CONCEPTS academic emergency medicine; residency, emergency medicine

A c a d e m i c Emergency Medicine: A National Profile With and Without Emergency Medicine Residency Programs From the University of Colorado Health Sciences Center, Denver;* Case Western Reserve University, Cleveland, Ohioff

Steven M Chernow, MD*§ Charles L Emerman, MD~e Mark Langdorf, MD*§ Carl Schultz, MD*§

University of California, Irvine;t and Education Committee,

Study objective: Formal data are lacking regarding emergency departments in academic medical centers, particularly those without an emergency medicine residency program. The EducationCommittee of the Society for Academic EmergencyMedicine conducted a survey to define a national profile of academic emergencymedicine. Design: Prospectivesurvey with telephone follow-up.

Societyfor Academic Emergency

Academic medical centers.

Medicine, Lansing, Michigan.§

Setting:

Receivedfor publication

Participants: One hundred twenty-three academic medical centers as defined by the Association of American Medical Colleges.

October 29, 1991. Revision received March 9, 1992. Acceptedfor publication April 10, 1992. Presented at the Scientific Assembly of the American College of Emergency Physicians in San Francisco, September 1990.

Results: Results were obtained from 94 (78%)institutions: 27 (29%) had an emergencymedicine residency program and 67 (71%) had no emergency medicine residency program. Significant differences were found between those with and without emergency medicine residency programs regarding 24-hour attending coverage (96% versus 73%), mean weekly clinical faculty hours (26 versus 33), the number of emergency medicine board-certifiedfaculty, faculty recruitmentdifficulties (25% versus 75%); and the presence of a curriculum for housestaff (96% versus 38%). No significant differences were noted regarding the presence of a curriculum for medical students (78% versus 64%). Of the 67 institutions with no emergencymedicine residency programs, 42% were actively planning a program, and 42% would consider future development of a program. Conclusion: This article provides the first comprehensiveprofile of emergency medicine in the Association of American Medical Colleges academic medical centers. Programswith emergencymedicine residency programs provided more 24-hour attending coverage, had more emergency medicine board-certified faculty, and reported less difficulty recruiting additional faculty than institutions with no emergencymedicine residency program. Both need to expand their undergraduateeducational activities. Many institutions with no emergencymedicine residency program are attempting to develop emergencymedicine residency programs. [Chernow SM, Emerman CL, Langdorf M, Schultz C: Academic emergency medicine: A national profile with and without emergency medicine residencyprograms.Ann ErnergMeflAugust1992;21:947-951.]

AUGUST1992 21:8 ANNALS OF EMERGENCYMEDICINE

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RESIDENCY PROGRAMS Chernow et al

INTRODUCTION

RESULTS

Emergency medicine is the newest of the medical specialties. Studies have attempted to clarify u n d e r g r a d u a t e emergency medical education in medical schools,i, 2 and the need for 24-hour attending coverage in emergency medicine residency programs.3, 4 Regulations regarding resident hours and attending coverage in emergency departments have recently been suggested. 5 Little formal information has been published regarding the clinical and academic environment of EDs in academic medical centers, particularly those with no emergency medicine residency program. We therefore surveyed all EDs, including those without a n emergency medicine residency, in academic medical centers as defined by the Association of American Medical Colleges. The purpose of the survey was to collect data on faculty, housestaff, and curriculums to provide a national profile of emergency medicine in the Association of American Medical Colleges academic medical centers and delineate differences between institutions with and without emergency medicine residency programs.

Of the 123 academic medical centers, 120 had EDs. Results were obtained from 94 of these institutions (78%), Of these, 27 (29%) h a d an emergency medicine residency program, and 67 (71%) had n o emergency medicine residency program. Fourteen (15%) were independent academic departments, and 64 were sections of other departments, including general surgery (41%) and internal medicine (38%). Attending clinical coverage is summarized (Figure 2). Twenty-four-hour ED attending coverage was provided in 26 (96%) of emergency medicine residency programs and in 49 (73%) Of the institutions with no emergency medicine residency p r o g r a m (X2 = 6.4, P = .01); 18% of institutions with no emergency medicine residency p r o g r a m provided 12 or fewer hours of ED attending coverage. The mean number of full-time faculty p e r 10,000 annual ED patient visits was 2.2 +_1.0 for emergency medicine residency programs and 1.76 + 1.2 for institutions with no emergency medicine residency program. The mean number of clinical hours p e r week for full-time faculty in institutions with emergency medicine residency programs was 26 + 4.3 hours compared with 33 + 9.2 hours for full-time faculty in institutions With no emergency medicine residency p r o g r a m (P = .0001). The mean number of clinical hours p e r week for full-time faculty in both types of institutions was 31 + 8.5. F o r t y - f o u r percent of the faculty in institutions with no emergency medicine residency programs and 62% of the faculty in emergency medicine residency programs published in the emergency medicine literature within the past five years. The percentage of faculty publishing correlated inversely with the required clinical hours (R = - 0 . 3 5 ; P < .002),

MATERIALS AND METHODS All 123 academic medical centers as defined by the Association of American Medical Colleges were surveyed between May 1989 and May 1990 (Figure ]).6 Telephone contact was made with each institution to obtain the name(s) of the ED director(s). A survey instrument was developed by the Education Committee of the Society of Academic Emergency Medicine. The survey was forwarded to the directors of the academic EDs. Telephone follow-up and repeat mailings were conducted for nonresponders. The survey requested information regarding the institution, faculty clinical coverage and publishing, b o a r d certification of faculty and directors, housestaff clinical hours and curriculum experience, u n d e r g r a d u a t e clinical rotations and curriculum, regular emergency medicine conferences, and future consideration regarding development of an emergency medicine residency program. Data were analyzed using the statistical analysis system. Values are expressed as proportions or as means _+s t a n d a r d deviation. Student's t-test was used to compare two means. Z2 analysis was performed to test the significance of differences in proportions. Figure 1. Association of American Medical Colleges criteria of American medical centers Must have a signed affiliation agreement with a college of medicine accredited bythe Liaison Committee on Medical Education Be a nonfederal member of the Association of American Medical College's Council of Teaching Hospitals Be under common ownership with a college of medicine, o r have most medical school department chairmen as the hospital chiefs of service, or have the chairman responsible for appointing the hospital chief of service Provide a short-stay, general hospital service

Figure 2. Hours of clinical attending coverage % of Programs

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Academic emergency medicine: a national profile with and without emergency medicine residency programs.

Formal data are lacking regarding emergency departments in academic medical centers, particularly those without an emergency medicine residency progra...
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