This special 25th anniversary issue is literally a ‘once in a generation‘ collection of papers all commissioned, collated, edited and accepted by the outgoing Editor-in-Chief Tony Brown. As every paper makes for interesting, important even essential reading, they have ALL been made freely available online (FOAM) and each one is summarised below – a memorable ‘swansong‘ from Prof Tony Brown.
Editors Past and Present
The road less travelled: An editor’s journey. The outgoing Editor-in-Chief Tony Brown introduces the 25th anniversary issue, cautions about the dramatic changes that are happening in journal publishing and presentation, and looks back at his time as EIC; mentioning the proudest achievements – a stand against drug company advertising led by George Jelinek – and this anniversary issue (hopefully!), as well as the funniest article.
Reflections on 25 years at the Journal by George Jelinek reflects on his 25 year tenure at EMA from its founding days (George was the pioneering first Editor) where all the preparation and paper editing were done manually in-house. Jelinek also discusses why EMA adopted open peer review and why disclosure of competing interests is fundamental to alerting readers to potential drug industry influence, despite being so poorly adhered to.
Congratulations and happy 25th birthday, Emergency Medicine Australasia has Gerry FitzGerald describe how management systems and processes were gradually set up to streamline the journal, ending up with entering a contract with Blackwell Science Asia that facilitated Medline® listing in 2001.
Past, present and future of emergency care research by Jeff Kline looks at a historical perspective of EM research from the 1980s on, and explains why it is so hard to do high-impact research (even for someone as world-renowned as him!), citing his own struggle with his TOPCOAT trial.
Clinical research is a priority for emergency medicine but how do we make it happen, and do it well? by Simon Brown and Geoff Isbister is, in part a response to the Keijzers et al article (see next paper) but, in main is a plea, with some cogent suggestions, that EM research needs to and indeed can ‘get it right’.
Clinical research priorities in Emergency Medicine and Clinical research priorities in Emergency Medicine: Results of a consensus meeting and development of a weighting method for assessment of clinical research priorities are two papers from Gerben Keijzers, Ogilivie Thom, David Taylor et al on behalf of the ACEM Clinical Trials Group. The first paper reports the outcome of a survey of FACEMs on clinical research priorities and develops a list of identified research themes to potentially guide areas for collaboration. The second paper outlines the results of a consensus meeting and, using a novel weighting method, draws up a matrix to allow reproducible comparison of research questions.
Finally Development and validation of the Emergency Department Assessment of Chest Pain Score (EDACS) and 2h accelerated diagnostic protocol by the powerhouse Martin Than, Louise Cullen and the ACS research groups in Auckland and Brisbane respectively, describes an Accelerated Diagnostic Protocol (EDACS-ADP) that successfully identifies half of the patients presenting to ED with possible cardiac chest pain as having low risk of short-term adverse cardiac events with a high (100%) sensitivity and a decent (59%) specificity. If reproduced in other settings, this EDACS-ADP has the potential to revolutionise ED chest pain care with huge cost reductions.
Emergency Medicine Practice
Emergency Medicine in the fourth decade: Angry young man or mid-life crisis? is from Andrew Singer, someone who has served ACEM on either the Board of Censors (BOC as it was known) or on Council for an astounding 20 years. Andrew looks at the three particular challenges of:
- who are we treating
- who are we training
- who are we and what are we going to be in the future?
This is essential reading especially for those who missed his Tom Hamilton Oration (this is his compelling transcript) at the recent ACEM Annual Scientific Meeting.
International emergency medicine: Past and future from another doyen of Australasian Emergency Medicine, Peter Cameron, looks back at the drivers for the development of EM, the current spectrum of activity and countries and systems that have been successful, and at those where EM has not flourished and indeed some of EM’s failures.
@George Jelinek provides a walk through time in From little things: How it all started describing the origins of EMA as a broadsheet Emergency Doctor, to a bound journal Emergency Medicine, to Blackwell Science Asia’s involvement and finally to Emergency Medicine Australasia as we recognise it today, that was born in February 2004. Five colour figures of a front cover from each iteration will satisfy even the most nostalgic of (older) readers.
Next the Past and future of journal publishing from David Cone is a fascinating look at the 40-odd years of EM journal history in general, naturally looking hardest at the greatest changes and opportunities now brought about by the emergence of the internet and electronic publishing.
Scott Weingart along with Jeremy Faust take this a step further in Future evolution of traditional journals and social media education and enthusiastically describe how the internet is redefining the very role of journal publications. Weingart and Faust offer three key ways that peer-reviewed journals can maintain and increase their relevance in today’s electronic milieu, built around social media and #FOAMed.
Finally in Future of publishing: Perils, pitfalls and opportunities Tom Griffin and Chris Graf from Wiley Blackwell articulate the four different potential futures for journal publishing companies: progression, proliferation, dislocation and/or explosion.
Education and Training
The first article Past and future of emergency medicine education and training by Victoria Brazil is as incisive as it is provocative, taking a refreshing look at how EM training might or should look, with assistance from some Science Fiction modelling!
Real textbooks or e-books: What is happening right now? by arguably the best known EM textbook author ever, Judith Tintinalli, makes a good case for why real (paper) books are still currently outselling e-book equivalents, perhaps because they are best for curriculum learning and study revision, particularly prior to an assessment or exam. But even traditional textbooks are going online to become interactive and, as she says “tomorrow is now”.
Free Open Access Medical education (FOAM) for the emergency physician by Chris Nickson and Mike Cadogan shows just why they run one of the world’s most successful EM blogs, demonstrating their passion for financially unrestricted access to the best medical education – even pitting this against the traditional medical journal. Nickson and Cadogan usefully recommend various other FOAM blogs, podcasts and websites and list some FOAM EM physicians who use Twitter®.
No review of contemporary EM education could possibly be complete without Mel Herbert, who with his colleagues in the Brave new world of emergency medicine education neatly compares two hypothetical clinical scenarios. The first is from 1989 when an inexperienced RMO inserting an intercostal catheter encounters disaster, with the second 25 years later where the same inexperienced RMO successfully performs this practical procedure following immediate education on her smartphone, complete with online searches of the relevant literature and video, plus real-time tweets to aid her – even Jim Roberts, of Roberts and Hedges fame, offering to watch the procedure (would that we all potentially had that degree of expert mentorship!). Hypothetical it may be, practical and possible today – absolutely!
The last paper Fit for the future? The relevance of Emergency Medicine Australasia to current and prospective emergency medicine trainees gives Rob Mitchell and co-authors an unfettered opportunity to make many excellent suggestions how EMA can be of most value in its next 25 years. In particular Mitchell discusses whether EMA is ‘fit for purpose’ (whatever that is) and goes on to give examples of some high-value, future directions such as engaging with social media, enhancing content and delivery, building curriculum links and improving access and engagement.