In total, 236 of 290 (81% response rate) individuals attending one of two full-day symposia on emergency medicine filled out the survey. The majority of respondents were female (n=138, 59%) and physicians (n=171, 74%). Most attendees reported prior training as general practitioners (n=117, 53%) and were currently employed in private practice (n=148, 64%) (Table 1. Demographics of practitioners attending two symposia on emergency and acute care, Myanmar January 2015). Demographics of practitioners attending two symposia on emergency and acute care, Myanmar, January 2015).
A majority (n=133, 56.5%) spent some to all of their clinical time each month providing care to patients identified as having emergency medical conditions (Table 2. Self-reported exposure to emergency medicine, acute care and prehospital systems amongst practitioners attending two symposia on emergency and acute care, Myanmar January 2015). Self-reported exposure to emergency medicine, acute care and prehospital systems amongst practitioners attending two symposia on emergency and acute care, Myanmar, January 2015). However, a large majority of respondents (n=192, 84%) reported little or no formal training (<2 weeks of training) in emergency and acute care. Even though participants reported little formal exposure to preparation in this field, they perceived the development of emergency and acute care services to be a public health priority in the country (n= 184, 81%).
When asked to assess healthcare in Myanmar, respondents rated the overall quality of acute and emergency care in their country as fair (median 2 IQR+/-2-3 on a 5-point Likert-scale). A large proportion (n=214, 94%) felt that existing physicians should be incentivized to undertake more training in emergency medicine. In open response, several remarked that taking time out from existing practice to engage in emergency medicine training would be a financial burden, unless financial incentives were provided for attending such trainings.
Additional factors noted by participants limiting access to emergency care training in Myanmar included 1. lack of specialized training programs; 2. current job requirements and hours would limit time available for emergency medicine training; and, 3. lack of suitable employment opportunities in emergency medicine/acute care (listed by 51, 45, and 33% of respondents, respectively).
Given the limited physician workforce and time constraints faced by current physician providers in the country, respondents were asked whether non-physician entities could be enlisted to provide emergency and acute care services: 82% (n=191) agreed that non-physicians should be utilized to provide direct patient care.
Respondents were also asked to self-report on the current status of prehospital and patient referral practices in the country. Systems for interfacility referral were largely present at the majority of health facilities. Seventy-one percent self-reported use of transfer protocols in their work environment and 60% reported ambulances as the primary mode of patient transport (with 76% noting ambulance availability at their home health facilities for interfacility transports). When asked where efforts should be initially focused to improve the overall quality of emergency and acute care, the most common answer was to improve the quality of prehospital care (n=62, 27%).
Health workers with training in emergency medicine > 2 weeks were more likely to care for emergencies on a regular basis and were also more likely to provide verbal sign-out on inter-hospital transfer (p=.05, p=.02, respectively). However, prior training had no bearing on the following items: opinions of overall emergency care, utilization of ambulance for transfer, the role of prehospital care in improving overall acute and emergency care, as well as whether the building of emergency services, systems and training should be a priority in Myanmar.