Stanford Emergency Medicine International
Visiting Scholars Program (SEMI)

The Stanford Emergency Medicine International is a program set up for International Medical Scholars/Faculty who wish to work and train at Stanford University Medical Center for one to two month rotations. Please note: it is not an elective for U.S. physicians-in-training.

Background and Goals

The practice of Emergency Medicine (EM) as it is known in North America exists in only a few other countries in the world.  Most western European countries have well-developed emergency medical services, although Emergency Medicine as a specialty currently has a limited role in most of these countries.  In most of the world, the specialty of Emergency Medicine does not exist.  In addition, emergency medical services in most underdeveloped countries are poorly organized at best and non-existent in many cases. Over the past several years, international interest in Emergency Medicine as a specialty has increased rapidly. Several US academic medical centers have already started fellowship training programs in International Health for EM physicians because of this new and expanding interest. 

There has also been a growing focus on providing leadership and training to physicians from other countries in the development of Emergency Medicine programs abroad. In the search for how to best achieve this goal the concept of an “observational” Emergency Medicine fellowship program has been developed.  Such a program would complement, but not replace, other international EM development initiatives, such as international conferences, faculty exchanges, and EM publications.

An observational program would provide the opportunity for physicians from other countries to obtain the skills, knowledge, and resources needed to become leaders in the development of EM in their home countries, while avoiding many logistical difficulties. It is increasingly difficult for foreign physicians to obtain US medical licenses, such as would be required in a traditional fellowship program.   An observational program would avoid such a requirement as residents would not be directly involved in caring for patients.  Foreign physicians involved in emergency medical care already have trained in another medical specialty and often already have some clinical emergency medical experience.  Thus, they are often more interested in learning the organizational, educational, and administrative aspects of EM as practiced in the US rather than the basic clinical aspects of emergency medical care.

Another difficulty for foreign physicians seeking training in the US is funding. There is a growing trend at the federal level to restrict funding of graduate medical education positions in the US to only graduates of US medical schools and it is becoming more and more difficult for foreign medical graduates to enter US residency or fellowship training programs.  Foreign physicians entering into an observational program would be at least partially funded by their own countries or medical institutions, with the expectation that they would return to their home countries to implement their new knowledge and skills. Additional funding would be provided by the individual physician or possibly from private sponsors. Thus, there would be no conflict with the US government’s plan to restrict funding of graduate medical education to US graduates only.

The Stanford University Division of Emergency Medicine has developed such a visiting scholar’s program. Stanford is ideally situated for this program as all of the necessary educational, personnel, and facility resources for training in Emergency Medicine are already in place.  The Stanford International Emergency Medicine Program will easily fit into the existing residency training program at Stanford.  Thus, it is not necessary to develop a completely new training program, which would require more time and would incur greater operational expenses.

To summarize, an “observational” international EM fellowship program offers the following advantages over a traditional “clinical” fellowship program:

1. Avoids the problem of obtaining a US medical license for foreign physicians
2. Avoids the problem of limited availability of US EM residency training programs for foreign physicians
3. Avoids the problem of “brain drain” (the tendency of foreign physicians to not return to their home countries after completion of training)
4. Avoids the expense of developing a completely independent training program
5. Offers the training opportunity to a potentially much larger number of physicians from other countries than traditional training programs

Goals of the Fellowship

The Stanford Emergency Medicine International Visiting Scholar Program would aim to accomplish the following:

• To facilitate and encourage the development of Emergency Medicine in other countries
• To allow cross-cultural exchange between emergency physicians in the US and physicians in other countries
• To train and mentor international physicians as leaders in Emergency Medicine development in their home countries
• To familiarize fellows with the general systems of EM practice and training in the US
• To provide training in clinical education methods, research, and ED administration
• To provide knowledge of resources that can be applied to EM development, such as textbooks, journals, conferences, and the Internet
• To establish strong bilateral institutional and personal relationships for future collaborative work

S. Mahadevan, MD
Director, Stanford Emergency Medicine International Visiting Scholar Program (SEMIVSP)
Associate Chief, Division of Emergency Medicine
Medical Director, Stanford University Medical Center Emergency Department

Matthew Strehlow, MD
Assistant Director, Stanford Emergency Medicine International Visiting Scholars Program (SEMIVSP)
Clinical Instructor, Division of Emergency Medicine
Stanford University Medical Center