Emergency Medicine: The Paradigm Shift.

Emergency Medicine began as a clinical specialty focused on the provision of pre-hospital and hospital emergency room based care. Fifty years later, it has matured into a new paradigm: it is a complex specialty with a global reach and expansive practice in a variety of geographic and clinical arenas. "E <i>mergency Medicine is a specialty caring for all types of patients, in any place, for any problem, right away, and in the right way</i> ." It is a global population-based specialty, a system of care, has a unique clinical practice compared to other specialties, and is also a management specialty. The curriculum continues to expand to meet community and global needs in a number of areas: emergency pediatric and obstetrical care, emergency critical care, telemedicine, and partnering with public health. The challenges to emergency medicine are global. The most important, and the most pervasive global challenge, is managing stress and burnout which is due to a large number of complex issues. Professional development must be supported and encouraged to produce emergency physicians with cognitive and leadership skills to continue to lead the specialty forward, and to continue to improve the care of the public.