These policies seem a bit at odds with the recent denouncement on short courses. In this second scenario, how should a medical director certify that this new hire can manage a trauma patient? How can they watch them assess a trauma patient, practice inserting a chest tube, perform a pericardiocentesis, or even a thoracotomy, before they are hired?

While ATLS provides one with a chance to perform these procedures, its strength is teaching the physician a step by step assessment of the trauma patient, and being able to tell a trauma surgeon at their institution or 50 miles away exactly what they have found, procedures they have performed, and why the patient needs an urgent operation or transfer to a higher level of care. It also covers areas such as care of the elderly, disaster management and emergency preparedness⁴, which are not listed in the EM model.

Granted ATLS does not make you competent in these procedures (that takes practice, which many EM physicians may not get even in years of working in an ED), but it is a step in the right direction. In addition, if a physician has been a supervising attending for EM residents, it is likely that they have supervised procedures, rather than performing those procedures themselves, so a “refresher” short course may be in order.

One may say, if I maintain my board certification in EM, through Maintenance of Certification (MOC), then that should suffice for my ongoing qualifications; however, there is no procedural competency associated with this.

The MOC covers professional standing, lifelong learning and self-assessment (LLSA), assessment of cognitive expertise, and assessment of practice performance.⁵ LLSA consists of readings and a test on these readings. Practice performance focuses on patient care practice improvement (PI) activities, and communication/ professionalism patient feedback programs.

Assessment of cognitive expertise is done by taking the ABEM ConCert exam, and professional standing means having a current, valid, full, unrestricted, and unqualified medical license.

In most states, physicians need a specific number of continuing medical education (CME) hours over a specified number of years. This later area is where continuing medical education comes into play.

The ACEP short courses are updated periodically, so it is a great way to stay up-to-date and learn about advances in the specific areas (resuscitation, trauma management).

The Short Course policy also states that there should not be “a specified number of continuing medical education hours in a sub-area of emergency medicine, as requirements for privileges or employment for physicians certified by ABEM or AOBEM.”¹