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Conference Information

Emergency Medicine Guidelines

Core Faculty Maximum Clinical Time Guideline

The Emergency Medicine program requirements state “A core faculty member, a member of the program faculty, is one who provides clinical service and teaching, devotes the majority of his or her professional efforts to the program, and has sufficient time protected from direct service responsibilities to meet the educational requirements of the program.” The RRC realizes there is a great deal of variability in program faculty. However, the RRC feels it is useful for Program Directors to understand how the RRC assesses protected time for core faculty. The RRC feels that core faculty should not be working more than 28 clinical hours per week. This maximum would allow for some protected time as specified in the Program Requirements.

Faculty Scholarly Activity

Individual Core faculty Productivity:

At minimum, 80% of individual core faculty members should demonstrate at least one piece of scholarly activity per year, averaged over the previous 5 years period, as noted in the Program Requirements.

Collective Peer-Review Publications:

The programs faculty must demonstrate significant contributions to the specialty of Emergency Medicine. At minimum, this should include one scientific peer-reviewed publication for every five core faculty members per year (averaged over the previous 5 year period). When considering the programs collective peer-reviewed publications, each publication may be counted only once, even if multiple faculty members were involved as co-authors.

Faculty Staffing Levels

It is important that each program maintain sufficient levels of faculty staff coverage in the emergency departments in order to ensure adequate clinical instruction and supervision, as well as efficient, high quality clinical operations. The RRC-EM uses a faculty staffing ratio of 4.5 patients per faculty hour or less as a guideline in this determination.

This may be calculated in the following manner:

(Patient visits per year / Faculty hours per day) / 365 days per year = Patients per faculty hour

Example: ((70,000 patients per year / 55 faculty hours per day) / 365 days per year) = approximately 3.5 patients per faculty hour

RRC Use of ABEM Data

Successful attainment of board certification by program graduates is an objective measure used by the RRC- EM to evaluate program quality. Program graduates are expected to take the ABEM Written and Oral certifying examinations. Over the 5-year period immediate preceding program review at least 70% of program graduates taking the Written Examination and at least 80% of graduates taking the Oral Examination should become certified on their first attempt. The RRC-EM will take into account improvement or declines during the period considered and will consistently monitor programs according to these criteria.

Duty Hours on Emergency Medicine Rotations

There must at least an equivalent period of continuous time off between scheduled work periods. Residents may attend educational activities between work periods, but at some point in the 24 hour period must have an equivalent period of continuous time off between the end of one activity (work or educational) and the start of another activity (work or educational).

GUIDELINES FOR PROCEDURES AND RESUSCITATIONS

Numbers include both patient care and laboratory simulations

Adult medical resuscitation 45
Adult trauma resuscitation 35
ED Bedside ultrasound *
Cardiac pacing 06
Central venous access 20
Chest tubes 10
Procedural sedation 15
Cricothyrotomy 03
Disclocation reduction 10
Intubations 35
Lumbar Puncture 15
Pediatric medical resuscitation 15
Pediatric trauma resuscitation 10
Pericardiocentesis 03
Vaginal delivery 10

* See Procedural Competency Guideline

Qualifications for Emergency Medicine Faculty

All emergency medicine faculty supervising emergency medicine residents on emergency medicine rotations must be board certified by the American Board of Emergency Medicine, or have appropriate educational qualifications in emergency medicine. Examples of educational qualifications acceptable to the RRC include:
Certification by the American Osteopathic Board of Emergency Medicine
Certification by a subspecialty board sponsored or cosponsored by the American Board of Emergency Medicine
Recent residency or fellowship graduates actively working toward certification by the above boards
Additionally, faculty providing supervision to emergency medicine residents on emergency medicine rotations must have appropriate qualifications relative to the patient population for which they provide EM resident supervision. For example, a faculty member board certified in pediatrics and pediatric emergency medicine would be qualified to supervise EM residents on pediatric cases, but not adult cases.

Planned Educational Experiences for Resident Programs

Programs may utilize individualized interactive instruction for up to 20% of the planned educational experiences (i.e. on average, 1 hour out of the five hours per week of planned educational activity (PR V.E.1)

The remainder of the required educational activities may use either small group techniques (such as breakout groups, serially repeated conference sessions, or practicum sessions), or large group planned educational activities, as noted in PR V.E.3.

The RRC-EM will review individual program curricula to verify that planned educational activities:

Average at least five hours per week of educational time (PR V.E.1);

Are appropriately faculty supervised;

And have an evaluative component (consistent wit PR VII.C) to measure resident participation (PR V.E.2) and educational effectiveness (PR JV.C.1.d.1)

Sleep Room

Emergency Medicine Residents must be provided with a system for adequate and appropriate sleeping quarters that are safe, quiet and private on a continuous 24 hour basis (excluding hospitals where the Emergency Medicine Residents only work day/early evening shifts).

Throughput Times

The suggested maximum average throughput times for Emergency Department patients are 4 hours for discharged patients, and 8 hours for admitted patients to arrive on the floor excluding observation patients.

Core Competencies Guideline

Annual Competency Assessment – The programs must define competencies that are expected for each year of training taking into account the defined ACGME core competencies. Multiple tools may be used to evaluate these competencies. Competency evaluation of chief complaints, procedures, resuscitations and off-service rotations may be used as part of the annual competency evaluation. The RRC will review:

What competencies are expected for each year of training? What are the measurable competency objectives for each year of training? How are these objectives measured? How are deficiencies remediated?

Deficiencies in specific areas does not necessarily mean that the resident is held back in progressing to the next year; however, plans must be in place to achieve the required competencies.

Chief Complaint Competency – The RRC expects that programs will assess the competency of residents to handle key chief complaints in emergency medicine. At the time of program review, the program will demonstrate how it assesses resident competency for 3 chief complaints over the course of the training program. The program can use a variety of tools including direct observation, check-lists, simulations, etc.

Procedural Competency – The primary responsibility for the determination of procedural competency rests with the program director and the faculty. The RRC accredits programs, and does not certify or credential individuals.

The RRC expects programs to assess the competency of residents to perform key index procedures. At the time of program review, the program will need to demonstrate how it assesses competency of residents for 3 procedures.

Selected index procedures should consequentially impact patient care, and ideally facilitate competency assessment initiatives across disciplines.

One of the selected procedures must be ED bedside ultrasound.

Resuscitation Competency – The RRC expects programs to assess resident competency in the resuscitation of critical patients. These include adult and pediatric medical and trauma resuscitations. At the time of program review, the program will demonstrate how it assesses competency in one type of resuscitation. The program may use a variety of techniques including simulations and direct observations.

Off-Service Rotations – The program should define and prepare in written format measurable competency objectives for all off-service rotations, the evaluation tools to assess achievement of the objectives and the plans to remediate when necessary. At the time of program review, the measurable objectives and the evaluation tools for all off-service rotations must be available for review by the site visitor.