Background: Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher-and lower-resource settings. Objective: To systematically review the literature to evaluate the composition of EM training programs in low-and middle-income countries (LMICs) developed through partnerships. Methods: An electronic search was conducted using four databases for manuscripts on EM training programs-defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care-developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings: Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions: Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.

BackgroundEmergency care (EC) can improve health outcomes and reduce disparities [1]. Despite this, EC is often extremely limited in low-and middle-income countries (LMICs), including Haiti [2,3]. In addition to investments in education, human resources and operations, developing successful emergency care systems requires designing, building and maintaining high-quality emergency departments (EDs).Studies from high-income settings have demonstrated that an ED's physical infrastructure is closely related to its operational success [4][5][6]. However, no standards exist for ED design in LMICs. Uniform application of design principles from high-income settings would be inappropriate due to variations in disease burden, staff training, health system characteristics, and financing. To address this gap, we present our experience with ED design at Hôpital Universitaire de Mirebalais (HUM), an academic hospital in central Haiti.As part of a quality improvement project to redesign the HUM ED, we collected feedback on the current design from key stakeholders to identify priority design features Marsh RH, et al. Emergency Department Design in Low-and Middle-Income Settings:

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