A Perspective on Training in Emergency Medicine in Europe: Harmonisation, Challenges and Future Directions.

Emergency Medicine (EM) in Europe has evolved from a fragmented service into a mature, stand-alone specialty with structured postgraduate training. Despite progress, significant disparities remain in specialty recognition, training duration and structure, subspecialty exposure, educational methods, and assessment across European countries. To address these gaps, the European Society for Emergency Medicine (EUSEM) and the Union Europeenne des Medecins Specialistes (UEMS) Section and Board for EM developed the European Training Requirements (ETR) for EM, first adopted in 2018 and updated in 2024. The ETR defines minimum standards for training content, duration, organisation, and assessment. It is endorsed by all EUSEM national societies and UEMS specialties, a major milestone in recognising EM as essential to Europe's frontline healthcare. The European Board Examination in Emergency Medicine (EBEEM) was established as a competency-based pan-European assessment aligned with the ETR, providing an objective measurement of trainee readiness for independent specialist practice. In this perspective, we review literature, policy documents, and survey data to describe advances and persisting disparities in EM training. We highlight programmes exemplifying alignment with outcome-based models and the ETR framework, illustrating harmonisation pathways while respecting national contexts. We argue that the ETR and EBEEM, supported by longstanding national frameworks and guidance from the International Federation for Emergency Medicine (IFEM), can drive genuine harmonisation of EM training across Europe. Finally, we describe these developments within global EM evolution, where strengthening of emergency care systems particularly in low- and middle-income countries, offer significant potential to reduce morbidity and mortality.