In reply

Abstract

We welcome the comments from our experienced rural emergency medicine colleagues. However, their letter comingles emergency medicine workforce issues with residency training issues. The argument that non–American Board of Emergency Medicine (ABEM)/American Osteopathic Board of Emergency Medicine (AOBEM) physicians can deliver high-quality patient care is not at odds with the position that training program accreditation should require ABEM/AOBEM-prepared or -certified instructors. We recognize that the “dream” of staffing all emergency departments (EDs) with emergency medicine residency–trained physicians is beyond reach. However, when it comes to training, we have a responsibility to the public to ensure patient-centered training, which encompasses both patient safety and quality of care. The Emergency Medicine Residency Review Committee must have a standard benchmark to ensure instructor quality; they have chosen board certification. Although it is conceivable that individual emergency medicine residency programs could be allowed to provide alternative credentials for rural faculty members who can prove added qualifications for emergency medicine residency instruction (eg, additional training and experience in emergency airway management, procedural sedation, ultrasonography), the logistics of constructing this level of individual verification would be prohibitive and lack standardization. Furthermore, we are unable to find any evidence to suggest that emergency medicine residents trained under non-ABEM/AOBEM-trained physicians provide improved patient care. We believe that ABEM-trained physicians are not the only faculty members deemed competent to teach emergency medicine residents. In fact, each of our emergency medicine residency programs and all emergency medicine residency programs that we are aware of support multidisciplinary instruction in the respective settings of each specialty's own domain. That is, our residents learn orthopedics from orthopedic surgeons in orthopedic clinics and consulting in the ED, pediatric critical care from pediatrics intensivists in the pediatric ICU, obstetrics from obstetricians on labor and delivery, etc. However, no emergency medicine residency program that we are aware of uses nonspecialty faculty to teach specialty-specific knowledge and skills. As emergency medicine faculty, we do not support knowingly placing trainees in clinical learning environments where the supervising physicians have not been formally trained to provide the care they are delivering. We recognize that experienced rural providers of all training levels, including family practitioners, have valuable insight for the training of emergency medicine residents. However, within the constraints of duty hours and a 3-year training program, it is our responsibility to maximize residents' exposure to quality faculty and ensure the required breadth in curriculum that comes with an ABEM/AOBEM certification. In doing so, it is an academic reality that only emergency medicine board-certified physicians may oversee training of emergency medicine residents. The Emergency Medicine Residency Review Committee has the best interest of patients and patient safety at heart when they make this demand. The most vital difference in training can be summed up in 5 words: airway management and procedural sedation. Finally, the authors of the program director's guide squarely reject any attempt to use the rural rotation guide to politicize the rural emergency medicine turf. Our article focuses on the development of rural emergency medicine rotations for emergency medicine residents and is not an advocacy piece for having non–emergency medicine board-certified faculty in rural EDs; this is a Residency Review Committee decision. Rural Emergency Medicine Rotations: Could Family Practice (ABFM) Faculty Supplement ABEM faculty?Annals of Emergency MedicineVol. 62Issue 6PreviewWe commend the authors of this article1 for the excellent suggestions that promote rural rotations for emergency medicine residents. But much of their commentary on other aspects of the rural emergency medicine workforce is inaccurate and specialty-centric instead of patient-centric. Are American Board of Emergency Medicine (ABEM)–trained physicians the only competent faculty to teach emergency medicine residents? If so, is this evidence based or simply a reflection of scope of practice issues that are historical, rather than forward thinking? Full-Text PDF