Many countries offer regular courses in mountain medicine. The medical commissions (Medcom) of UIAA and ICAR, together with the International Society for Mountain Medicine (ISMM) established minimal requirements for a formal Diploma course in August 1997 (Interlaken, Switzerland). Many course organisers adopted these standards and the resulting Diploma in Mountain Medicine (DiMM) has become a widely respected qualification. The regulations have been updated to reflect developments in mountain medicine, ideas presented at meeting of course organisers in November 2018 and to ensure that the high standard of the DiMM is maintained. The member organisations approved the administrative group to change the regulations at their individual meetings in Katmandu, Nepal (November 2018). The regulations become effective for new and re-approval applications from January 2019.
To be applicable the diploma has to be acceptable internationally and to form a realistic goal for all countries regardless of their educational facilities. It has to be sensitive to the international and cultural diversity of the members of the UIAA, ICAR and the ISMM. Different countries have different administration systems for both medical and mountaineering regulation (or lack of regulation). Different cultures have different learning styles and education assessment systems. The regulations have to be sensitive to these differences yet will strive to protect its international credibility and ensure a high uniform basic standard. The names of approved courses and their geographic location, main language and contact email address will be posted on the member organisations’ websites.
Organisers of mountain medicine courses can apply to endorse their courses with the label of UIAA, ICAR and ISMM Diploma of Mountain Medicine by sending a standard application form and the course programme to Jason Williams at (JDWilliams@salud.unm.edu) Applications are to be English and a separate form is required for specialty modules. The administrative group will discuss the application and the course organiser will be notified of its decision. We will acknowledge receipt of the application within three weeks. We may ask for further details within one month. A definitive answer regarding registration of the course will be given within three months. The course may be approved, rejected with reason(s) or referred to the UIAA and ICAR medical commissions and the ISMM.
All courses must be open to all suitably experienced candidates regardless of age, sex, nationality, race, creed or religion. A course organiser can set pre-entry qualifications (e.g. medically-qualified doctors only) if it is felt necessary.
All foundational courses should cover the core syllabus (see below) in both theory andpractical skills in both medicine and mountaineering for 120 hours. Course organisers have 29 hours for topics specific to the needs of their country or their course. This will be in addition to the foundational international syllabus. Many foundational courses far exceed the 120 hour requirement. Organisers may apply to run specialty courses in Expedition and/or Rescue Medicine. The syllabi are set out below.
Courses should endeavor to affiliate to a university or professional body for academic accreditation. The medical faculty overseeing the course should be appropriately qualified and able to demonstrate suitable continuing professional development. Medical content can be instructed by non-doctor medical faculty at the discretion of the programme, for example paramedics and nurses, however, experienced doctors must instruct a majority of the medical content and oversee all program medical content.
Fully qualified UIAGM/IFMGA guides must oversee the content of the mountaineering elements of the diploma. Other non-guide course instructors can instruct mountaineering and rescue skills at the discretion of the programme. All practical mountain skills instructors on the course should have any required national qualifications.
Courses must have a support system in place for their students. For example, each student should have a mentor for the duration of the full course.
Some course organisers will chose to run their approved course over several modules to cover the whole syllabus during different seasons. In this case any candidate starting the course should complete it within four years unless there are very exceptional extenuating circumstances and they can produce evidence to support the fact that they have continued to be active in the skills required.
Courses must have some form of valid theory assessment and demonstration of practical skill. The level of medical knowledge and depth of study should be at least equal to a postgraduate medical qualification. The minimum level of mountaineering skills is set out in Appendix 1. The formal assessment system must have a pass, fail or deferral potential for both the medical and mountaineering sections of the course. Foundational and Specialty course assessments should use two questions supplied by the administrative group for that year. These are available from Jason Williams (JDWilliams@salud.unm.edu). Organisers should assess the answers to an appropriate standard. (How the question is presented and answered by the candidate is open to the course organiser to decide. For example, 1200 word essay; short answer question; structured viva, etc.)
The Diploma in Mountain Medicine qualification can only be awarded to Health Care Professionals registered with a national professional regulatory body (Physicians, Paramedics, Nurses, etc.). The Diploma in Mountain Medicine cannot be awarded to basic life support personnel (EMT’s, First Responders, First Aid, etc.). Students in the final part of their course can start the course but must be registered prior to award of the full qualification.
The UIAA/ICAR/ISMM foundational course must be completed before any candidate can be awarded a Diploma for an additional expedition course or rescue course. Once the foundational mountain medicine course and a specialty rescue module are successfully completed the student can be awarded the title “Mountain Emergency Physician/Paramedic etc.
Courses should publish a full list of Diploma holders on a website accessible to the public with names, date of issue and diploma number. Courses should follow country specific data protection laws. The website should have links to and from the websites of the UIAA, ICAR and the ISMM.
The providing programme, or other national regulatory body, must establish a reaccreditation system appropriate to national regulations (but with a maximum cycle of 5 years) and publish a list of Diploma holders and expiration dates. Diploma holders must maintain documentation of their continued personal professional development (mountaineering and medical skills and activity, relevant courses attended, any research and/or teaching undertaken).
The minimum requirement is a logbook system that will be reviewed by the providing programme, or other national regulatory body, within a maximum of five years.
A student can obtain the Diploma in Mountain Medicine qualification by attending more than one DiMM programme. This is permitted only when a formal transfer agreement exists between programmes that include a gap analysis of course curriculum to ensure all requirements are met.
Courses may incorporate online learning tools into their program. Online learning should not take the place of adequate field time and skill assessments. A majority of the course must take place in person.
New courses are approved for 2 years. They should have formal links to an established Diploma for support during the initial two years. New course organisers must invite members of the UIAA Medcom, ICAR Medcom or ISMM to observe their courses.
An application for re-approval must be made after 2 years and then, if successful, every 4 years. A re-approval request, comprises a re-application form and a formal site visit report from an external assessor acceptable to the administrative group who has been present at a course during the preceding 2 years. The standard external assessor site visit report form is available from Jason Williams (JDWilliams@salud.unm.edu). Examples of an acceptable external person could include another course organiser, a member of the Administrative group or another member the UIAA or ICAR Medcom(s) or ISMM. Courses must be able to pay reasonable travel and in country expenses for the presence of an external assessor. To minimise expense the assessor could be used as an outside teacher on the course and should never expect more than reasonable expenses that have been agreed beforehand. Any major changes made to a programme during the four year approval cycle should be communicated to the administrative group.
The administrative team is made up of representatives elected by the member organisations and their respective presidents. The minimum number of persons is three. It will conduct its work by email and be accountable to the member organisations. A representative with a conflict of interest must inform other members of the team of the conflict. Decisions are made by consensus. The administrative team does not have the authority to alter the regulations. Its role is to approve courses by assessing the curriculum and assessment methods, and to keep a record of courses (so that enquiries can be directed to course organisers).
David Hillebrandt (firstname.lastname@example.org), Urs Hefti (email@example.com) George Rodway (firstname.lastname@example.org) Rianne Van der Spek (email@example.com) for the UIAA Medcom;
John Ellerton (firstname.lastname@example.org), Jason Williams (JDWilliams@salud.unm.edu), Bruce Brink (email@example.com), and David Watson (firstname.lastname@example.org) for ICAR Medcom;
Remco Berendsen (R.R.Berendsen@lumc.nl) and Hermann Brugger (email@example.com) for ISMM.
Oliver Reisten (firstname.lastname@example.org) with a special focus on the specialty rescue module.
The DiMM can be awarded upon completion of the Foundation Training Course in Mountain Medicine (120 hours)