The ExpedMed Textbook: Expedition & WIlderness Medicine

For those of you who are interested in learning more about Expedition Medicine or Wilderness Medicine, I'd like to mention our textbook, Expedition & Wilderness Medicine, that was recently published by Cambridge University Press.

This textbook is used as the syllabus for our Expedition Medicine National Conference and also as a teaching tool for many other courses and organizations around the globe.

The textbook is a hardcover text over 700 pages in length, with full-color photos and diagrams.  We recruited more than sixty experts from around the world who contributed content for this project.  Contributors include many notable individuals such as 

Richard Carmona, MD, MPH, FACS: 17th Surgeon General of the United States

Luanne Freer, MD, FACEP, FAWM: past president of the Wilderness Medical Society and founder and director of Everest ER

Ken Kamler, MD: Vice President of The Explorers Club and author of Doctor on Everest

Richard Williams, MD, FACS: Chief Health and Medical Officer for NASA

Peter Hackett, MD: Director, Institute of Altitude Medicine

We have been pleased to read many favorable reviews of our book in multiple journals including the New England Journal of Medicine and JAMA. Here's an excerpt from the JAMA review:

Expedition&Wilderness Medicine, edited by Bledsoe, Manyak, and Townes, is a comprehensive guide to the multitude of issues facing the expedition physician. The book is organized into 3 sections covering expedition planning, specific and unique environments, and specific wilderness illnesses and injuries. The comprehensive and often humorous chapters have been edited in a style that allows for easy reading, and they include numerous excellent illustrations.

Several of the chapters are written by some of the world’s authorities on the topic. Not only have many of the authors published widely on their areas of expertise, they have spent considerable time in the field. The authors have diverse experience ranging from serving as the expedition physician on a climb of an 8000-m peak in the Himalayas to providing medical care to a patient injured thousands of feet underground in a Mexican cave. This experience—and the willingness of many of the authors to illustrate ways to avoid future problems by describing their own misadventures in the field—contribute to the strength of this text.

Expedition & Wilderness Medicine is a must-read before any expedition. It carefully details what an expedition medical kit should contain, along with details on what to consider taking along for toxicological and dental emergencies. Although this book is aimed at the expedition and wilderness medicine physician, many of the chapters are superb summaries of core emergency medicine knowledge that are better distilled and presented than chapters in some more traditional textbooks of emergency medicine. We recommend this text to all who practice acute care medicine and all physicians who hike, climb, or vacation outside the city or who might encounter anyone else who does.

Jones ID, and CM Slovis. JAMA. 2009;302(4):442-44

We'll be writing more about opportunities in Wilderness Medicine and Expedition Medicine here on Freelance MD, but for those of you who need something to begin your journey, pick up a copy of our textbook online or attend our Expedition Medicine National Conference and receive the book for free.

HELP: Health Emergencies in Large Populations

Health Emergencies in Large Populations course. (H.E.L.P.)

From time to time I hear from people who are interested in a possible career change into humanitarian assistance. Some just want to get their foot in the door in order to volunteer from time to time, while others are looking to make a career jump into humanitarian medicine full time.

When asked what a good "next step" might be to learn more about humanitarian and disaster assistance, I recommend the Health Emergencies in Large Populations course (or H.E.L.P. course for short). 

The HELP course is taught at a variety of locations each year. One is taught at my alma mater, the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The HELP course is designed to introduce participants to a wide variety of topics related to humanitarian disasters including food and nutrition, environmental health, infectious diseases, ethics and human rights, and international law. I can vouch for the excellence of the Hopkins course and the quality of the Hopkins HELP instructors-- they are world experts and excellent teachers.

The HELP course is not for everyone, but for those who are considering a change into humanitarian medicine, it's a great way to gain skills and exposure to a variety of issues. Furthermore, the networking opportunites at a course like this are priceless and can sometimes lead to future job opportunties.

International Emergency Medicine

Here's a career focus that has tremendously expanded over the past decade for Emergency Medicine physicians:  International Emergency Medicine.

Not too long ago if you were an Emergency Physician and you wanted to do international work, you simply picked a geographic location and went.  There was no formal training and most practitioners learned by doing. 

While much of the international work done by these hardy individuals was well intentioned, many reported that it was difficult adjusting to a foreign assignment, especially in a remote region.  Few of these physicians had any training in tropical medicine and even fewer had exposure to public health.

In the 1990's a group of Emergency Physicians with extensive experience in international and remote medical care came together to attempt to codify the training needs of physicians who were going to similar locations.  Out of these discussions, a formal curriculum was recommended and fellowship programs in International Emergency Medicine began to spring up around the country.

I was fortunate enough to have been one of these International Emergency Medicine fellows from 2002 to 2004.  Our program included training in public health, clinical shifts at our academic institution, and extensive field work overseas.  It was a great experience and opened the door to a thousand opportunities for me that completely altered the trajectory of my career.

In 2004, towards the end of my fellowship, we published a review article in Prehospital and Disaster Medicine that reported on the International Emergency Medicine fellowships offered around the country to EM trained residents. You can read that article here . When the article was published, there were eight programs available. I find 23 on the website of the Society for Academic Emergency Medicine now.

Of course, there are detractors. When I told people I was going to extend my training for two years to do a fellowship in International Emergency Medicine, a number of my colleagues questioned whether this would be a good investment of time. Why not just sign up with an international organization and go?  Why lose two years being a fellow when you could be overseas gaining experience, or working in an emergency department somewhere paying off school loans?

I wasn't sure how to answer these questions when I decided to do the fellowship.  At the time, I just thought it was the right thing for me and I was really excited about the opportunity.

In retrospect, it has turned out to have been a pivotal moment in my career and an excellent investment of time. The fellowship in International Emergency Medicine  exposed me to leaders in international medicine. It trained me in public health. It offered me incredible opportunities to perform field work in remote locations all over the globe and it taught me how to think like an academic physician-- how to research, how to teach, how to write.

So the question is, if you're an Emergency Medicine doc and you're interested in international work, should you do a fellowship in International Emergency Medicine? 

My answer: it depends. 

It depends on a lot of factors including where you see yourself in five years and what your long-term goals are for your career. Not everyone has to do a fellowship to do international work. I know plenty of physicians who are not fellowship trained who do short-term international work and absolutely love it.

However, if international medicine is something you think you would like to do full-time as a career focus, then a fellowship might be the right move for you. The longer you spend overseas in remote areas the more important training in public health becomes. Also, the connections you make through a fellowship can open up job opportunities that you never would have found otherwise.

For those who are EM trained, fellowships in International Emergency Medicine are a good place to start a career in international health.

Tropical Medicine Education

Whether from the upsurge of "exotic" diseases popping up in the developed world, or a general curiosity in alternative medical careers, interest in Tropical Medicine appears to be growing. At our ExpedMed conferences on Expedition and Wilderness Medicine I am consistently approached by physicians who are interested in learning even more about Tropical Medicine and/or careers in tropical health.

There are a variety of ways a physician can obtain training in Tropical Medicine. For most, an intensive four or five day CME conference like our ExpedMed events will suffice. However, for those who want to go even deeper into the world of Tropical Medicine, the next step is earning the Diploma of Tropical Medicine & Hygiene (DTM&H).

The DTM&H is a certification program endorsed by the American Society of Tropical Medicine & Hygiene (ASTM&H). Diploma recipients must receive didactic training in Tropical Medicine from an ASTM&H approved course and then successfully pass a test of knowledge administered by the ASTM&H.  

Currently, there are 18 approved diploma courses around the world. A full list of the approved courses can be seen here. However, while all the courses are good, two continue to set themselves apart in terms of prestige and the endorsements I hear among those who practice Tropical Medicine as a career focus:  the annual course at the London School of Hygiene & Tropical Medicine and  The Gorgas Course in Clinical Tropical Medicine .

The Diploma in Tropical Medicine & Hygiene course at the London School of Hygiene and Tropical Medicine begins each January and runs until March and costs approximately $7,700 to attend. The course is limited to 70 students who rotate between lectures and clinical exposure in the Hospital for Tropical Diseases where tropical medicine cases are seen. The London School of Hygiene and Tropical Medicine has been been at the forefront of of integrated medical education for over 100 years and is recognized world-wide as a leader in Tropical Medicine education. Students can expect a broad exposure to tropical disease taught by experts from around the world.

The only drawbacks to the London program that I have heard relate to the city of London itself.  First, the expense of living in London can be prohibitive for some due to the cost of transportation and living expenses in the city. Also, since the course takes place in a developed city, I have heard some reports that the clinical exposure can be hit or miss since it is dependent on what cases are available.  However, participants still give the program overwhelmingly glowing reviews and everyone I spoke to said they would wholeheartedly recommend the course to interested peers.

The Gorgas course is directed by Dr. David O. Freedman of the University of Alabama-Birmingham. The Gorgas course is also run each spring and  is based in Lima, Peru. Participants live in Lima for the duration of the 3 month program.  While the Gorgas course does not have the long history of the London program, it is famous for the quality of its clinical exposure and past participants raved to me about the incredible breadth and depth of cases they examined and treated. Students rotate between classroom work and rounds in the  Instituto de Medicina Tropical (Institute of Tropical Medicine). Two field trips are included in the curriculum- a trip to high altitude in Cusco, and a trip into the Amazon jungle. 

From all accounts, the teaching at the Gorgas course is superb and the clinical exposure unparalleled. The only drawback to the Gorgas course is the limited number of positions offered each year. Only 30 positions are available and applicants come from all over the world. The application process takes place over a year before the course begins, so application in the fall of 2009 is for a position in the 2011 class.  The cost currently is $6,395 which includes flights within Peru and accommodations on both field trips.

One of the benefits of both courses is the network of peers a participant develops during the durations of their studies. Since both courses draw students from around the world, past participants tell me that one of their biggest enjoyments was learning from their peers and kindling friendships with individuals who live on the other side of the globe. The Gorgas course even has a Facebook group for its graduates, and both courses have distinguished faculty and supportive alumni networks.

Our ExpedMed faculty has ties to both programs. Dr. Michael Callahan and Dr. David Townes are both graduates of the London course, while Dr. David Warrell and Dr. Alan Magill teach at the Gorgas course.  

In sum, for those interested in further training in Tropical Medicine, there are numerous resources available. If you are not sure if Tropical Medicine is for you, try attending one of our ExpedMed events where you will get 3-5 days of Tropical Medicine from some of the premiere lecturers in the world.  After attending one of our events you will not only have a much better grasp of Tropical Medicine, but you will feel more confident deciding whether the investment of time and resources for one of the more intensive programs is right for you.

ExpedMed Interview with Dr. Eric Johnson

Former President of the Wilderness Medical Society, Dr. Eric Johnson, sat down with us at a recent ExpedMed meeting to discuss Wilderness Medicine.

ExpedMed TV Interview

Here's a television segment that discusses our first Expedition Medicine National Conference and interviews Dr. Greg Bledsoe.

Renting a Satellite Phone

If you're going to a remote place, you might want to consider renting a satellite phone.  These phones have come down significantly in price and can be rented very easily.  In this video, Dr. Greg Bledsoe demonstrates how convenient it is to rent a satellite phone and ship it back to the rental company.

Ship passing through Saint Simons Island Sound

Ok, this is a little bit frivolous and not specifically about WIlderness Medicine, but every time I stand on this beach and look across to Jekyll Island I feel good.  It's one of my favorite places in the world and this blog will be discussing other beautiful places in the future.  

 

In this video a ship passes through the sound between Saint Simons Island and Jekyll Island.  I love it.

Hudson Bay in Churchill

Here's a quick video of the Hudson Bay in Churchill, Manitoba.  

 

The brisk wind was whipping up the sea foam and splattering our crew and cameras.

Polar Bear In Churchill

Our ExpedMed crew went to Churchill, Manitoba this past October.  Here's a quick video of one of the polar bears that approached out Tundra Buggy one morning.  We'll be posting more information about this and other trips very soon.  Keep watching the ExpedMed blog for more information.

Welcome

Welcome to the ExpedMed blog.

 

ExpedMed is a medical education company that teaches Wilderness Medicine and Expedition Medicine.  We've been around since 2006, but blogging is new for us.

 

We're hoping to use this blog to provide resources for those who venture into remote areas.

 

Thanks for your interest and stay tuned!