The State of the Specialty

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The RRC reviewed 32 programs and accredited two new core EM programs, six EMS fellowship programs, and one pediatric EM fellowship program.

I have now completed attendance at my third Residency Review Committee (RRC) meeting. I again ventured from Florida to Chicago for a jam-packed agenda. As you may know, the major task of the RRC is to review both core and sub­specialty emergency medicine programs for accreditation. Each application for accreditation or continued accreditation is 100-200 pages in length with dizzying complex language that I’m just now begin­ning to understand. My more senior colleagues at the end of their six-year terms (my term is two years) can almost recite the program requirements for the core programs verbatim. All-in-all, the RRC reviewed 32 programs, and I am pleased to announce the new accreditation of two core EM programs, six EMS fellowship programs, and one pediatric EM fellowship program (Table 1).

Table 1. Newly Accredited Programs
University TN Memphis (EM Core)
University TN Murfreesboro (EM Core)
University Arizona (EMS)
University of Southern California (EMS)
UCSD (EMS)
Indiana University (EMS)
EMS Brown University (EMS)
University TN Chattanooga (EMS)
University Texas at Houston (Peds/EM)

While our responsibilities primarily include reviewing programs and providing guidance on the education requirements for all ACGME-accredited emergency medicine programs, the RRC also coordinates with the American College of Emergency Physicians (ACEP) and the American Board of Emergency Medicine (ABEM). At our last meeting, we heard from our ACEP and ABEM liaisons, who provided updates from their respective fields and relayed data regarding our subspecialties.

ABEM’s executive director reported that of the 31,154 ABEM diplomates, 1,283 (4.1%) currently hold an ABEM-issued subspecialty certificate. So, in what are our colleagues specializing? Table 2 shows where we are now. With the expansion of critical care training options for EM and the recent accredi­tation of EMS as a subspecialty, I predict a major jump in these fields over the next several years that will easily eclipse the number of medical toxicology specialists. This trend will take the lead for fellowship-trained emergency physicians.

Table 2. Number of Subspecialty Certificates
Anesthesiology CCM: 0 (first exam in 2014)
Emergency Medical Services: 195
Hospice and Palliative Medicine: 94
Internal Medicine CCM: 44
Medical Toxicology: 356
Pediatric Emergency Medicine: 264
Sports Medicine: 142
Undersea & Hyperbaric Medicine: 188
Pain Medicine: 5 (not an ABEM certificate)

Emergency medical services

The first EMS certification examination was given to 350 candidates in October 2013; 204 passed (58.3%). Of note, fellowship training was associated with passing the examination.

Critical care medicine

On October 9, 2013, the second admin­istration by the American Board of Internal Medicine (ABIM) of the Internal Medicine CCM (IM-CCM) certification examination for ABEM diplomates took place. There were 19 ABEM diplomates who took the examination; all 19 passed. To date, 44 ABEM diplomates have taken this examination, and all 44 have passed.

ABEM is now a co-sponsor with the American Board of Anesthesiology (ABA) for certification in Anesthesiology Critical Care Medicine (ACCM). Emergency physicians entering ACCM fellowships are required to complete 24 months of training. There are about 10 programs that are approved by the ABA to accept emergency physicians (check the ABA website for a comprehensive list).

Clinical ultrasonography

ABEM is pursuing subspecialty certification in clinical ultrasonography; expect more to come on this in the future.

An alert for the PGY1s and medical students – the emergency medicine in-training examination will be administered in 2016 in both paper and computer-based formats. Deciding which programs receive paper exams and which receive electronic exams has not yet been completely established. The final bit of good news from ABEM is that in the upcoming year, there will not be an increase in examination fees; for now, ABEM is holding fees steady.

ACEP Academic Affairs Committee (AAC) update

This committee is spearheading ACEP’s focus on GME funding with the goal of identifying GME issues and advocacy solutions, including ascertaining the value of GME and the effect of health care reform on GME funding. The EM model is currently undergoing a revision for 2015. In collaboration with other organizations in our specialty, EMRA has been asked to develop recommendations regarding inclusion of integrated models of care and transitions of care between the ED and primary care.

We also discussed the impact of the RAND report, which revealed that approximately half of all hospital admissions come through the ED. This was followed by ACEP’s promotion of the Choosing Wisely campaign, which encourages proper resource utilization and evidence-based medicine for decisions like CT head for mild traumatic brain injury, urinary catheters for “convenience,” and PO rehydration methods, just to name a few.

When I left the RRC meeting and returned to Florida, not only was I cheered by the balmy weather, but I was also inspired to do more. Our specialty is doing great things, and continues to push the boundaries and break down barriers that were present just 5 or 10 years ago. And I’ve got a feeling that the best is yet to come.

Loose ends

In previous years, the RRC met in September and February, but will be transitioning to a June/January schedule to fulfill a Next Accreditation System (NAS) requirement. I love hearing from you! If you have any comments or concerns, be sure to contact me as soon as possible, so that I can take your thoughts to the next meeting. Let me know how I can best serve the EMRA members.

My term as RRC rep is quickly coming to a close, and it is time to start thinking about the next person in line. The EMRA Board is seeking interested residents for the RRC representative position. The term will start with a transitional orientation RRC meeting in January 2015 with board responsibilities beginning at the 2015 SAEM meeting. Please contact me at rrcemrep@emra.org if you are interested in the position or just want to pick my brain about the responsibilities it entails. It has been a great term so far, and I know that even bigger things are in store for the next RRC representative.

Brandon Allen, MD

Brandon Allen, MD

RRC-EM Representative, University of Florida, Gainesville, FL
Brandon Allen, MD

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