Editors: Andy Tenner, Heike Geduld, Teri Reynolds, Nikki Roddie (some of whom are at this conference and were introduced). This incredible World Health Organisation #FOAMed resource was released this month. The full–text PDF version of book along with the slide–set for instructors are freely available below: https://www.who.int/emergencycare/publications/Basic-Emergency-Care/en/

A new WHO Training Course that is KEY in low resource settings was also launched. In Africa when an EM Physician or EM Nurse qualifies we suddenly have to step in and start or run a unit, often alone! We just aren’t trained for that. The entire course will become freely available soon as a #FOAMed resource. The slide–set, facilitator guide and student guide will become open access, as soon as peer review processes and refinement are complete (manyattendees of the conference are also involved in this process, African Solutions to African problems!) It helps that this resource is being published by the WHO because the credibility of the name can be used to advocate to your political decision-makers in ministries/departments of health.

James is the current president of IFEM. He led with the comment, “EM is the poorest defined speciality ever developed”. Why did EM start? EM filled a gap – a lack of organised trauma systems (US and Canada). But gaps are different in Africa – therefore the definition of EM varies: a shifting scale of definition.

1. ‘Servant Leadership’: which I love: it values diverse opinions, cultivates a culture of trust, develops leadership in others, encourages and, thinks about others. 
2. ‘Agency’: Is our capacity to act independently and make our own choices. We need to claim our identity as African emergency care providers to increase our sense of agency.
3. ‘Revolution’: In thinking about what AFEM is and does and what African Emergency Care wants to achieve, we need to think about what we CANNOT do. There are 40 countries in this room, the majority are clinicians, and our view of health is limited by our fairly clinical viewpoint. If we want to make bigger change, on a bigger level, we need to open our minds to broader viewpoints. Think about emergency care system development in conjunction with social welfare experts, politicians, engineers, epidemiologists, patients and multiple spheres of knowledge. How do we bring these other people in? We cannot do this alone, we need to pull in stories of emergency care from non-emergency care people. 

1. Recognise nurses impact:

• Nurses are well positioned for the emergency centre (biggest group of health professionals). They are incredibly trusted by communities; nurse practitioners are well trusted by patients. Evidence suggests that nurse practitioners outscore other health providers with regards to quality of care and patient satisfaction. Trauma nurse practitioners – evidence that they decrease LOS, patient satisfaction, and complications. 

2. Essential knowledge and skills:

• Great strides were made with regards to nursing education challenges and solutions in Sub– Saharan Africa however, strategic leadership and mentors are required.
• Self–assessment survey of nurses in Kwazulu Natal: only 52% competent to perform CPR, 64% to assess GCS,42% to administer drugs in cardiac arrest.
• Outdated and static curriculum and a mismatch between needs and curricula becoming a barrier to effective education.
• Developing a framework for emergency nursing practice in Africa; social accountability is a essential for transforming nursing education – link to article: https://doi.org/10.1016/j.afjem.2012.09.001
• New type of learners – with different needs and strengths – Curricula should be dynamic and adaptive.

3. Research and Scholarship:

• Researchophobia – research need to be demystified.
• PHD vs doctor of nursing practice (practice scholar vs research scholar) –  new PhD in practice, instead of research – great for nursing leaders in Africa.
• Qualitative research undervalued: evidence that inform recommendations.

4. Career pathing and role models
5. Be innovative 

• Blue skies thinking – no limits (old ways don’t open new doors)

6. Make nurses visible:

• Nurses “operate under the radar” – they are trained to be silent; The public and media unaware of the importance of nursing; traditional subservience still common;  The media ignores nurses – don’t really understands what nurses do – a good example is the Thailand Cave Rescue – very little emphasis on the nurse that was part of the team. 

1. Conceptualisation (at home) – preparation to learn the procedure, indications, contraindications, patient counselling. We can do this but simply getting the student to read something, eg procedure textbook or FOAM resource such as LITFL
2. Visualisation (at home) – view the procedure in its entirety eg video 
3. Verbalisation – instructor should talk-through entire procedure step by step, learner to narrate it back, this cements the correct sequence
4. Guided Practice – in a step-wise fashion, from sub-component practice to linkage practice. Do microskills, break up the procedures into smaller parts and teach components separately. Some microskills can be practiced at home!
5. Feedback – to facilitate perfect practice, do not let them do it wrong, stop them so they don’t get motor-imprinting of incorrect practice.  Can also consider video for feedback.
6. Skill Mastery – repeat practice regularly, spaced repetition
7. Autonomy – do on real patient!

1. skills acquired from simulation can be transferred to real patients
2. simulations do not have to be expensive to be effective
3. commitment from learners and a safe environment 

• Nickel down – investment ensures engagement – “why do you think the baby passed out?”
• Evidence – “what do you think the literature suggest around…”
• Rules – lay down rules at the begging
• Do – guided practice of skill
• Stop – as soon as a mistake is made – and correct immediately

1. Shared social networks that focus on emergency care in Africa – clinical care, education, leadership & development
2. Shared online educational resources that are specific to emergency care in Africa
3. The use of tech to further develop implement locally applicable educational materials, clinical guidelines &research programs.
4. Better together!

• Collaborative training – Involve other departments when you are the only EMP in country. Don’t try to do it all yourself!
• Vary the modality of educational interventions: lectures case presentations, quizzes esp ECG, radiology, use PBL, praatical sessions, trial exams, watch videos, journal club (AFJE), sims, M&M meetings
• Be careful of well-meaning international speakers who don’t understand the healthcare context. Need to guide & direct the content & discussions regarding suitability of management, equipment knowledge, cultural appropriateness. Teaching on completely unobtainable interventions can make students despondent.

1. Find the love – Earn attention from the classroom with our own enthusiasm and motivation. It cost nothing to be enthusiastic. There are two types of learners: fixed mindset vs growth mindset.
2. Interleaving – Switch between ideas while teaching, we cant really focus beyond 15mins. Go back over the ideas again in different orders to strengthen your understanding
3. Concrete examples: Use specific examples to understand abstract ideas
   1. If you know that a particular case/medical problem is hard to manage or badly managed: ask students to“collect” those cases & bring them to class. In business they use Harvard Business Review, some options in EM to use are JETem http://jetem.org/ & CPC https://westjem.com/cpc_em
4. Elaboration: Explain & describe ideas with many details

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