How to choose an expedition medicine courseBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i1608 (Published 06 April 2016) Cite this as: BMJ 2016;353:i1608
- Matt Wilkes, STR in anaesthesia
As the popularity of expedition medicine has grown, so has the number of courses. Seasoned adventurer Matt Wilkes advises on how to choose one that suits
Being a doctor on an expedition is wonderfully rewarding and an opportunity to use your skills in new and challenging environments. A 2013 BMJ Careers1 article suggested attending an expedition medicine course before your departure. That was good advice then; indeed, we would argue now that such courses have become essential. However, as the number of courses has grown to match the demand, the choice can be bewildering.2
Why are courses important?
The recent explosion in the popularity of expedition medicine has led to a drive to raise standards.3 The Faculty of Pre-Hospital Care has published consensus guidelines on competencies for UK wilderness medics.4 It is hoped the guidelines will be a positive step and encourage industry operators to recognise the worth of their doctors, meaning fewer medics out of pocket and fewer still out of their depth. Either way, the guidelines are an excellent benchmark by which to judge the relevance of a particular course.
What courses are out there?
Basic courses last up to a week and cost anywhere between £500 and £1000 (€663-1326; $726-1450). Specialist courses for particular environments are also available: for example, mountain, diving, or jungle medicine. These usually last two weeks and take place on location. Accordingly, they cost more, between £1000 and £3000.
The most in-depth courses are the diplomas. These include the two diplomas in tropical medicine and hygiene, and the diplomas in travel medicine and mountain medicine. Two new programmes specific to expedition and wilderness medicine have just been announced by the University of Exeter and the Faculty of Travel Medicine in Glasgow. Diplomas cost around £5000, not including equipment, travel, or accommodation. Learning is via intensive classroom weeks, fieldwork, essays, and exams. Some diplomas can be extended to a masters through a dissertation and additional fees.
Finally, there is the fellowship of the Academy of Wilderness Medicine programme, based in the United States but open to all via an online learning platform. Participants gather points from accredited courses, lectures, publications, and expeditions over a period of up to five years. The fellowship is popular in the United States but has not been such a hit elsewhere.
Choosing the right course
To choose the right course candidates must assess the demands of the planned expedition, their skills and long term goals, as well as the course itself.
For a simple trip, six months of emergency medicine experience and a basic course will be enough for most doctors. Basic courses should cover pre-assessment, vaccinations, kit, casualty evacuation, security, and communications—all keys to a successful expedition. Consider the location, class sizes, and experience of the faculty to judge value for money. Look for a good mix of theoretical teaching and practical workshops in the programme. A responsible course should also give you an understanding of the standards you need to meet for your particular trip. Finally, courses are a great way to make contacts, giving you an edge in an increasingly crowded expedition jobs market.
For more complex expeditions, think specifically about the participants, the activity, and the environment. What are the participants’ nationalities, ages, comorbidities, and expectations? Will any specialist knowledge be required to accommodate them?
As the medic, you must be at least as capable and ideally better at the planned activity than the participants.4 Pick a course that covers hazards inherent in the activity—for example, crevasse rescue—and arrange additional outdoor skills training if needed.
If you are travelling to altitude, supervising divers, or venturing into the jungle then contemplate one of the specialist two week courses. Many of these “location” courses are part holiday, which is great, but assure yourself that the programme covers what you need in sufficient depth.
If your long term goals lie in the remote environment then consider a diploma. Doctors are prone to badge collecting, so try to assess honestly the value of the diploma to you, bearing in mind the many other things you could do with the money, as well as the annual leave and effort you’ll expend completing it.
Existing diplomas are quite varied in their aims and content. Pick one that you can use to bolster any future career aspirations. Diplomas score points on specialty training application forms. Always look hard at the faculty and partnering institution to make sure the course is sustainable and that any academic credits earned are transferable. The diploma may take several years to complete. Speak to someone who has done it recently: ask if they enjoyed it, if it ran smoothly, and how much they spent beyond the course fees—for example, on equipment.
The key to a successful trip is preparation. Pick a course that will prepare you well, and the expedition will be all the more enjoyable for it.
Competing interests: I have read and understood BMJ Group policy on declaration of interests and delare the following interests: I am editor of Adventure Medic magazine and have taught on a number of expedition medicine courses in the past, but I am not currently affiliated to any one course.