Program Director Opinion on the Ideal Length of Residency Training in Emergency Medicine

This study sought to define expert opinion on the ideal length of training (LoT) for Accreditation Council of Graduate Medical Education (ACGME)-accredited emergency medicine (EM) residency programs.

A cross-sectional Web-based survey was sent to program directors (PDs) at all ACGME-accredited EM residency programs during a study period of August to October 2014. The primary outcome of ideal LoT was determined in two ways: 1) subjects provided the ideal total LoT in months and 2) then separately selected the type and number of rotations for an ideal EM residency curriculum by month, the sum of which provided an alternative measurement of their ideal LoT. We did not include vacation time. Descriptive statistics and an analysis of variance are reported.

Response rate was 68.0% (108/159) with 72% of respondents (78/108) directing programs in the PGY 1-3 (36-month) format and 28% directing PGY 1-4 (48-month) programs. More than half of subjects (51.9%) have direct personal experience with both formats. When asked about ideal total LoT, PDs averaged 41.5 months (n = 107; SD = 5.5 months, range = 36-60 months). When asked to provide durations of individual clinical experiences for their ideal EM program, the sum total (n = 104) averaged 45.0 months. Results from a factorial analysis of variance revealed statistically significant effects of PDs' past training experiences: participants who trained in a 36-month program had statistically significantly lower LoT (mean = 39.2 months) than participants who trained in a 48-month program (mean = 44.5 months). There was also a statistically significant effect of current program format on ideal LoT: participants who directed a 36-month program had statistically significantly lower LoT (mean = 39.8 months) than participants who directed a 48-month program (mean = 45.8 months).

PD opinion on ideal LoT averages between 36 and 48 months, but is longer when the sum of desired clinical rotations is considered. While half of the respondents reported direct experience with both PGY 1-3 and PGY 1-4 training programs, opinions on ideal LoT through both methods corresponded strongly with the length of the program the PDs trained in and the format of the program they currently direct. PD opinions may be too biased by their own experiences to provide objective input on the ideal LoT for EM residency programs.