Dr. Gorgas: You’ve clearly done some work for this interview, and you’re right. Can you amass the medical knowledge needed to do well on the qualifying exam in a three-year span versus a four-year time span. Yes, the numbers show that. Can you develop some of the other skills that are unique to the oral examination or the virtual oral examination better in a four-year time span than you can in a three-year time span? Well, the statistics are starting to pull apart a little bit there, saying there might be a slight advantage to four-year programs. The next and very interesting question is, as we continue to extend that assessment scope, are we going to see a bigger difference in four-year programs than three-year programs?

What does ABEM believe? ABEM believes the numbers. Are you going to be a better emergency physician if you’re seven years into your experience instead of three or four? Likely you will be. What we’re looking at is, “What is the definition of competency?” What is that critical skill set to say you are able to independently practice emergency medicine?” That’s the fine line of ABEM.

Dr. Dark: Still talking about this three- versus four-year situation. The ACGME recently announced plans to have every emergency medicine program transition into a four-year pathway.⁵ Does ABEM have an official comment on that?

Dr. Gorgas: Much like ABEM took a couple of years to make a determination about the certifying exams, the ACGME Emergency Medicine Review Committee (RC-EM) has taken at least a couple of years to come up with their new program requirements. One thing that we will say is, we really respect the RC-EM and their ability and expertise in defining the learning environment that is critical for creating a successful emergency physician. ABEM looks at the individual and certifying the individual. The ACGME looks at the environment and accrediting the environment.

Consider that there are only now three specialties that have only three years of training besides emergency medicine. All three of those are primary care specialties—family medicine, pediatrics, and internal medicine. I think emergency medicine has really tried to label itself as a unique specialty whose primary focus is not primary care.

From a sense of pride, and from a sense of logic, do we belong in a three-year or a four-year bucket? ABEM has not leaned into the public comment period yet. We are hoping to hear from diplomates and candidates for certification as it relates to board eligibility. How do they feel? Board eligibility is going to be impacted by the change, and we will be speaking with the ACGME with that lens in mind.