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Santiago and Clinica Santa Maria (University of San Sebastian),
added additional training sites. The Santiago-based training
programs are relatively strong academically and host several
experienced career EPs as faculty, most at the assistant
professor academic rank. These urban Santiago programs are
designed to have 4-12 residents per year with a three-year
training duration. Each of the training programs in Chile has a
primary academic institution and most also have an affiliated
public institution that they are partnered with. The curriculum
and core content of these programs loosely follows the Amer-
ican core content with some modification to meet Chilean
needs, pathology, and epidemiology. Curriculum transfer and
export helped to rapidly advance these training programs in
the 1990s assisting the development process.
Academic development of EM is proceeding in Chile but most
of the training programs are hosted within the Departments of
Internal Medicine or Surgery. Independent academic units for
emergency medicine with academic autonomy are still several
years off in most institutions. Most of the emergency medicine
divisions are lean in terms of faculty numbers, and academic
salaries are still relatively low. Very few faculty have progressed
beyond the assistant professor rank. Faculty development is
critical to the long term viability of EM in Chile but it requires
both resources and time (12). Furthermore, the clinical hours for
many EM faculty are excessive and not compatible with academic
development. There is inadequate protected time, inadequate
faculty mentoring, and few independent peer-reviewed publi-
cations to allow for academic promotion. As a new specialty this
is not surprising, but academic productivity must be addressed
as a priority in the future. International EM programs in the
United States and Europe can assist these academic units with
curriculum transfer, focused training programs, research and
publication, and prepackaged educational materials saving each
new academic unit from “reinventing the wheel” (13).
New graduates of the existing training programs are success-
fully being integrated into the Chilean health care system and
many are actively recruited to high quality private hospitals
and academic positions. Having noted that, very few hospitals
have an emergency department fully staffed with EM trained
physicians. Mixed groups of physicians staff the national emer-
gency departments, but presumably as the current training
programs add to the pool, more physicians trained in EM will
staff emergency departments in the future. Distribution of
these graduates beyond the Santiago metropolitan region is
desirable, but there are still great needs in Santiago.
International exchanges and longitudinal academic support
have played a prominent role in the development of EM in
Chile, and many different institutions have been involved over
the years. A partial list (those known to the authors) includes:
1. University of Southern California:
20+ years with
student, resident, and faculty exchanges, educational
support, consulting and sabbatical exchanges and faculty
mentoring
2. UCLA:
Hosting international fellowship training for
Chileans, and faculty mentoring
3. Mayo Clinic, Rochester Minnesota:
Conference
support and sponsorship, faculty development, current host
of the ACEP ambassador to Chile
4. Stony Brook University:
Conference support, resident
exchanges
5. George Washington University:
Educational support
and consulting
6. University of North Carolina:
Educational support and
consulting
7. Harvard University:
Educational support and consulting
8. ACEP representatives:
Educational support and consulting
9. EM:
Reviews and Perspectives, Emergency Medical
Abstracts, Essentials of EM and other conferences and busi-
ness interests have provided tuition discounts and interna-
tional pricing options, faculty mentoring
10. Fulbright Program
(Valenzuela, R: Regionalization of
Trauma Care Project, 2015)
This list is an excellent manifestation of the 8
th
MDG which
focuses in on global partnerships as a vehicle for develop-
ment. Emergency medicine in Chile is a prime example.
Longitudinal support programs have been shown to have
greater impact than shorter consultation efforts in Chile.
ORGANIZED MEDICINE AND SOCIETIES FOR
EMERGENCY MEDICINE IN CHILE
Prior to EM having its own representative body, the
critical care society (SOCHIMI) allowed EM professionals a
place to meet, lecture, and present their research from the
mid-1990s onward. This permissive and inclusive behavior
within the critical care community was critical to EM devel-
opment in Chile, and reflects the close parallel interests
of EM and critical care. Eventually this partnership led to
EM residency graduates in Chile having access to a single
additional year of training with access to critical care board
certification. The evolution of EM in Chile allowed a reten-
tion of close ties to critical care which was very different
to the U.S. evolution where early on the split away from
critical care initially helped define the specialty, but
hindered academic and research development later on.
[REV. MED. CLIN. CONDES - 2017; 28(2) 163-169]