Talk:International emergency medicine

Fellowships

Moved to talk because no references and likely incomplete. RJFJR (talk) 14:54, 21 July 2010 (UTC)

Fellowships are provided at the following universities:

Duke Medical Center
Stanford University Medical Center
Alameda County Medical Center - Highland Hospital
Loma Linda University
Keck School of Medicine at the University of Southern California
George Washington University
Emory University
Medical College of Georgia
Rush University/ Cook County Hospital
University of Illinois at Chicago
The Johns Hopkins University
University of Maryland
Columbia University/New York Presbyterian Hospital
Long Island Jewish Medical Center
University of Rochester Medical Center
University of Pittsburgh
Vanderbilt University
Rhode Island Hospital- Brown University

International emergency medicine page (expansion and revisions)

Hello, my name is Matthew, and I'm an undergraduate student from Rice University. I'm intending on expanding and rewriting this article for a class project. Currently there isn't much more than a definition and description of the International Conference on Emergency Medicine. I'd like to create more of a focus on the establishment/improvement of emergency medicine in developing countries. There is actually a fairly extensive literature on international emergency medicine in some of the emergency medicine journals so there is a lot of scope to add information about the state of emergency medicine in the developing world and initiatives that are underway to improve it. I'm still trying to figure out how to strike a balance between a broad overview of the topic and examples from specific countries. My plan is reorganize what is already there and to create sections like "Overview of international emergency medicine", "Institutions involved", "Role in the overall health system", "Initiatives to expand emergency medicine", and "Challenges." I would be glad to hear if anyone had ideas on other sources I could use as most of my intended sources are from medical journals. Any suggestions for the best way to go about this project? Mjs15 (talk) 15:45, 3 October 2012 (UTC)

Welcome. Toil away. If you have any queries on anything, ask at WT:MED, where you introduced yourself earlier. I know a bit about the editing policies so feel free to ask anything on my talk page. --Anthonyhcole (talk) 15:52, 3 October 2012 (UTC)

Global perspective

Hi, nice work on a complicated topic. I think the article, ironically, needs a little bit more 'global perspective'. A basic example to illustrate what I mean is the reference to "practicing abroad", which means different things depending on where you are. Similar problem with "emergency medicine in other countries" being a key part of the definition. Other than what? Is "international medicine" actually, specifically, the practice First world emergency medicine in Third World countries? I don't like these terms, but to be honest I prefer them to developed/developing, which IMO are actually more loaded.

Are there cultural practices outside of the global capitalist monoculture that could be considered "emergency medicine"? If so, are these part of "international emergency medicine" when they are used in, for example, the United States? Or is "international emergency medicine" a unidirectional transfer from Us to Them? (With Anglo-American and Franco-German the only choices. Which actually makes me wonder, even within the first world, about the state of Soviet international emergency medicine...)

None of which is to trash your hard work or even suggest we need to remove anything, but I do think some expansion and reframing is necessary. Salaam, groupuscule (talk) 19:40, 26 October 2012 (UTC)

Thanks for the c/e and feedback. This is just my first draft of the article, so I'll try to address some of your concerns when I go back to rewrite and expand it.

I see what you mean about trying to write from a more global perspective and I'll try to incorporate that into my edits. However, I think that developing and developed are probably the clearest terms for discussing countries in international emergency medicine, as well as being the ones used in the literature. Of course, they are not ideal either, especially as some otherwise fairly developed countries lacked emergency medical systems until recently. I'll give the issue some more thought.

I don't know much about "cultural practices outside of the global capitalist monoculture" but international emergency medicine is certainly about more than just transfers from us to them. Research and best practices should flow both ways. I'll try to emphasize that more in my edits. Mjs15 (talk) 01:03, 28 October 2012 (UTC)

Peer Input

Hi Matt! I think this article is a really good and well-written. I have a few suggestions which you can feel free to take or ignore. I think under the importance section the final sentence in the third paragraph needs to either be rephrased or cited so that it won't be perceived as a factual claim without any proof. Also, I think in general it would be good to be cognizant of the fact that this is an encyclopedic entry so the language needs to be neutral. So one sentence in particular that I think needs to be rewritten or cited is under the importance section also and it says "Emergency departments are excellent locations to train health care providers and to collect data due to the density of patients". Also, some of the transitions seem a little too colloquial for an encyclopedic article such as of course and as would be expected so I think it'd be helpful if you changed that. Best, Lgriffin92 (talk) 02:46, 30 November 2012 (UTC)

GA Review

This review is transcluded from Talk:International emergency medicine/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Sasata (talk · contribs) 20:53, 17 January 2013 (UTC)

I'll take this on, but before I post a review, I'd like some assurance that there will be someone willing to work on this (the student who submitted for GAN has not edited since December 10). Access to the sources used in the article will be essential. Any takers? Sasata (talk) 20:53, 17 January 2013 (UTC)

I'm still around. As a college student I tend to be fairly busy but just let me know what you need and I'll see what I can do. Thanks. Mjs15 (talk) 01:39, 18 January 2013 (UTC)

Very good; I'll post a review later this week. Sasata (talk) 23:37, 21 January 2013 (UTC)

Resolved comments (see two sections below on the article talk page)

Comments possible useful links: public health, developing world, white paper, critically ill, cost-benefit study, variable, curriculum, travel medicine, field medicine, infection control, disease burden the lead is currently a bit US-Centric; is IEM offered as a fellowship in non-US programs as well? "it was the high number of traffic and other accident fatalities in the 1960s that spurred by a white paper from the National Academy of Sciences that exposed the inadequacy of the current emergency medical system and led to" something's wrong with the grammar in this sentence "These are conditions that potentially threaten the lives of those who are afflicted by them and yet adequate and/or timely treatment may not be available for much of the world's population." Source for this statement? If it's the same as the previous sentence, it needs to be placed at the end. "For instance, a 2008 study of Zambia published by" It wasn't a study of Zambia, rather, it was a study of its "current status of anesthesia and its allied disciplines (intensive care medicine, emergency medicine, and pain therapy)". I'm worried that a primary source is being used to advance a position; has this study been cited in any reviews? Arnold (1999) is the most frequently cited paper in this article, but it's now 14 years old. WP:MEDRS (particularly, WP:MEDDATE) advises us to "Look for reviews published in the last five years or so, preferably in the last two or three years." Have there not been any review papers that cover the same material published since then? Any textbooks? Any dedicated chapters in more general textbooks on Emergency medicine? "EMS" is used as a shorthand starting in the "Models of emergency care" section, but is not defined anywhere Hauswald and Yeoh is a primary study from 1997, and so not particularly MEDRS-compliant; can the cost-benefit argument be supported with a secondary source? "In developing counties international emergency medicine is one among many initiatives" the subheader right above indicated this subsection is called "Developed countries"; should the underlined be "developed"? "…international emergency medicine is one among many initiatives underway to shape the future of the specialty." Confused, isn't international emergency medicine the specialty? "Its authors argue that attempting to cover all of those areas may be unrealistic and that a more targeted focus on acquiring necessary skills might be more productive." this sentence needs a citation "Given the relatively young nature of emergency medicine as a specialty in the world as a whole there are" can we trim the underlined without sacrificing meaning? "a far greater number of nations (50+) are in the process of developing those systems." this statement will become dated (see WP:DATED), so an {{as of}} template could be useful here "Preventive care is clearly a crucial part of healthcare" "Some money may be available from wealthier nations or international organizations but careful decisions still need to be made. Regardless of the amount of preventive care available, though, health problems requiring immediate attention will still occur and emergency medical programs could increase access to care." source? Hobgood et al. (2009) isn't marked by Pubmed as a review, but the similar-sounding Singer et al. (2009) PMID 19594974 is; could you check if the latter source can be substituted? "It is targeted towards all medical students in order to produce a minimum competency in emergency care for all physicians, regardless of their specialty." citation please "As would be expected, countries that have" the underlined sounds like editorializing and should be trimmed several dated statements: "The most recent conference took place in Dublin, Ireland on the 27 - 30 June, 2012."; "Up until now the conference has rotated"; "new members have been accepted in recent years" "An important step for the advancement of emergency medical care" who says this is important? The authors of the primary source cited at the end of the paragraph? I can't find this article indexed in Pubmed, and it seems the entire paragraph is based on a possibly dubious source. "An alternate route is providing additional training" an alternate route of what? "This has the benefit being more rapid to implement as physicians already trained in other areascan add the necessary emergency skills to their repertory." fix grammar "Educational opportunities in emergency medicine are simply not available"; "Botswana just opened its first medical school in 2009" there is no need to define acronyms (eg. CEM(SA), EMSSA) if they aren't used later "An important notion present in emergency medical systems development" Again, I'm not comfortable with how the article often tries to tell the reader what's important (especially when sourced to a primary study); please rephrase "Despite the intuitive appeal of the thought that increasing availability to emergency medicine will improve patient outcomes" The suggestion that the thought has intuitive appeal sounds like editorializing; also the phrase "More to the point" soon after the final two paragraphs need end-of-paragraph citations please include pubmed id's to all of the the cited sources; it makes it easier for the reader to read the abstract and otherwise follow-up on sources (the {{pmid}} template is an easy way to implement this)

There hasn't been any activity on this page since I posted the above review on Jan 27, and few substantial edits to the article itself. I'm going to remove this from the GAN queue now; any interested editors are welcome to use the above suggestions to improve the article. Sasata (talk) 23:19, 14 February 2013 (UTC)

I'm working my way through the edits slowly. I'll renominate the article once I get around to fixing all of your concerns. Thanks for posting your review. Mjs15 (talk) 05:00, 15 February 2013 (UTC)

The changes already made during the GA Review

I'll take on the changes recommended in the GA review. Seeing as the article wasn't promoted at that time and is not currently under review, I can get this article up to GA status at my own pace. AmericanLemming (talk) 21:35, 17 June 2013 (UTC)

Resolved comments

possible useful links: public health, developing world, white paper, critically ill, cost-benefit study, variable, curriculum, travel medicine, field medicine, infection control, disease burden  Done Changed by Mjs15 on 30 January 2013 the lead is currently a bit US-Centric; is IEM offered as a fellowship in non-US programs as well? "it was the high number of traffic and other accident fatalities in the 1960s that spurred by a white paper from the National Academy of Sciences that exposed the inadequacy of the current emergency medical system and led to" something's wrong with the grammar in this sentence  Done Changed by Mjs15 on 15 February 2013 "These are conditions that potentially threaten the lives of those who are afflicted by them and yet adequate and/or timely treatment may not be available for much of the world's population." Source for this statement? If it's the same as the previous sentence, it needs to be placed at the end.  Done Changed by Mjs15 on 3 February 2013 "For instance, a 2008 study of Zambia published by" It wasn't a study of Zambia, rather, it was a study of its "current status of anesthesia and its allied disciplines (intensive care medicine, emergency medicine, and pain therapy)". I'm worried that a primary source is being used to advance a position; has this study been cited in any reviews? Arnold (1999) is the most frequently cited paper in this article, but it's now 14 years old. WP:MEDRS (particularly, WP:MEDDATE) advises us to "Look for reviews published in the last five years or so, preferably in the last two or three years." Have there not been any review papers that cover the same material published since then? Any textbooks? Any dedicated chapters in more general textbooks on Emergency medicine? "EMS" is used as a shorthand starting in the "Models of emergency care" section, but is not defined anywhere  Done Changed by Mjs15 on 3 February 2013 Hauswald and Yeoh is a primary study from 1997, and so not particularly MEDRS-compliant; can the cost-benefit argument be supported with a secondary source? "In developing counties international emergency medicine is one among many initiatives" the subheader right above indicated this subsection is called "Developed countries"; should the underlined be "developed"?  Done Changed by Mjs15 on 15 February 2013 "…international emergency medicine is one among many initiatives underway to shape the future of the specialty." Confused, isn't international emergency medicine the specialty?  Done Changed by Mjs15 on 15 February 2013 "Its authors argue that attempting to cover all of those areas may be unrealistic and that a more targeted focus on acquiring necessary skills might be more productive." this sentence needs a citation  Done Changed by Mjs15 on 15 February 2013 "Given the relatively young nature of emergency medicine as a specialty in the world as a whole there are" can we trim the underlined without sacrificing meaning?  Done Changed by Mjs15 on 3 February 2013 "a far greater number of nations (50+) are in the process of developing those systems." this statement will become dated (see WP:DATED), so an {{as of}} template could be useful here "Preventive care is clearly a crucial part of healthcare"  Done Changed by Mjs15 on 3 February 2013 "Some money may be available from wealthier nations or international organizations but careful decisions still need to be made. Regardless of the amount of preventive care available, though, health problems requiring immediate attention will still occur and emergency medical programs could increase access to care." source? Hobgood et al. (2009) isn't marked by Pubmed as a review, but the similar-sounding Singer et al. (2009) PMID 19594974 is; could you check if the latter source can be substituted? "It is targeted towards all medical students in order to produce a minimum competency in emergency care for all physicians, regardless of their specialty." citation please  Done Changed by Mjs15 on 15 February 2013 "As would be expected, countries that have" the underlined sounds like editorializing and should be trimmed  Done Changed by Mjs15 on 15 February 2013 several dated statements: "The most recent conference took place in Dublin, Ireland on the 27 - 30 June, 2012."; "Up until now the conference has rotated"; "new members have been accepted in recent years" "An important step for the advancement of emergency medical care" who says this is important? The authors of the primary source cited at the end of the paragraph? I can't find this article indexed in Pubmed, and it seems the entire paragraph is based on a possibly dubious source. "An alternate route is providing additional training" an alternate route of what?  Done Changed by Mjs15 on 15 February 2013 "This has the benefit being more rapid to implement as physicians already trained in other areascan add the necessary emergency skills to their repertory." fix grammar  Done Changed by Mjs15 on 15 February 2013 "Educational opportunities in emergency medicine are simply not available"; "Botswana just opened its first medical school in 2009"  Done Changed by Mjs15 on 15 February 2013 there is no need to define acronyms (eg. CEM(SA), EMSSA) if they aren't used later "An important notion present in emergency medical systems development" Again, I'm not comfortable with how the article often tries to tell the reader what's important (especially when sourced to a primary study); please rephrase "Despite the intuitive appeal of the thought that increasing availability to emergency medicine will improve patient outcomes" The suggestion that the thought has intuitive appeal sounds like editorializing; also the phrase "More to the point" soon after the final two paragraphs need end-of-paragraph citations please include pubmed id's to all of the the cited sources; it makes it easier for the reader to read the abstract and otherwise follow-up on sources (the {{pmid}} template is an easy way to implement this)

The changes remaining to be made from the GA Review

These are the things that I'll be changing. AmericanLemming (talk) 22:21, 17 June 2013 (UTC)

Resolved comments

the lead is currently a bit US-Centric; is IEM offered as a fellowship in non-US programs as well?  Not done As far as I can tell, IEM is only offered as a fellowship in US programs. I don't have a source that says that, but that's my understanding. AmericanLemming (talk) 19:42, 19 June 2013 (UTC) "For instance, a 2008 study of Zambia published by" It wasn't a study of Zambia, rather, it was a study of its "current status of anesthesia and its allied disciplines (intensive care medicine, emergency medicine, and pain therapy)". I'm worried that a primary source is being used to advance a position; has this study been cited in any reviews?  Done I've reworded the phrase to better represent the nature of the study. And yes, the study has been cited in one review, "Clinical review: International comparisons in critical care - lessons learned," (see "Priorities for future international research" section near the end). The PubMed ID is 22546146. AmericanLemming (talk) 19:32, 19 June 2013 (UTC) Arnold (1999) is the most frequently cited paper in this article, but it's now 14 years old. WP:MEDRS (particularly, WP:MEDDATE) advises us to "Look for reviews published in the last five years or so, preferably in the last two or three years." Have there not been any review papers that cover the same material published since then? Any textbooks? Any dedicated chapters in more general textbooks on Emergency medicine?  Not done There are a few review papers on IEM that are more recent, but the two I found were more focused on the specifics of the literature from a particular year than on defining what exactly IEM is, like Arnold (1999) does. Anyway, the two reviews I found are as follows: International Emergency Medicine: A Review of the Literature from 2010 International Emergency Medicine: A Review of the Literature from 2009 Hauswald and Yeoh is a primary study from 1997, and so not particularly MEDRS-compliant; can the cost-benefit argument be supported with a secondary source?  Not done I'm afraid not; no other source that I know of mentions the cost-effectiveness of adapting Western EMS standards to developing countries. AmericanLemming (talk) 19:42, 19 June 2013 (UTC) "a far greater number of nations (50+) are in the process of developing those systems." this statement will become dated (see WP:DATED), so an {{as of}} template could be useful here  Done "Some money may be available from wealthier nations or international organizations but careful decisions still need to be made. Regardless of the amount of preventive care available, though, health problems requiring immediate attention will still occur and emergency medical programs could increase access to care." source?  Done Hobgood et al. (2009) isn't marked by Pubmed as a review, but the similar-sounding Singer et al. (2009) PMID 19594974 is; could you check if the latter source can be substituted?  Done several dated statements: "The most recent conference took place in Dublin, Ireland on the 27 - 30 June, 2012."; "Up until now the conference has rotated"; "new members have been accepted in recent years"  Done "An important step for the advancement of emergency medical care" who says this is important? The authors of the primary source cited at the end of the paragraph? I can't find this article indexed in Pubmed, and it seems the entire paragraph is based on a possibly dubious source.  Done there is no need to define acronyms (eg. CEM(SA), EMSSA) if they aren't used later  Done "An important notion present in emergency medical systems development" Again, I'm not comfortable with how the article often tries to tell the reader what's important (especially when sourced to a primary study); please rephrase  Done "Despite the intuitive appeal of the thought that increasing availability to emergency medicine will improve patient outcomes" The suggestion that the thought has intuitive appeal sounds like editorializing; also the phrase "More to the point" soon after  Done the final two paragraphs need end-of-paragraph citations  Done please include pubmed id's to all of the the cited sources; it makes it easier for the reader to read the abstract and otherwise follow-up on sources (the {{pmid}} template is an easy way to implement this)  Done

GA Review

This review is transcluded from Talk:International emergency medicine/GA2. The edit link for this section can be used to add comments to the review.

Reviewer: Cryptic C62 (talk · contribs) 16:29, 12 July 2013 (UTC)

My overall impression: The research and sourcing in this article is top-notch, and it is clear that a lot of work has been put into it. However, the quality of prose leaves much to be desired, and there are some organizational issues that need to be addressed. Finally, I see some minor problems in the footnotes, but we can look at that later.

Organization

Resolved comments

Where is the History section?  Done I've moved the History section from my sandbox into the article. You'll have to let me know what you think. AmericanLemming (talk) 21:51, 18 July 2013 (UTC) Solid. I'll leave prose comments below. --Cryptic C62 · Talk 02:18, 21 July 2013 (UTC) Where are the images? Ambulances, hospitals, medical professionals, medical schools, policy directors, etc.  Done Following your advice, I've now added 7 pictures to the article from Wikimedia Commons. All of them are public domain or Creative Common-licensed, so there's no problem there. However, the formatting could be improved, especially for the three co-alinged pictures at the bottom of the article. AmericanLemming (talk) 22:34, 18 July 2013 (UTC) In my experience, the easiest approach is to find existing images in Wikimedia Commons, our file repository. Find an image you'd like to use, then find the licensing below the description. If the license says "creative commons" or "public domain", then it can be used freely. Wikipedia:Picture tutorial can explain how to add the image to an article, and how the various parameters work. I've added one to the Developing countries section as an example; if you're not a fan of the image or its placement, feel free to revert. Does this help? --Cryptic C62 · Talk 12:52, 18 July 2013 (UTC) You've been quite helpful. I have removed the image, however, as ambulances are costly and often unsuited to the conditions present in many countries. (See the relevant section in the article.) But I have added some other images. AmericanLemming (talk) 22:42, 18 July 2013 (UTC) Good! If you haven't already, you may want to review WP:CAPTION for some tips on writing excellent captions. --Cryptic C62 · Talk 02:18, 21 July 2013 (UTC) The Emergency medicine in the developing world section starts by giving a detailed explanation of one specific subtopic, followed by "Emergency medical care may be applicable in many areas aside from traffic injuries" which returns to the the more general topic. This is a very unintuitive way of organizing this section. It leaves the reader thinking "Wait, what does this have to do with IEM?"  Done I've attempted to summarize the paragraph by adding a sentence to the beginning. AmericanLemming (talk) 06:59, 25 July 2013 (UTC) The first paragraph of Models of emergency care is far too large. It should be split or shortened.  Done AmericanLemming (talk) 20:49, 12 July 2013 (UTC) As far as I can tell, the Emergency medicine in the developing world and Models of emergency care sections are not specifically about international emergency medicine. Perhaps these should become subsections of a top-level Background section. This could also include the Definition section.  Done AmericanLemming (talk) 20:53, 12 July 2013 (UTC) I'm not sure that the History section should be nested under Background, as the two serve different purposes. A Background section should provide the reader with content and context necessary to understand the topic. In most cases, it is not necessary to understand the History of a topic in order to understand the topic as it currently exists. However, as you are more familiar with the subject than I am, you might disagree with that last point. I'm actually a bit of an outsider to this topic myself. My brother, Mjs15, rewrote the entire article last fall but hasn't been able to get it up to GA since then because he's too busy. Hence, that's where I come in. Anyway, when I first read the article myself, I was confused as to what IEM actually was, owing to the somewhat confusing nature of the Definition section. Having spent way too much time working on it, I know understand that, as the article says, "The most commonly accepted definition of international emergency medicine is that it is 'the area of emergency medicine concerned with the development of emergency medicine in other countries.'" I guess what I'm getting at is that having the History section nested under Background reinforces the most commonly accepted definition and prevents the reader from being confused and asking, "So what exactly is IEM?" If you think that the average person can read the Definition section and understand what IEM is without needing reiteration from the History section, I would be open to moving it. AmericanLemming (talk) 00:56, 1 August 2013 (UTC)

Prose comments

Resolved comments

"The straightforward definition of international emergency medicine..." Why "straightforward"? Everything written on Wikipedia should be straightforward in its presentation. What is needed here is the most commonly accepted definition of IEM.  Done AmericanLemming (talk) 18:10, 12 July 2013 (UTC) "Included in those nations are some that are otherwise quite developed but lack a complete emergency medical system." Such as?  Done AmericanLemming (talk) 19:24, 12 July 2013 (UTC) "As the researchers Razzak and Kellermann identify" This phrase can and should be cut. The findings presented in this paragraph are obviously factual.  Done AmericanLemming (talk) 18:12, 12 July 2013 (UTC) "These are conditions that potentially threaten the lives of those who are afflicted by them and yet adequate and/or timely treatment may not be available for much of the world's population." Clunky phrasing which can be shortened. Try this: "These are potentially life-threatening conditions, and yet effective treatment is often unavailable for much of the world's population."  Done AmericanLemming (talk) 18:17, 12 July 2013 (UTC) "For instance, a 2008 study of anesthesia, intensive care medicine, emergency medicine, and pain therapy in Zambia published by the International Anesthesia Research Society found that only 50 percent of hospitals had an emergency medical system that transported patients." The finding has nothing to do with most of the study items listed. As such, the list should be shortened: "For instance, a 2008 study of medical systems in Zambia published by the International Anesthesia Research Society found that only 50 percent of hospitals had an emergency medical system that transported patients."  Done AmericanLemming (talk) 18:20, 12 July 2013 (UTC) "Of course, emergency medicine also improves public health..." Never use "of course". See MOS:OPED for details.  Done AmericanLemming (talk) 18:21, 12 July 2013 (UTC) "Simply put, the Anglo-American..." Cut "simply put". It does not improve the sentence in any way.  Done AmericanLemming (talk) 18:22, 12 July 2013 (UTC) I see an Anglo-American model and a Franco-German model. Does Asia not exist? Well, yes, Asia does exists, but as far as I can tell there is no Asia model of emergency medicine. A quick search on PubMed and Google for "asia model" or "asian model" will give you nothing pertinent. Source 1 of the International emergency medicine article says that China, Hong Kong, Japan, the Philippines, South Korea, and Taiwan use the Anglo-American model, so I guess you could say that the Anglo-American model is the Asian model. One method of clarifying this point would be to split the sentence in two, then highlight a few countries that use each model: The Anglo-American model (used in such countries as X, Y, and Z) relies on "bringing the patient to the hospital". The Franco-German model (used in such countries as ع, Ҩ, and פ) operates through "bringing the hospital to the patient." Another option would be to simply add a sentence later in the paragraph summarizing what you said above. --Cryptic C62 · Talk 01:33, 14 July 2013 (UTC)  Done AmericanLemming (talk) 03:03, 14 July 2013 (UTC) "The use of these descriptors for emergency medical systems has been criticized as an oversimplification and a needless source of controversy." A contentious claim such as this should be immediately followed by a citation.  Done AmericanLemming (talk) 22:15, 12 July 2013 (UTC) "For instance, a cost-benefit analysis found that creating an EMS system in Kuala Lumpur that met U.S. standards for cardiac arrest response ... would cost $2.5 million and only save four neurologically intact lives." Two problems: First, the symbol "$" is not enough to unambiguously identify the currency being used. Presumably this should read "US$2.5 million". See WP:CURRENCY for details. Second, four lives per what? Per year?  Done AmericanLemming (talk) 18:50, 12 July 2013 (UTC) "Elements of both of the major conventional models have been incorporated with the EMS system following French influences and being staffed by physicians while an American approach to emergency medical residency training is also present." Read this sentence out loud. Pause only when you see a comma or period. See the problem?  Done AmericanLemming (talk) 18:53, 12 July 2013 (UTC) "within many emergency medicine residences" Should this say "within many emergency medicine residencies"?  Done AmericanLemming (talk) 18:25, 12 July 2013 (UTC) "practiced-based learning" Presumably this should say "practice-based", which would make much more sense.  Done AmericanLemming (talk) 18:26, 12 July 2013 (UTC) "Indeed, the breadth of skills..." Cut "indeed". This is an encyclopedia article, not an essay for a college writing course.  Done AmericanLemming (talk) 18:28, 12 July 2013 (UTC) "Indeed, the breadth of skills needed in international emergency medicine make it unlikely that one standardized program could fulfill the training needs for all of the various future tasks in international emergency medicine." This can be shortened: "Indeed, the breadth of skills needed in international emergency medicine make it unlikely that one standardized program could fulfill the training needs for every scenario."  Done AmericanLemming (talk) 18:29, 12 July 2013 (UTC) "the primary topical areas" Do you mean "topic areas" or "topical areas"? The two have different meanings.  Done AmericanLemming (talk) 20:01, 12 July 2013 (UTC) "Such exchanges can work both ways, however, as the fact that 23 to 28 percent of all physicians in Australia, the United States, the United Kingdom and Canada received their training at international medical schools suggests." Yikes, this one is a doozy. How about this: "Such exchanges can be mutually beneficial; 23 to 28 percent of all physicians in Australia, the United States, the United Kingdom and Canada received their training at international medical schools."  Done AmericanLemming (talk) 18:32, 12 July 2013 (UTC) "They are attempting to establish effective systems" Unclear time reference. See WP:PRECISELANG. Is that better? "Given the relatively young nature of emergency medicine as a specialty globally, as of the mid-2000s there were only a few advanced emergency medical systems and a far greater number of nations (50+) that were in the process of developing those systems." I'm sorry, but I really don't understand what information this sentence is trying to convey. Think about the point that you were hoping to make here, imagine how you would relate it to someone verbally, and then write that instead. Is that better? AmericanLemming (talk) 18:58, 12 July 2013 (UTC) I don't see much of a difference. After rereading, I think I've isolated the problem: The sentence is of the form "Given X, Y" or more simply "X implies Y". However, X and Y appear to be equivalent, so the use of this construction just causes confusion. I suggest simply cutting out the first clause.  Done AmericanLemming (talk) 02:46, 14 July 2013 (UTC) "The process of development has been described as usually beginning in academia and patient care before burgeoning out to administrative and economic concerns and finally health policy and agendas." The "has been described" construction makes this sentence really awkward. Also, burgeoning? Really? The goal is to convey information in a way that anyone can understand it. SAT vocab words should only be used when not suitable alternative can be found. Try this instead: "The process of development usually begins in academia and patient care, followed by administrative and economic concerns, and finally health policy and agendas."  Done AmericanLemming (talk) 18:34, 12 July 2013 (UTC) "Given the limited resources of many developing nations a vital part of how emergency medicine fits into the health system is how to fund it." I know you don't believe in commas, but they can really help. Also, avoid "how to", as it sounds like a how-to guide (seriously). "Given the limited resources of many developing nations, a vital part of how emergency medicine fits into the health system is how it is funded."  Done AmericanLemming (talk) 18:35, 12 July 2013 (UTC) "This is a particular problem for a nation like Zambia" The problem with the phrase "a nation like Zambia" is that is does not explicitly clarify which characteristic of the nation is relevant. Better: "This is a particular problem for poorer nations such as Zambia," Notice the comma. Believe in the commas.  Done AmericanLemming (talk) 18:37, 12 July 2013 (UTC) "Despite the myriad differences in the contexts of counties" This whole paragraph is in need of help, but before I try to dissect it, it is important for me to know this: is "counties" a typo for "countries"?  Done AmericanLemming (talk) 18:40, 12 July 2013 (UTC) I tweaked the phrasing a bit. You dig it? --Cryptic C62 · Talk 01:33, 14 July 2013 (UTC) I think that your phrasing is much clearer and more accessible than mine. The only thing I might change is removing the "may." I think it weakens the effect of the sentence. AmericanLemming (talk) 02:43, 14 July 2013 (UTC) A fair point, done. --Cryptic C62 · Talk 12:52, 18 July 2013 (UTC) (History) "Emergency medicine is a relatively young specialty that was first developed in the United States in the 1960s." Stating that it is "relatively young" is bad for two reasons: First, it's redundant, as the sentence gives a more precise timeframe later. Second, it does not employ precise language.  Done AmericanLemming (talk) 06:53, 21 July 2013 (UTC) "it was the high number of traffic and other accident fatalities in the 1960s that spurred a white paper" Avoid the passive voice. Try this: "the high number of traffic and other accident fatalities in the 1960s spurred a white paper" see the difference?  Done AmericanLemming (talk) 06:56, 21 July 2013 (UTC) "[various countries] followed suit shortly thereafter" Avoid colloquialisms, as they are unlikely to be understood by non-native readers.  Done AmericanLemming (talk) 07:04, 21 July 2013 (UTC) "International emergency medicine conferences had been launched in the previous decade" It is entirely unclear what "the previous decade" refers to. 60s, 70s, or 80s? No idea.  Done AmericanLemming (talk) 07:05, 21 July 2013 (UTC) Err, I don't see any change. Perhaps an edit was dreamed? --Cryptic C62 · Talk 02:20, 31 July 2013 (UTC) Look at the last sentence of the paragraph. I believe it reads "International emergency medicine conferences had been launched in the 1980s, and national emergency medicine organizations began increasing their support for the development of the speciality in other countries." I think you might have missed it. If that's not what it says, though, do let me know. AmericanLemming (talk) 03:39, 31 July 2013 (UTC) Ah, butts, my mistake. I was looking at a similar sentence a bit later on: "Moreover, several international emergency medicine conferences had been launched in the past decade". I'm not sure how I missed this earlier, but this sentence seems very redundant with the sentence highlighted above. I think the first instance of this sentence cloning could be removed, as it seems somewhat misplaced the (non-international) Emergency medicine section. --Cryptic C62 · Talk 03:53, 31 July 2013 (UTC)  Done Is that better? AmericanLemming (talk) 04:11, 31 July 2013 (UTC) "By the early 1990s, the emergency medicine systems in these six countries were largely mature" The meaning of "these six countries" is clear if it is used in the same paragraph in which the countries were introduced. The meaning becomes less obvious if it is used in a different paragraph, and even less obvious if it is used in a different section. In particular, the first sentence of a section should give the reader enough context without forcing them to hunt upwards for missing information.  Done AmericanLemming (talk) 07:08, 21 July 2013 (UTC) "leading some of the practitioners of emergency medicine in those countries "to turn their attention to developing the specialty in other countries." " Why does this sentence end with a direct quote? This is a pet peeve of mine. I am of the belief that direct quotes should only be used when there is a compelling reason to do so, and I can think of no reason that applies here.  Done I have attempted to paraphrase the quote. AmericanLemming (talk) 07:11, 21 July 2013 (UTC) "international emergency medicine as a subspecialty was born" It wasn't born. It's not a mammal.  Done Hopefully I'll eventually learn to avoid using idioms and the like on Wikipedia. AmericanLemming (talk) 07:13, 21 July 2013 (UTC) "There were several reasons for the heightened interest in developing emergency medicine in other countries. One was the example given by countries with mature emergency medical systems, particularly the United States and the United Kingdom." I don't follow this at all. How is the second sentence one of the several reasons referred to in the first sentence? I think that I understand the reason for your confusion. The first sentence of that paragraph (if that's what your talking about, which I think you are) refers to the fact that since emergency medical systems were mature by the 1990s, the practitioners of emergency medicine in those countries were able to turn their attention from developing emergency medicine as a speciality in their respective countries to other countries. The second sentence, while still referring to the mature emergency medical systems in those countries, focuses on the fact that the demonstrated success of these emergency medical systems led health policy leaders, as well as the general public, in countries without these developed emergency medical systems to think that attempting to develop such systems would be worthwhile. In short, while both sentences are about mature emergency medical systems, the first sentence is about the impact those systems had on health policy makers and health professionals in the countries with mature emergency medical systems the second sentence is about the impact those systems had on health policy makers and health professionals in the countries without mature emergency medical systems Of course, it's entirely possible that I don't understand your question, either. AmericanLemming (talk) 07:33, 21 July 2013 (UTC) "the collapse of communism in Eastern Europe, which paved the way for new ideas" The collapse of communism was not a construction worker or a steamroller. As such, there was no paving. (Avoid colloquialisms)  Done Yep. Here's another one. AmericanLemming (talk) 07:18, 21 July 2013 (UTC) "And the aging population in many countries has" Sentences should not begin with "and".  Done Again, one day I'll train myself to think literally... AmericanLemming (talk) 07:15, 21 July 2013 (UTC) Development organizations ... "help other countries establish and develop emergency care systems." They provide "ongoing educational and organizational assistance." The first quote can easily be paraphrased. The second quote seems like such a wishy-washy yes-man phrase that it should be kept as a quote, but why is it a separate sentence? Development organizations ... help establish and develop emergency care systems in other countries by providing "ongoing educational and organizational assistance."  Done I think you're better at writing articles than I am. AmericanLemming (talk) 03:43, 31 July 2013 (UTC) Nonsense. It takes two sets of eyeballs to get write the most goodly. --Cryptic C62 · Talk

Footnotes

Resolved comments

Ref numbers based on this revision. Ref 4 History of the Development... is broken. Unfinished template, perhaps?  Done It's better than it was, but it might need more improvement. You'll have to let me know. AmericanLemming (talk) 04:23, 31 July 2013 (UTC) Ref 17 Kobusingye... Very hard to tell where one author ends and another begins. This should employ the convention used everywhere else: Last, First; Last, First. Also, why is the raw url given instead of linking the article title?  Done The good news is that the author names are in the correct order and the article title now links directly to the pdf. The bad news is that it only does so with a rather ugly | in front. AmericanLemming (talk) 04:35, 31 July 2013 (UTC) I just removed the "|" without any problems. When using external links, you don't need to insert a pipe to separate the url from the anchor text. You only need a space: [http://www.whatever.com Title] Ref 19 Krym... As far as I can see, this is the only citation which abbreviates the name of the journal (CJEM). This should be spelled out in full to be consistent with the others.  Done AmericanLemming (talk) 03:59, 31 July 2013 (UTC) Regarding the paragraph on the International Conference on Emergency Medicine (ICEM): All of the citations used were published by the ICEM, which is problematic. While there is little doubt that the information is accurate, the notability of the ICEM has not been established. If the only information available on the organization was published by the organization, why should we assume that it is notable enough to be mentioned in this article? See Wikipedia:Third-party sources for more details. ) I've got a few sources to back it up. Ref 4 calls the International Foundation for Emergency Medicine (the organization that plans and hosts the ICEM) "probably the most active, broad-based, international organization dealing with international EM development issues." I've got several other PubMed sources as well: Source 1, Source 2, Source 3, and Source 4. Take a look at those and tell me what you think. AmericanLemming (talk) 05:08, 31 July 2013 (UTC) I'll continue reviewing after the above issues are addressed. --Cryptic C62 · Talk 16:29, 12 July 2013 (UTC) Thanks for your detailed review. I will begin addressing your concerns today. AmericanLemming (talk) 18:09, 12 July 2013 (UTC) I have now addressed or deferred all of your concerns. I cannot make further progress on some items until you give me more feedback (the ones marked  Not done or ), and if you think some things need further improvement (any of the ones marked  Done), then feel free to do so. AmericanLemming (talk) 01:28, 13 July 2013 (UTC) I'll be away until 27 July. Hopefully there's enough good stuff in here to keep you occupied until then. Cheers! --Cryptic C62 · Talk 02:18, 21 July 2013 (UTC)

As sort of a random question, how much work would I be looking at if I wanted to get the article to Featured Article status? AmericanLemming (talk) 04:05, 31 July 2013 (UTC)

The best way to answer that question would be for you to just go ahead and nominate the article at WP:FAC. The article is definitely good enough that, at the very least, you'll get some useful feedback; it certainly won't be quickfailed. --Cryptic C62 · Talk 00:42, 5 August 2013 (UTC)

Picky comments

I'm not an expert on FA, so take all my comments below with a grain of salt. I've tried to be picky to give you as much as possible to work with. I also made some changes as I went, which you should feel free to revert any (or even all) of.

My first impression is that this looks quite good, and I'm very grateful for your work on it. This was a topic that I wasn't familiar with, and I learned a lot reading this article. The difference between Anglo and Franco health care models was particularly interesting.

The biggest issue for me (as you'll gather from my comments below, made as I went) is that I felt much of the analysis this article presents should be more directly attributed in-text; many statements that seemed to verge on opinion or interpretation are presented in Wikipedia's voice as established fact. None seemed terribly egregious, but it wouldn't be a hard issue to fix; just change more of the prose to "Weiner et al. state that a key factor in international emergency medicine", etc.

A secondary issue was that I was unclear what debates or controversies might exist in this specialty. (There's the debate over the definition, but I found it difficult to understand what the second group of authors saw as oxymoronic, or what their disagreement meant in practical terms.) Some discussion clarifying different approaches/schools of thought, and critiques of those approaches, would be useful, if this exists.

I hope some of this is helpful! Thanks again for your work on this one, it's really terrific how far you've brought it. -- Khazar2 (talk) 02:56, 19 August 2013 (UTC)

Comments

• "However, this definition has been criticized as oxymoronic, given the international nature of medicine and the number of physicians working internationally." -- wouldn't this make it redundant, rather than an oxymoron? I'm not sure I follow this part.

Truth be told, I'm not exactly sure either. I didn't write that sentence. MJs15 did. But, seeing as he is somewhat occupied at the moment, take a look at the relevant paragraph from the source in question at the bottom of the talk page. AmericanLemming (talk) 06:59, 20 August 2013 (UTC)

• "although these countries' EMSs did not become fully mature until the early 1990s" -- this seems like an opinion that might be attributed to someone. It seems likely that the field will continue to develop in both developed and developing nations, whereas this paragraph implies that some countries are finished with that process.

The relevant sentence from the source is "With maturation of EM as a specialty in these countries, a number of EM practitioners in the early 1990s started to turn their attention to developing the specialty in other countries." That same article notes that the precise years in which EM started and became mature in these countries are debatable. AmericanLemming (talk) 03:49, 20 August 2013 (UTC)

• How does "improved healthcare" lead to more interest in emergency medicine?

To quote the relevant section of the source directly, "There are also a number of reasons for recent increasing interest in developing EM within other countries. These include the general overall medical system improvement in most countries." As the quality of healthcare improves, it raises public expectations for healthcare, as the public begins to expect further improvements (Or at least that's what I'm inferring.) Also, as some aspects of a healthcare system are "brought up to speed," it makes both policy-makers and the public more aware of other aspects that need to improve (Again, I'm reading between the lines.) As a disclaimer, none of my explanation here is directly supported by the source. AmericanLemming (talk) 06:36, 20 August 2013 (UTC)

• I feel that the lead may be more detailed than necessary. For example, I was surprised that the discussion of whether the definition is oxymoronic rests entirely on a three-page article; perhaps there's just very little written about this topic, but that seems like a minor blip to make it into the lead.

Well, the FA reviewer thought that the lead was way too short and didn't cover everything in the article, so I greatly expanded it. I stand by the lead as a whole, but it is true that the alternative view mentioned in the lead is a minority view. I guess it's a question of whether it's significant enough to be mentioned. On one hand, we want to avoid giving undue weight, but on the other hand, we don't want to imply that everyone is in agreement on the definition. AmericanLemming (talk) 02:01, 20 August 2013 (UTC)

I wonder if it would be possible to just write something like "but this definition has also been criticized"? Perhaps you're right that it's better to have detail, though. -- Khazar2 (talk) 02:13, 20 August 2013 (UTC)

• " "increased public expectations...in many countries."" -- this seems like a quote that could simply be paraphrased; the exact wording doesn't seem terribly important

 Done AmericanLemming (talk) 02:09, 20 August 2013 (UTC)

• " thus showing a need to improve emergency medical care" -- I'd suggest attributing this analysis to its author in-text as well as in the citation.

 Done AmericanLemming (talk) 02:11, 20 August 2013 (UTC)

• As a broad note, I feel like the article includes many statements that seem to me borderline on whether they need in-text attribution. "Emergency departments are excellent locations to train health care providers and to collect data, because of the high number of patients" seems like a bit of opinion that shouldn't be in Wikipedia's voice; I wouldn't flag an individual statement like that, necessarily, but it seems to happen often.

 Done I've attributed that entire paragraph to the authors of the source. As far as the article in general goes, if you think it would benefit from more such attribution, I'll put it in there, but that would take a while. AmericanLemming (talk) 07:12, 20 August 2013 (UTC)

• "which relies on "bringing the patient to the hospital", and the Franco-German model, which operates through "bringing the hospital to the patient."" -- these quotations should be followed by an inline citation

 Done AmericanLemming (talk) 02:15, 20 August 2013 (UTC)

• "Within that understanding of emergency care models there is also an acknowledgement that current Western models may be totally inadequate in the context of developing nations." -- By "that understanding", do you mean Arnold and Holliman?

 Done Yes. I have clarified that point. However, in the interest of full disclosure, ref 10 does not warn against Western models in general; it merely advises against adopting all aspects of the United States' EMS model, as some of those are nor suited to developing countries. AmericanLemming (talk) 06:47, 20 August 2013 (UTC)

• "that current Western models may be totally inadequate in the context of developing nations" -- it seems like the Kuala Lumpur example demonstrates that Western models would not be cost-effective, but I'm not sure that's the same as "totally inadequate", which suggests to me a failure to provide care

 Done I'm glad you pointed that out. I didn't realize that it could be confusing to some people. AmericanLemming (talk) 02:18, 20 August 2013 (UTC)

• "In developed counties, international emergency medicine is one among many initiatives underway to shape the future of emergency medicine. " -- this phrasing seems like ad-speak--does it mean anything besides "international emergency medicine exists"?

 Done It does not. I have removed the sentence. One subtle bias this article may have is its attitude toward EM and EMS; the editor who wrote most of it, Mjs15, is an EMT. AmericanLemming (talk) 04:04, 20 August 2013 (UTC)

• "Such exchanges can be mutually beneficial. For instance, 23 to 28 percent of all physicians in Australia, the United States, the United Kingdom and Canada received their training at medical schools outside of the country in which they currently practice" -- does the source describe this as mutually beneficial? The article is titled "brain drain".

It does not. I think the idea is that while developing countries can benefit from short-term trips by physicians from developed countries, developed countries greatly benefit from physicians from developing countries who move there permanently. Obviously, developed countries benefit much more from this exchange than developing ones do, but I'm not sure if I can say that in the article without a ref to back me up. AmericanLemming (talk) 03:09, 20 August 2013 (UTC)

• "Some money may be available from wealthier nations or international organizations, but careful decisions still need to be made" -- another moment where this seems to me to veer into analysis

 Done I've removed the analysis, as I'm pretty sure the guy who added that sentence just put it in there, without a source to back him up. (Mjs15, the editor who expanded the article from a stub to a C- or B-class article, is my brother. He doesn't understand all of Wikipedia's nuances.) Also, I don't think removing the sentence changes the meaning of the paragraph at all. AmericanLemming (talk) 03:37, 20 August 2013 (UTC)

• "Regardless of the amount of preventive care available, health problems requiring immediate attention will still occur and emergency medical programs could increase access to care, particularly if they focus on low-cost but effective treatments administered by first responders" -- another moment that should be attributed to an author, I think. The article at times appears to be assembling an argument for the importance of this discipline.

I've attributed the second part of that sentence, but I think the first part falls under analysis/original research, however self-evident it may seem. I don't think I can find a ref for the first part, either. AmericanLemming (talk) 06:54, 20 August 2013 (UTC)

• "Africa is the continent most in need of developing emergency medical systems" -- is this universally agreed? Seems like another moment that could use "According to,"

 Done I think it's pretty obvious that the caption is true, but I understand the need to give attribution and then let readers come to their own conclusions. AmericanLemming (talk) 03:43, 20 August 2013 (UTC)

• "One key component in equipping nations to develop emergency medical systems is to identify the aspects of training that are essential for health care providers" -- attribute

 Done AmericanLemming (talk) 02:55, 20 August 2013 (UTC)

• "a standard curriculum is still useful for identifying core issues" -- attribute

 Done AmericanLemming (talk) 02:55, 20 August 2013 (UTC)

• "Scott Weiner suggests" -- should this be Scott Weiner et al.?

 Done Yes, it should be. AmericanLemming (talk) 02:32, 20 August 2013 (UTC)

• "Its application worldwide could lead to the boon of sharing best practices between emergency medicine practitioners in various countries, thus advancing the current standard of emergency care." -- attribute

 Done AmericanLemming (talk) 02:36, 20 August 2013 (UTC)

• "Educational opportunities in emergency medicine are not available in many countries, and even when present, they are often in their infancy" -- so if the goal of the specialty is to promote EMS knowledge and training in other countries, how is lack of training in other countries a "challenge" to that? Shouldn't it be expected that the people you plan to train are not yet trained?

I would say that this is analogous to the proverb "Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime." It's impossible for EM practitioners from developed countries to teach the relevant skills to every individual in developing countries who needs to know these things. I think the idea is that it's easier to train people in the relevant skills than it is to train people to train people in the relevant skills, hence the challenge.

In short, it's easier in the short run to train people than it is to train them to train other people, but it's more sustainable in the long run to do the latter. If you find it confusing, it may need some rewording, but I'm not entirely sure how to go about doing that. AmericanLemming (talk) 02:46, 20 August 2013 (UTC)

Relevant paragraph from source 3: As medicine has become more global, opportunities to practice in other countries have expanded. Indeed, ‘‘international emergency medicine’’ is to some degree an oxymoron. Medicine is by definition international. Nigerian physicians working in Great Britain or Kenya are obviously working internationally. So are Dutch physicians working in the Netherlands after training in the United States. Indeed, some of us have become transnational. This raises a definitional problem: if IEM is defined only as ‘‘... the area of emergency medicine concerned with the development of emergency medicine in other countries," this will have limited applica- bility to most international jobs.

Controversies

I do have a source that would seem to lists some controversies about IEM: Challenges in international medicine: ethical dilemmas, unanticipated consequences, and accepting limitations.

On a separate note, I am starting to think that the article isn't comprehensive enough for FA status. It doesn't mention international pediatric emergency medicine at all (a sub-subspecialty of EM), growth in the number of EM journals around the world; or any controversies about IEM. I probably should withdraw it from the FAN list, as I really don't have time to fix any of those gaps, either. AmericanLemming (talk) 07:35, 20 August 2013 (UTC)

I'm hesitant to try to judge as a non-expert, but from what you say those do sound like areas that should be included. Perhaps you should pull and try to fill those gaps, and then go for a peer review before taking this to FA again? I think you've done a good job addressing my concerns above, so I'm not sure I can make any further suggestions myself, but PR is a stop for many editors pre-FA; hopefully you could get some good further feedback there. In either case, though, I wish you the best of luck with this important topic! -- Khazar2 (talk) 00:25, 23 August 2013 (UTC)

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