Program Director Perspectives on the Impact of the Proposed 48-Month Emergency Medicine Residency Requirement: A...

In early 2025, the Accreditation Council for Graduate Medical Education (ACGME) announced proposed revisions to emergency medicine (EM) residency training to include substantial changes to the length of training programs, required rotations, and structured experiences. To date, no published national survey has sought to determine how these changes would impact individual programs.

Over a three-week period in April 2025, we anonymously surveyed program directors or their designees online through the Council of Residency Directors in Emergency Medicine listserv. Survey respondents were asked about the impact the changes would have on their programs and their overall opinions of the proposed 48-month minimum requirement.

A total of 86 program directors responded to the survey (response rate of 29.9%) with representative samples from current three-year (83.7%, 72/86) and four-year (16.3%, 14/86) programs. Most program directors reported that they would have to make significant revisions in either structured experiences, required rotations, or both. Most survey respondents from three-year programs (52/72) do not support the proposed changes, whereas all respondents from four-year programs (14/14) do support the changes (P<.001).

Proposed program requirements may require modifications in both three- and four-year programs; 33 of the 86 program directors surveyed reported that would need more than one year to meet the requirements, if adopted. This raises the concern that programs may not be prepared to implement the revisions within the proposed timeline, potentially impacting resident education and the future EM workforce. The ACGME should consider a staged rollout of requirements to allow them to be thoughtfully implemented in a meaningful way.