Increasing Role in Health Care

Emergency medicine is a dynamic and continuously evolving specialty. To suggest that emergency medicine practice remains unchanged since my residency graduation nearly a decade ago, or even since the last significant discussion regarding training length, would be a profound misrepresentation. The scope of our responsibilities and the depth of expert-level knowledge expected of us are constantly expanding. How do we effectively incorporate the necessary experiences and dedicated learning time to prepare our residents for this increasingly complex role? Standardizing training to an appropriate length offers the opportunity to better equip them for the present and future demands of emergency medicine practice.

Stripping away the understandable emotional responses surrounding the proposed increase in training length reveals a fundamental truth. The practice of emergency medicine today, and undoubtedly in the future, bears little resemblance to its iteration in years past. Therefore, a proposal to adjust the length of training should not be met with surprise but rather with thoughtful consideration and, frankly, a degree of advocacy.

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Dr. Little is the residency program director at AdventHealth in Orlando.

CON: The Four-Year Mandate: Where’s the Data?

by Megan Healy, MD, FAAEM

A large group of emergency medicine program directors (PDs) convened in March 2025 to discuss major concerns about a proposed mandate to extend emergency medicine residency training to four years, established by the Program Requirements Writing Group (PRWG) of the Accreditation Council for Graduate Medical Education (ACGME).

The experienced PDs who assembled represent three-year programs, which account for about 80 percent of all emergency medicine programs. This group is troubled by the methods used by the PRWG to develop the proposed changes, concerned about the lack of evidence to support the proposal, and frustrated by the absence of broader stakeholder engagement in this disruptive and consequential change.

The PRWG explains that their directive was to create a residency curriculum for the future of 2050. We all agree on the need to set and maintain high standards for emergency medicine training.

However, a time-dependent format change is not the clear way to achieve this. Among other conclusions, the group cited 5,000 patient contacts throughout the course of training as a benchmark for competency and 124 weeks of emergency medicine time as the interval necessary to meet this goal, without supporting data. Many current three-year programs can achieve these numbers within current formats.