In August, the College convened the Emergency Medicine – Building Our Future Summit to start internal conversations about the role and scope of emergency medicine.

The summit brought College Board members, councillors, and committee chairs together in-person, as well as hundreds of members and trainees who joined proceedings online.

ACEM President Clare Skinner said the summit was an opportunity to explore “how the College can rise and meet some of the challenges and take on some of the opportunities that lie ahead.”

There is no doubt the practice of emergency medicine and the skills required have changed and evolved since the College was founded 40 years ago. Emergency physicians can now choose from a broad range of career options and emergency care is delivered in a variety of settings. Emergency departments increasingly serve as the safety net for healthcare and social systems under pressure.

In closing the summit, she said, “we are the College. If we want change, then we need to engage in it and we need to be the change.”

“Emergency medicine came about to help people and communities. In the end it isn’t about us, it’s about the people who need and seek emergency care.”

The thought-provoking discussions will be invaluable in shaping the future of the College as it strives in its mission of promoting excellence in the delivery of quality emergency care in coming decades. Information on the summit, key findings and additional resources can be found here.

Throughout the modern era, ACEM has taken steps to nurture diversity and inclusion at all levels of the organisation – with the aim of better understanding who we are as a College and as a wider medical community.

In early 2018, the Diversity and Inclusion Steering Group (pre-cursor to the current Inclusion Committee) was formed to guide the College’s work in this area, providing leadership and accountability in all matters related to diversity and inclusion.

With the belief that words and actions matter, the College defined its Core Values in 2018. The Core Values – Respect, Integrity, Collaboration and Equity – “are at the heart of who we are”, then President Dr Simon Judkins said. They define the College’s guiding principles and underpin the way the organisation works to meet its vision and mission.

To encourage members and trainees to be leaders in cultural change, the College introduced the ACEM Wellbeing Award and ACEM Diversity and Inclusion Award. The Wellbeing Award celebrates those who are proactive in encouraging and promoting the physical and mental health of emergency department staff, while the Diversity and Inclusion Award shines a spotlight on those that proactively support diversity and foster inclusion in emergency departments and beyond.

The College also looked inward with its first Membership and Trainee Diversity Survey in 2022. The voluntary survey sought to determine the cultural landscape of members and trainees, better promote inclusivity, and ensure that all members and trainees are properly represented.

President Dr Clare Skinner said diversity and inclusion are “really important to the College and to the people we look after. There is really good evidence that when we have diversity of leadership and diversity of decision making, then we make better decisions and we provide better healthcare.”

During this time the College released its inaugural Governance and Leadership Inclusion Action Plan, developed a College-wide mentoring program and continued to advocate for all members, trainees and SIMGs – as it looked to create a better, fairer and more inclusive emergency medicine workforce for all.

Throughout 2022, ACEM began implementing a revised FACEM Training Program – the changes were the culmination of years of consultation and hard work from the College, Council of Education (COE), peak medical bodies, and other key stakeholders.

Then Deputy Censor-in-Chief Dr Kate Field said that, in part, the changes were about “redefining what the journey of a trainee to FACEM actually is”.

The revised program also introduced a selection component that “changed the dialogue” around training, leading to registrars “hitting the ground and running on the first day” of training.

The pathway of training was also split into four distinct stages, with then Censor-in-Chief and Chair of the Council of Education Dr Barry Gunn explaining that “each training stage now [has] a more defined focus”.

The rollout of this revised program presented a series of challenges that had to be surmounted to provide the best outcome for incoming and currently enrolled trainees. The COE settled on a staged approach that would have the least impact on trainees and see them transitioned to the revised program over time.

ACEM President Dr Clare Skinner said, “It is high quality education and training that is the foundation of safe, effective, compassionate emergency care and we are grateful for the work that members and college staff do in this space”.

The third iteration of the Innovate Reconciliation Action Plan (2022-2024) was launched in July of 2022, as the College continued to embrace the concept of a shared national identity and enshrined reconciliation in its Constitution.

ACEM envisages a future where Aboriginal and Torres Strait Islander peoples experience culturally safe emergency care that is self-determined, free from bias and racism, and enhances opportunities for quality health outcomes. The College believes achieving this will lead to flourishing health and improved wellbeing for all Australian communities.

ACEM President Dr Clare Skinner said, “The RAP is the beginning. It is the starting point for interactions, conversations, and plans.”

“It is an invitation for people who have been left out of the room to enter it, and for others – who have talked the loudest – to learn to sit quietly in the room and listen.

“Then we will take action to imagine and create a better and fairer way of doing things – together.”

The College, on behalf of the International Federation for Emergency Medicine, hosted the 21st International Conference on Emergency Medicine in Melbourne. The conference’s theme was ‘Better care for a better world’ and sought to encourage healthcare with a foundation of equity, social justice and sustainability.

During the event, ACEM President Dr Clare Skinner said, “This is a really important time to work together, to stick together, and we must take this opportunity to change the world, for the better.”

The conference brought together emergency medicine practitioners and experts from around the globe to contemplate the big issues, themes and challenges in relation to delivering and improving emergency care on an international scale.

ICEM22 Convenor and former ACEM President Dr Simon Judkins said, “We wanted a conference, not just about how we practise medicine within the flexible walls of the emergency department, but about how we, as emergency care clinicians, can embrace our role as advocates, as leaders for change, and as leaders for access to global emergency care.”

“We wanted a conference about how we address the existential challenges which face our communities, looming larger now than ever before.”

In October, the College launched its second iteration of the Te Rautaki Manaaki Mana: Excellence in Emergency Care for Māori at the biennial hui held at the Whangarā Marae near Tūranganui-a-Kiwa (Gisborne), Aotearoa New Zealand.

Kaikōkiri (Champions), and other health professionals with a shared interest in health equity and the Manaaki Mana movement from across the nation, attended the hui where they shared experiences and connected with each other and held discussions on how to strengthen care.

The goals of the second Manaaki Mana Strategy are closely aligned with priority areas for action in Whakamaua: Māori Health Action Plan 2020-2025 – the government’s direction for Māori health advancement.

At the heart of Manaaki Mana are the people: Everyone who seeks our care and everyone providing emergency medical care in Aotearoa New Zealand and Australia.

While the College has made steady progress, there is more work to be done to achieve Pae Ora.

In 2022, the College launched its inaugural annual State of Emergency report. The aim of this report is to collect data from rural, metropolitan and tertiary hospitals around Australia to provide an accurate snapshot of emergency departments. Key indicators include staffing shortages, patient demographics and discharge times over a 12-month period.

These key indicators are presented at a national level and are then broken down in more detail by each jurisdiction. The report has suggested several nationwide approaches to address and alleviate the systemic pressures emergency departments currently face.

A similar report is being developed for Aotearoa New Zealand for 2023.

ACEM President Clare Skinner said, “State of Emergency 2022 will inform us, and guide us, as we work collaboratively with government, other Colleges and health services, as well as patients and carers and all other stakeholders across the health system, on the creation of an equitable health future, for everyone.”

In 2020, as part of ACEM’s efforts in realising equity in health for all communities across Australia and Aotearoa New Zealand, the College called for a vote to change the ACEM Constitution to specifically include health equity for Indigenous peoples.

The measure stated the College would “Strive for excellence and equity in emergency care for Aboriginal, Torres Strait islander and Māori communities in Australia and Aotearoa New Zealand, through a commitment to the principles of Te Tiriti o Waitangi in Aotearoa New Zealand, the process of Reconciliation in Australia and the intent of the United Nations Declaration on the Rights of Indigenous Peoples.”

The measure passed with the support of the vast majority of Fellows.

Dr John Bonning, then President of the College, said the passing of the resolution was the “right thing” and he was proud to see its addition into the ACEM Constitution.

“It’s great to see. We had a lot of excellent engagement through the voting period and it is satisfying to see so many voices stand up to say that we can do better and let’s start here.”

The first case of COVID-19 was reported in December of 2019, and arrived in Australia late January, and Aotearoa New Zealand in late February. On 11 March of 2020, the World Health Organization declared a global pandemic.

While the pandemic impacted all members of society, the pressure placed on front-line medical workers was unprecedented. In this instance, the College’s role was to support and advocate for its members, trainees and SIMGs and create policy and guidelines to respond to the constantly changing and uncertain circumstances and demands caused by the pandemic.

In March, ACEM was able to coordinate and develop COVID-19 guidelines promptly, so that there were protocols in place to protect emergency physicians, other clinical and hospital staff, and patients and their carers from the new virus. These guidelines were built to assist healthcare workers with decisions about appropriate healthcare delivery in emergency departments across Australia and Aotearoa New Zealand. This document was constantly updated to reflect the ever-evolving situation, informed by available research and learnings from other countries across the globe.

ACEM worked closely with federal and state governments to develop and implement healthcare policy and protocols specifically designed to support emergency departments and was heavily involved in the National COVID-19 Clinical Taskforce in Australia.

The College was also a leading voice in the media, prominently advocating for members, trainees, SIMGs and communities, in the face of significant pressures and uncertainty.

Dr John Bonning, then President of the College, said at the time that emergency doctors would continue to step up, serve and care for their communities on the frontline of the coronavirus response.

“The skills, expertise and commitment of emergency doctors means we have a vital role to play in the response to coronavirus, and we are dedicated to working for our communities, and some of the most vulnerable in society, in their time of need,” he said.

ACEM also collaborated locally with other medical colleges as well as emergency medical colleges from around the world to advocate for appropriate action during the pandemic. Notably, ACEM partnered with the Royal College of Emergency Medicine, ACEM’s United Kingdom equivalent, to stand with and support the tri-national emergency workforce.

While advocacy and leadership were an integral part of the College’s role during this period, it also had to find new ways to perform its other core functions for emergency specialists and trainees, especially in the ongoing provision of training and assessments.

It was clear very early in the pandemic that impacts on college operations were going to be felt for some time to come. ACEM formed the Examination Contingencies Working Group that worked quickly with key stakeholders, examiners and regional venues to ensure examinations could continue to be delivered, albeit across different jurisdictions, countries and time zones, so that trainees could continue to progress through their training despite the pandemic.

ACEM was one of the most successful medical colleges in adapting to online and multi-site examinations during the pandemic, delivering exams for 2121 candidates from May 20 to August 21.

Developing a robust wellness and support network during this time was also crucial, as so many struggled to adapt to halted and confined working and living conditions. This was made even more difficult by the increasingly acute demand EDs faced, and the workforce shortages due to furloughed staff. The College launched and promoted a wellbeing hub with specialised supports for members and trainees in both regional and metropolitan settings, running regular wellness seminars and online events to help keep members engaged, informed, supported and connected.

At the commencement on Emergency Medicine Wellness Week in April 2020, then ACEM President Dr John Bonning said, “As we grapple with the ongoing fluid situation, our commitment to the health, safety and wellbeing of our members, trainees and staff is unwavering.”

The Hobart Annual Scientific Meeting was held in November of 2019 with the theme ‘The Changing Climate of Emergency Medicine’. The ASM had a broad range of seminars and discussions, but the impact of climate change on the health system was a central theme throughout.

On the final day of the ASM, the College officially declared climate change to be a medical emergency, acknowledging the increasing pressures emergency departments would face when the effects of climate change become more pronounced.

ACEM members joined several hundred doctors outside the Royal Hobart Hospital for a march for climate action, calling for immediate government action on climate change.

FACEM and advocate for climate action Dr Rohan Church said, “As emergency doctors, we are faced with real life or death situations every day, and this climate emergency is really just another version of a life or death situation that we need to act on.”

ACEM President at this time Dr John Bonning said, “The evidence is clear: projections show that climate change will cause a significant rise in the number of overall ED presentations, an increase in the complexity of presentations as well as surges resulting from climate disasters.

“With the research also showing that climate change will exacerbate existing health inequities, we have an obligation and responsibility as emergency doctors to speak up, take action ourselves and demand action from government.”

As part of the College’s journey towards Reconciliation, ACEM launched the second Reconciliation Action Plan in September 2019.

The plan was built upon the foundations created by the first Innovate RAP and reiterated the College’s commitment to health equity for Aboriginal and Torres Strait Islander peoples. It presented a strategy to make this a reality for First Nations peoples accessing and working in emergency departments across the lands known as Australia.

The College built on its work in developing culturally safe emergency departments, and an emergency medicine workforce that is responsive to the needs of Aboriginal and Torres Strait Islander patients.

ACEM also entered into a partnership with The Lowitja Institute, Australia’s national institute for Aboriginal and Torres Strait Islander health research, to enhance cultural safety in Australian emergency departments.

The Institute’s chief executive Janine Mohamed said, “This work is important because it’s about leadership and for other organisations to follow ACEM’s lead in wanting to enhance cultural safety in health care encounters and ultimately improve health outcomes.”

The first Manaaki Mana Strategy was launched at the Winter Symposium in Rotorua, Aotearoa New Zealand in May of 2019. The strategy is part of the College’s commitment to achieving health equity for Māori patients, whānau and staff in all emergency departments.

It was built upon the four pillars of Pae Ora (healthy futures for whānau), Whānau Ora (healthy families), Wai Ora (healthy environments) and Mauri Ora (healthy individuals) and sought to empower people to address the inequalities that lead to disparity in health outcomes.

At the launch, Co-Chair of Te Rautaki Manaaki Mana Dr Inia Tomas said, “This strategy is specifically designed to improve the experience of Māori patients and their whānau in the emergency department.”

“The emergency department is a small but important part of the overall patient experience and journey, and we should all feel empowered to make changes to effect this in a positive way.”

“What we do, no matter how small, will make a difference to patient experience, engagement and health outcomes overall.”

In October 2018, the College hosted the inaugural Mental Health in Emergency Department Summit. The summit was designed to discuss and construct policy initiatives to improve the treatment of people coming to emergency departments in Australia seeking mental health care.

The summit was hosted by ACEM, but included medical, nursing, peer worker, consumer and carer representatives. The summit delegates agreed that urgent action was required, across multiple disciplines, including emergency medicine, to tackle the mental health crisis Australians face.

The consensus statement developed during this event included acknowledging that all Australians have the right to access timely and appropriate mental health care, free from stigma and discrimination; ensuring mental health patients do not stay in emergency departments for more than 24 hours; and acting on the work that needs to be done to build a mental health system which supports prevention and early management.

The key asks in the statement were designed to be used for collaborative advocacy by stakeholders across the healthcare sector to advocate for and build better policies surrounding mental healthcare.

Then ACEM President Simon Judkins said the summit was an opportunity to “send a really strong message” by bringing together “policy makers, bureaucrats and, most excitingly, patients – to hear their lived experience.”

“The aim is to get a common message and a common goal.”

In 2019, a partner summit was held in Aotearoa New Zealand addressing the need to better manage the mental health crisis that Aotearoa New Zealand emergency departments faced.

Over 900 emergency doctors attended the 2018 Annual Scientific Meeting held in Perth, which marked the 35th anniversary for the College. This year had many landmark events throughout to celebrate this important milestone.

Celebrations for the 35th anniversary culminated at the ASM, which included a powerful tribute to the founding Fellows of the College who were able to all reunite together on stage.

FACEM Dr Michelle Johnston welcomed delegates to the ASM in an opening ceremony steeped in the organisation’s history and following the theme of On The Edge.

Dr Johnston said that “struggles begun are never over” but celebrated that “those hardened by the challenges of being on the edge, through time, through space, through history, can prevail.

“Afterall, we are here on the edge of the planet celebrating emergency medicine.”