The PRWG also identified a set of new experiences necessary for emergency medicine training and claimed these cannot be achieved in a three-year format. The writing group included few three-year PDs—educators who know best what can be accomplished within existing structures.

The PRWG also leaned heavily on a survey where PDs were asked to build an imagined program without constraints, with the individual components adding up to more than could be covered in 36 months.¹ This survey was not conducted in a transparent fashion and is not sufficient for claiming PD consensus on training length. The rationale for the format change is lacking, and alternative measures could be used to ensure high training standards.

The PRWG has not provided convincing evidence of a problem with emergency medicine graduate competency on a scale that requires this level of disruption. Nor have they demonstrated that a time-dependent format change would make meaningful change to improve graduate competency. Our public letter to the ACGME cites current literature, including a study that shows no difference in performance of three- and four-year graduates, and higher qualifying exam pass rates for three-year program graduates.^2,3 In addition, the PRWG proposed a time-dependent format change, even as the ACGME itself moves towards competency-based education as the model of the future. The writing group has failed to present measures that will be used to evaluate whether this intervention is meeting its goals. We need more data to support this change.

This proposal is being pushed through without responsible engagement with current education leaders and without addressing major concerns about the burden on institutions, programs, and trainees.

Why? There are serious potential unintended consequences on the workforce, non-physician providers and departmental staffing, resident debt, student recruitment, fellowship training, and more. The ACGME should, of course, maintain their focus on the education of our future physicians, but they do not operate in a vacuum, as the last few years have demonstrated.

As a specialty, we need time and data to understand the effects of this change and to prepare if this course of action is indeed supported by evidence. The internal ACGME comment form is insufficient to address these concerns and the Council of Residency Directors in Emergency Medicine (CORD), as the organization that represents PDs, has also been disappointingly silent since the PRWG presentation, declining to create a forum for membership input on the proposal.