Boarding and Crowding Are Facts of Life. It's Time We Adapt Resident Education to Them

Although the COVID pandemic and its aftermath may have shone a light on the issues of emergency department (ED) crowding and boarding, these are not new problems. Much has been written on ED crowding for the past 35 years, analyzing its causes and effects on both patient care and resident education. However, relatively little has been done to explore how to adapt resident education models or leverage physician-in-triage models and other by-products of overfilled waiting rooms to prepare residents for the inevitability of boarding in their future careers. In this article, we examine how the understanding of ED boarding has evolved over time with particular reference to resident education. We then review strategies that have been proposed to improve resident education in times of ED crowding. Ultimately, we propose shifting the paradigm to one in which ED boarding is accepted as an inevitability such that residency training programs can focus on ways to prepare future emergency medicine attendings for this reality.