Residency training in emergency medicine: the challenges of the 21st century

Emergency Medicine is a relatively young specialty in the United States as well as in other parts of the world. It was only 36 years ago, in 1968, that the American College of Emergency Physicians was founded. Two years later, the University of Cincinnati in Cincinnati, Ohio, USA launched the first Emergency Medicine Residency Training Program. Until the inception of this program, staffing of "Emergency Rooms" consisted largely of physicians who were not trained in the specialty of Emergency Medicine. Emergency Medicine Residency training programs fulfill the need to have Emergency Medicine trained physicians staffing Emergency Departments. There are three and four year training formats for Emergency Medicine in the United States. The University of Cincinnati program is a full four-year program, which teaches residents to master the many diagnostic, procedural, and interpersonal skills required of Emergency Medicine physicians. Diagnostic skills must encompass the pathology affecting all organ systems in all age groups and both sexes. Procedural skills include airway management, vascular access, cavity access, and wound repair. Interpersonal skills are demanding as well, requiring leadership/management of the Emergency Department care team, immediate patient rapport, and dealing with patient/family grief. The Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) ensures that all programs have a structured curriculum complete with both didactic and bedside teaching, as well as structured methods for evaluation of both residents and faculty. According to manpower studies, a great need still exists for Emergency Physicians in many United States hospitals, particularly in rural communities.