Establishing Minimum Patient Volume Requirements for Emergency Medicine Residencies

Area of Science:

• Medical Education
• Emergency Medicine Residency Training
• Healthcare Quality Improvement

Background:

• Current ACGME EM program requirements (PR) mandate a minimum annual patient volume of 30,000 at the primary clinical site.
• This volume serves as a proxy for ensuring adequate clinical exposure for residents during their training.
• Revisions propose shifting to a minimum number of patient visits per resident, aggregated across all EM rotation sites.

Purpose of the Study:

• To evaluate the feasibility and implications of modifying ACGME EM program requirements.
• To assess current resident clinical exposure in terms of patient visits per resident.
• To establish an evidence-based threshold for minimum patient encounters during EM residency.

Main Methods:

• Calculated aggregate patient visits per resident for each EM program using ACGME program information.
• Multiplied weekly emergency department (ED) volume at each site by the number of weeks spent in EM rotations.
• Divided the total patient visits by the approved resident complement for each program.

Main Results:

• Of 282 programs, 24.1% had fewer than 3000 patient visits/resident, with a mean of 4507.8 and median of 4219.5.
• Nearly 25% of 4-year programs fell below the 3000 visits/resident threshold.
• Adjusted calculations for 3-year programs showed 0.9% falling below 3000 visits/resident.

Conclusions:

• The proposed minimum of 3000 patient visits/resident, aggregated across all sites, aligns with current program offerings and existing PR.
• This revised metric aims to ensure adequate patient experiences for residents.
• While not currently tracked, the proposed PR supports a foundation for patient encounters, with an ideal target of 5000 per resident.