19 Clinician uptake of SM has been driven by demand for educational content that is engaging, timely and accessible. SM also allows discussion around topics where the evidence base is emerging. Medical journals must engage with this paradigm.6 There is a false dichotomy between SM and medical journals. The two have distinct but overlapping roles, and can be mutually enhancing rather than exclusive. The challenge for EMA is to maintain its rigour as a publication vehicle for original research and reviews, while simultaneously facilitating the development of educational content that can be disseminated via SM. In this way, the two modalities can work synergistically to increase the ready availability of high-quality material. Educational and research content are not mutually exclusive, but certain EMA article types have greater relevance to trainees. For example, review articles are generally more effective for learning because they provide a broad overview of a topic. Case reports are useful in that they include a clinical synopsis and summary of a disease process. The ‘From Other Journals’ section is another helpful feature, particularly for time-poor clinicians. Internationally, certain journals have developed article types that provide a more explicit educational focus. For example, the ‘Clinical Review’ and ‘Practice’ sections of the BMJ include practical guidance for common clinical scenarios.20 Other publications feature case challenges and clinical quizzes.21-23 Editorial summaries, such as ‘Key Practice Points’, are also used by some journals to place findings in a clinical context. EM journals have also introduced novel article types. Annals of Emergency Medicine, for instance, regularly publishes ‘Systematic Review Snapshots’. These provide expert commentary on high-quality systematic reviews published in other journals, and relate the outcomes to EM practice.24, 25 Other examples include the Emergency Medicine Journal's ‘Best Evidence Topic Reports’ and Academic Emergency Medicine's ‘Progressive Clinical Practice’ papers.26, 27 Multimedia is also utilised by several journals to enhance educational value.6 For instance, the New England Journal of Medicine (NEJM) has a series of procedural skills videos that are widely used by trainees,28 and Academic Emergency Medicine has recently introduced a web-based ‘Peer-reviewed Lecture Series’.29 Both BMJ and NEJM have online learning modules linked to journal content and produce tailored email updates for junior doctors.23, 30 A number of publications also provide podcasts that build on published content.6 Although EMA should not simply seek to replicate all that is being done elsewhere, there is potential to diversify content and broaden delivery methods. In particular, explicit clinical reviews would be appealing to trainees, and provide an opportunity for ACEM members to publish without being required to perform original research. There might also be scope to improve the Journal's function as a clearing house for relevant clinical guidelines. In the context of training reform, stronger linkages between EMA content and the ACEM curriculum could also be considered. For instance, review articles could include a footnote referencing the relevant section of the curriculum. This would also allow EMA and the College to catalogue articles, and encourage the utilisation of local material in study programmes. Questions have already been raised about the role of the Journal in extending the educational reach of the College.16 For instance, while the College's Moodle™ platform collates online learning resources, could the Journal also be used as a vehicle for disseminating selected materials? A major obstacle to accessing EMA is the subscription fee. Although this is not generally an issue for paid up ACEM members (who automatically receive access), it limits the accessibility of the Journal to other users. The merits and barriers to moving towards an open access author-pays model have been discussed elsewhere.6, 16 Updating the Journal's style, design and website might also make for a more attractive product. The Medical of Journal of Australia's recent facelift illustrates how a change in livery can re-engage readers.18, 19 The EMA Strategic Planning Day concluded that EMA should work towards increasing ACEM members’ involvement in journal production and content.8 One means of doing so would be the development of an editorial position for a trainee. This strategy, which has been successfully employed by journals such as the Annals of Emergency Medicine and Australian Family Physician, would serve to sharpen educational focus and provide a mechanism for supporting emerging academic leaders.31, 32 EMA also has a role in facilitating engagement between Australasian EM clinicians and their Asia-Pacific counterparts. The Journal might be able to further support regional EM development by publishing educational material that can be applied in resource poor settings. Although EMA remains true to its mission, there is potential for modernisation. In the context of rising trainee numbers and increasing subscription to FOAMed, the case for enhancing educational utility is compelling. Options for innovation include enhanced interactivity with SM, introduction of novel article types, greater utilisation of multimedia, more explicit linkages with the ACEM curriculum and trainee participation in editorial processes. EMA should be rightly proud of its efforts to respond to the maturation and expansion of EM practice in Australasia. A renewed commitment to innovation will ensure that, for the next 25 years, the Journal retains an important place in the hearts and minds of EM trainees. The authors thank Drs Alex Markwell, Andy Buck, Colin Banks and Phil Naidoo for reviewing drafts of this article. RM is a regular contributor to MJA InSight. J-AR has provided toxicology content for Life In The Fast Lane. RM, AP and J-AR are past or current members of the ACEM Trainee Committee, but all views expressed in this article are their own.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.