Correspondence

Core Content Criticism

Kenneth V lserson, MD, MBA,

FACEP/

Richard V Aghababian, MD,

FA CEP

Adenosine: Adverse Interactions

Timothy J Mader, MD/

James T Niemarm, MD, FACEP

Charles B Cairns, MD

Adenosine During Pregnancy

Douglas A Propp, MD, FACEP

Kerryann Broderick, MD

Dan Pesch, MD

I

Core Content Criticism To the Editor. Emergency medicine residency programs are endeavoring to train physicians for practice in the 21st century. The residency programs, residency directors, trainees, and the entire field of emergency medicine, however, are poorly served by the . narrow view encompassed by the recently published "Core Content for Emergency Medicine" [August 1991;20:920-934], which purports to represent "the scope of emergency medicine practice--the universe of the specialty."

Dutifully detailed are the acute ills to which man is subject and the various modes of poking, prodding, and sticking ("procedures/skills") emergency physicians use in their practice. Categorized too are the ways we poke and prod each other ("administrative aspects of emergen- cy medicine") and the way we in turn are prodded ("medical-legal aspects"). Nowhere, however, does the Core Content acknowledge that emergency physicians must learn whetherto use the acquired skills they are permitted by law and cus- tom to employ (one formulation of bioethics). Neither does it cite any required knowledge of the external factors that encourage or limit access to emergency medical care-- both who gets in the door and what care wilt be provided (a subset of health policy)> These are not abstract questions for many emer-

gency physicians; they are a daily part of their practice.

It is surprising that, although an ethics curriculum for emergency medicine residents has been recent- ly published, 2 the only "ethics" sec- tion the developers of the Core Content included was a small sec- tion on administrative "ethics" that is a confusing mix of "medical eti- quette ̀,3 and law. It is a sad com- mentary on the state of emergency medical education that neither biomedical ethics nor relevant health policy issues are considered as important for residency graduates to know as are recognition of primary tumors of the heart {2.9) or panhy- pepituitarism (4.8.1), the develop- ment of accounting skills (20.13.1), or knowledge about the organiza- tions that compiled the Core Content document (20.11).

Anyone can be taught to regurgi- tate facts and perform basic mech- anical skills--we have proved that time and again. Physician education necessarily requires an awareness of the difference between what one is permitted to do and what one should do, as well as an awareness of one's place in a changing health care system. If these aspects of medical practice were overlooked, it is unfortunate; if they are no longer thought important, it is tragic.

Kenneth V lserson, MD, MBA, FACEP

Arizona Bioethics Program and Section of Emergency Medicine

University of Arizona College of Medicine

Tucson

1. Daniels N: Just Health Care. Cambridge, United Kingdom, Cambridge University Press, 1985.

2. Moskop JC, Mitchell JM, Ray VG: An ethics currlculum for teaching enwrgeney medicine residents. Ann Emerg Med 1990;19:187-192.

3. Ethical statements pertaining to medical care, in lserson KV, Sanders AB, Mathieu DR, et al: Ethics in Emergency Medicine. Baltimore, Williams and Wilklr~, 1986, p 237-239.

In Reply. I am sorry that Dr Isersen has decided to come fo~ard at this time to chastise the Core Content Task Force. In his letter he states that "the residency programs, residence directors, trainees, and the entire field of emergency medicine, however, are poorly served by the narrow view encompassed by the recently published Core Content...the only 'ethics' section the developers of the Core Content included was a small section on administrative 'ethics' that is a confusing mix of 'medical etiquette' and law." Apparently he was unaware of the process followed by the Task Force or he chose not to comment before new.

In 1989, nine emergency physi- cians were selected by the leaders of the American College of Emer- gency Physicians, American Board of Emergency Medicine, and Society for Academic Emergency Medicine to serve on the Core Content Task Force. At the task force's first meet- ing, it was decided that general recommendations and specific input would be solicited from several authoritative emergency medicine •

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