We were encouraged by Dr Liz Wolvaardt from the School Health Systems and Public Health and the Head of the School of Medicine, Prof Robin Green, who advised us to approach the Division of Emergency Medicine at the University of Pretoria and Steve Biko Academic Hospital to request the necessary mentorship. Prof Andreas Engelbrecht, Dr Vidya Lalloo and the rest of the emergency medicine team were all eager to assist us to ensure a successful endeavour.

Our training commenced in October 2018 and continued until the day the competition ended. The training sessions we attended included an EKG course, the VAPP (Venomous animals, poisonous plants) course and an EMTSS (Emergency medicine trauma surgical skills) course presented by the Division of Emergency Medicine. We also attended an Advance Trauma Life Support (ATLS) course convened by Prof Engelbrecht and wrote the relevant examination. Furthermore, we improved our knowledge by regularly attending emergency medicine academic days and participating in academic ward rounds. Our mentors ensured that we had enough hands-on time in the emergency department, performing patient assessments, emergency procedures and ultrasound examinations. Additional time was also scheduled for training on manikins by simulating important emergency situations. The knowledge and skills we acquired during this time not only helped us to secure a place among the top ten participants in this competition, but will benefit us throughout our careers as medical doctors. As the weeks passed and we learnt one life-saving skill after another, we could not help feeling that something was missing. How could we pass on some of the vital knowledge that we were gaining to other Tuks medical students? How could we help our fellow students to successfully complete their internships and community service with the knowledge required to, for example, identify and manage STEMIs, systematically manage polytrauma patients and use ultrasound to guide fluid resuscitation? As a result, the Tuks Emergency Medicine Student Society was established. The aim of the Society is to promote an understanding of emergency medicine among medical students at the University of Pretoria. The society will host symposiums and workshops covering important emergency medicine topics and will also prepare future undergraduate teams for participation in international events, such as the KKU ICEM.

Our big day finally arrived and we made our way to Khon Kaen. KKU’s 4^th ICEM amalgamated knowledge and various cultures and skills. The organisers were determined to ensure that all delegates reaped the benefits of this convergence of nationalities. During the opening ceremony the participants were divided into groups including members from different continents to ensure mingling and networking. Several activities and games were introduced as ice-breakers. Friendships were soon established and many questions were asked about fellow participants’ countries, languages and customs. The catering was outstanding and delegates were treated to a variety of Thai delicacies sourced from local markets.

On the second day, delegates travelled from their hotels to KKU’s Faculty of Medicine for the qualifying round, during which individual participants had to answer multiple-choice questions (MCQ) and teams answered short questions. Our team found the basic sciences MCQs rather challenging, but had no problem with the EKG-based MCQs. Our advanced knowledge of EKGs was a definite advantage throughout the competition, especially when we had to answer the short-answer questions. We were also well prepared for dealing with other medical emergencies, such as foreign-body ingestion, supra-ventricular tachycardia and paracetamol overdose.

As mentioned earlier, our invaluable knowledge of EKG was the result of the tireless mentoring efforts of the emergency medicine team at the Steve Biko Academic Hospital. We learned to appreciate that EKGs are valuable aids to clinical assessment that can be used to diagnose a variety of life-threatening conditions, and we are of the opinion that more EKG teaching should be included in our curriculum. Once we had mastered the system we had been taught, we concluded that EKGs are fun and easy to learn and decided to share our new-found passion for EKGs with our fellow students. Our newly established society will definitely arrange an EKG workshop with a quiz and a prize for the winner!   

Once the qualifying round had been completed, we visited the Thai Fun Fair, which was another exciting opportunity to spend time and participate in activities with our new friends. We were treated to a simulation of Thailand’s Songkran Festival (Water Festival) and a traditional Thai dance performance, not to mention the wide variety of food and sweets that were available. The organisers made a great effort to introduce us to Thailand’s rich culture and traditional practices.

That evening groups were taken on a guided tour of the local night market. The group leaders (medical students at KKU) showed us what they would typically enjoy on a night out and explained each dish. Once we had explored the market, we each selected several dishes and joined our groups for dinner, surrounded by locals. This outing was a truly unique experience, not only for us, but also for many of the delegates from neighboring Asian countries.

The teaching workshops and skills lab sessions that took place the following morning included stations on pre-hospital medicine, airway management and ultrasound and I am proud to say that the delegates from UP were more than able to demonstrate the skills presented. It was clear that we had been exposed to them before. This included the ultrasound station, which left many of our competitors baffled. However, we did learn new, alternative techniques for certain procedures. For instance, their antero-posterior approach to c-spine stabilisation during helmet removal proved to be very effective during simulations. We were also able to offer advice on how to improve their own practices and techniques – for bougie-assisted intubation, emergency medicine registrars in Thailand are taught remove the laryngoscope after placement of the bougie through the vocal cords before railroading the endotracheal tube over it. Our experience has taught us that the removal of the laryngoscope results in soft-tissue collapse, which obstructs the passage of the endotracheal tube over the bougie. We advised them to keep the laryngoscope in situ until the endotracheal tube had passed.

We again realised that the ease with which we completed the ultrasound workshop and answered the questions was due to the mentoring provided to us by Prof Engelbrecht and Dr Lalloo. We also realised that medical students at the University of Pretoria have very little exposure to bedside ultrasound, which is a clinical aid we can no longer afford to ignore in the curriculum, even at the undergraduate level.

The last day of the competition consisted of the semi-final, resuscitation and final rounds. Of the 32 teams that competed in the qualifying round, 16 teams moved on to the semi-final round. Our team was among the top ten qualifiers. The sixteen teams were then divided into two groups – A and B. Only the top two teams from each subgroup would immediately progress to the final round, while the rest had to compete in the resuscitation round. Afterwards the top team from each group would proceed to join the final round. The semi-finals consisted of short, rapid-fire, single-answer questions. Unfortunately our team was not one of the top two and was moved on to the resuscitation round.

The resuscitation round consisted of similar short questions, but with less time to answer. We established an early lead with the team from Vietnam close behind us. Eventually all the other teams were eliminated and we were tied with Vietnam.

We then moved to sudden death, but after six additional questions there was still no winner. Unfortunately on the next question we were beaten and were placed sixth out of the 32 participating teams.

All the teams were allowed to observe the final round. The theoretical part of the finals was identical to the previous rounds and consisted of clinical scenario-based questions, while the practical section consisted of two manikin-based simulations, ie a cardiac arrest and a shoulder dystocia. We were well prepared for the simulations as we had practised both these scenarios before! If only we had made it through that last question, we could have won the competition! Nevertheless, we are inspired by how much we learned and how close we came to the top.

During the awards ceremony, our team leader (Michiel) and team member LW Biggs were awarded bronze medals for outstanding individual performances during the MCQ round.

The intense semi-final, resuscitation and final rounds were followed by a farewell dinner during which the participants from each country were expected to present a cultural show. We learnt some Thai, Japanese, German and Spanish dance moves and in true South African spirit we pulled out all the stops by wearing African beadwork and adding traditional African make-up. We performed Shakira’s Waka Waka and even our supervisors joined in. Ours was the most loudly applauded item! It was a memorable evening of fun, food and dance.

The entire competition was an amazing opportunity to learn more about basic sciences, clinical skills and teamwork, and also to grow as individuals. Friendships were fostered and networks were established with colleagues across the globe. The experience has given us a new appreciation for different cultures and ethnicities.

We would like to thank the Faculty of Health Sciences of the University of Pretoria for their unbelievable support and foresight in allowing us to participate in this unique and unforgettable event.