13 General introduction and outline of the thesis CHAPTER 1 Motivation for this thesis The specialty of emergency medicine has evolved substantially over the last decades, and it continues to be an increasingly popular choice among graduating medical students (1). As the initial healthcare provider for many of his or her patients, an emergency physician is charged with the rapid assessment and gathering of the information needed for the initial workup and management of a variety of complaints and injuries. Emergency medicine is a team-oriented, dynamic specialty that focuses on the rapid evaluation and treatment of a diverse patient population consisting of both paediatric and adult patients. There are many potential reasons for choosing for a career as an emergency physician (2). Although a definite choice is usually made based on individual considerations, the decision to become an emergency physician is based on a strong interest in the dynamic aspects of an emergency physician’s working domain. One of the top reasons for becoming an emergency physician is probably the fact that in the emergency department (ED), no day is like another (3, 4) – emergency medicine is a field of work where variety is a key component: all types of patients (e.g., ranging from paediatric to geriatric), illnesses (covering almost all fields of medicine), and urgencies (e.g., ranging from non-lifethreatening to life-threatening) are seen in the ED. Indeed, a working shift in the ED is characterized by many challenges, as knowledge required to practise emergency medicine must be combined with both skills and compassion. Other appealing reasons for choosing emergency medicine are flexible work schedules, the variety of cases, the ability to perform procedures (e.g., placing tubes, stitching wounds, repositioning fractures), etc. (2). Although caring for older adults may not be the main reason that the majority of emergency physicians choose their careers, geriatric emergency medicine constitutes a large and increasing proportion of their work in the ED. This seems obvious, but it was only after the appointment of a geriatrician – Dr. Y. Schoon – as the medical head of our ED that I realized how strange it was that I did not receive any specific geriatric education during residency training. The ED residency program did not provide specific medical attention to the population of older adults in the ED, even though this group is rapidly growing and seems to benefit from ED physicians who are well aware of their specific clinical needs. Through the geriatric education sessions that were organized for our ED staff, I realized that better educated emergency physicians are needed to provide better medical care for older adults in the ED. It became clear to me that actions had to be taken for better preparation of both future and currently practising emergency physicians to make EDs suitable for the growing population of older adults, which was the reason for and starting point of this thesis work.
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