Hrev_master Emergency Care Journal 2022; volume 18:10891 In this issue of Emergency Care Journal we publish a letter from some young colleagues from CoSMEU (the Italian associa- tion of Emergency Medicine, EM).1 They express great concern on the several aspects the EM situation in Italy.2 The first issue is the collapse of the Emergency Departments (ED)2,3 caused by crowding/boarding combined with low available resources, particularly regarding EM physicians. The logical consequence is that EM is no longer attractive neither for “older” (indeed, not so much) physicians who are leaving their careers in great number, or “younger” doctors who are not attracted by the EM specialization,4 despite growing available access (up to 1000 training positions) in the recent years. EM residents are obviously worried of stressful situation of EM departments, in terms of both conditions and time spent at work. The editorial board of ECJ has already commented on the cri- tical situation of EM system in Italy, suggesting possible solutions,3 including the role of the territorial system and general practitioners. Other solutions are welcome, such as those provided by the UK’s Pre-Hospital Response Unit;5 however, time to build up the system is not in agreement with the immediate reduction of the EM crisis in Italy. Increased salary could be one prompt response for trying to stop diaspora of EM physicians from EDs. The change from Admission and Emergency Medicine and Surgery (MeCAU) to Emergency and Urgency Medicine in the hospitals could be a sign as stated by COSMEU, along with the possible equivalence reco- gnized by the Italian Ministry of Health with cardiology, gastroen- terology, pneumology, internal medicine and geriatrics.6 The latter opens the possibility of career progression also outside the EDs after years of strenuous work. Finally, I have some specific comment of the 5-year EM trai- neeship, being for a long time the Director of one of those schools. I completely agree that programs should be guaranteed and not shortened, and the European Curriculum for EM7 should be follo- wed in all schools (now 36) on the national territory, since standar- dization and certified training is still lacking. On the other hand, some initiatives are needed during the completion of the ongoing training program of future new EM specialists (e.g. extra-curricu- lar hours of job in low-intensity care in EM departments). Given the desire of most the EM trainees of working both in the ED and in the pre-hospital setting,7 since few hospitals allow this hybrid solution it should be limited the choice of working (only) in the pre-hospital setting, which is undoubtedly more remunerative, per- haps less stressful and with less urgent need of personnel. The last words are on research and professorship in EM. Despite research being a part of the European Curriculum for EM,8 it has long been neglected and not claimed as an important forma- tive point for EM resident in the past. Therefore, very few EM spe- cialist would achieve the scientific requirements for professorship (Table 1), according to the national scientific qualification promo- ted by Italian Ministry of the University.9 A separate specific scien- tific-disciplinary sector would not be the solution, since it would be equivalent to downgrade EM and compare it to Internal, Geriatric and Sport Medicine, which are now included in the same sector, as wells as Immunology. The only possible solution is to promote clinical research. As COSMEU stated “the ED is an enormous reservoir of data, from which a large scientific production could be obtained. This would allow the Italian emergency residents to gain significant weight in the scientific literature landscape (national and interna- tional). We need to become aware that research in EM is possible and we can and must do more as young researchers.” The require- ments are will, study, methodology, and time spent on it. Thus, don’t’ give up and let’s do it: “if you want to change the world, pick up your pen and write.”10 Correspondence: Lorenzo Ghiadoni, Emergency Medicine Unit, University Hospital of Pisa, Pisa, Italy. E-mail: lorenzo.ghiadoni@unipi.it Key words: Emergency medicine; emergency medicine training pro- grams; emergency medicine residents. Conflict of interest: LG is Editor-in-Chief of ECJ. Received for publication: 23 September 2022. Revision received: 23 September 2022. Accepted for publication: 23 September 2022. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2022 Licensee PAGEPress, Italy Emergency Care Journal 2022; 18:10891 doi:10.4081/ecj.2022.10891 Publisher's note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organiza- tions, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its man- ufacturer is not guaranteed or endorsed by the publisher. Emergency medicine residents: Don’t give up! Lorenzo Ghiadoni Emergency Medicine training program, University of Pisa; Emergency Medicine Unit, University Hospital of Pisa, Pisa, Italy Table 1. Candidate threshold values of professorship (associate professor) in internal medicine. Scientific Number Number H index * sector of articles of citations 5 years 10 years 10 years MED09 16 273 9 * Hirsch index: criterion for quantifying the prolificacy and scientific impact of an author, based on both the number of publications and the number of citations received. According to the definition, a scientist has an index n if at least n of those he/she has published have been cited at least n times each. [page 50] [Emergency Care Journal 2022; 18:10891] Non commercial use only References 1. Cascio M, Barcella B, Zaccaria G, et al. Italian Emergency Medicine residents’ perspectives. Emerg Care J 2022;18: 10870. 2. CoSMEU. Available from: https://cosmeu.wordpress.com/ cose-cosmeu/ 3. Coen D, Casagranda I, Cavazza M, et al. Facing the Emergency Department crisis in Italy, Emerg Care J 2021;17: 10331. 4. Poggiali E, Barbieri G, Salvatore V, Salinaro F. The Emergency Rooms and Emergency Medicine should not be the answer to the weakness of the Italian National Health System, Emerg Care J 2021;17:10304. 5. Sorlini C. Community Emergency Medicine: the right care, at the right time, in the right place. Emerg Care J 2022;18:10595 6. Ministero dell’Istruzione, dell’Università e della Ricerca. Modifica ai decreti del Ministro della sanità 30 gennaio 1998 e s.m. recante "Tabelle relative alle discipline equipollenti previ- ste dal/a norma/iva regolamentare per l'accesso al secondo livello dirigenziale per il personale del ruolo sanitaria del Servizio sanitaria nazionale" e 31 gennaio 1998 e s.m. recante "Tabella relativa alle specializzazioni affini previste dalla disciplina concorsuale per il personale dirigenziale del Servizio sanitaria nazionale". Available form: https://www.quotidianosa- nita.it/allegati/allegato1662036999.pdf 7. European Curriculum for Emergency medicine. Available from: https://eusem.org/education/curriculum/european-curri- culum-of-emergency-medicine 8. Piazza I, Barcella B, D’Ercole A, et al. Emergency medicine residents in Italy: Data from a national survey. Emerg Care J 2022;18:10439. 9. Ministero dell’Istruzione, dell’Università e della Ricerca. D.M. 8 AGOSTO 2018, N. 589 – Tabelle valori-soglia candi- dati e commissari. Available from: https://abilitazione. miur.it/public/documenti/2018/Tabelle_Valori_Soglia_ALLE- GATI_DM_589_2018.pdf 10. Ghiadoni L. If you want to change the world, pick up your pen and write. Emerg Care J 2021;17:9923. Editorial [Emergency Care Journal 2022; 18:10891] [page 51] Non commercial use only