National Survey of Telemedicine Curricula Among Emergency Medicine Residencies.

Changes in Sex, Race, and Ethnic Origin of Emergency Medicine Resident Physicians From 2007 to 2017.

Unscrambled: Every Emergency Medicine Spot Filled in Residency Match

Introduction: There is a minimal amount of published data regarding to Emergency Medical Services (EMS) fellowship programs. The purpose of this study was to obtain program characteristics and diversity data regarding EMS fellowship programs. Methods: A survey was sent to program directors at all EMS fellowship programs accredited by the Accreditation Council of Graduate Medical Education (ACGME). Data collected included: year program started, year program accredited, unfilled fellow positions, number of EMS faculty, gender, and race/ethnicity. Gender and race/ethnicity data from EMS fellowships were compared to emergency medicine (EM) residencies using data from the American Association of Medical Colleges. Data were analyzed using IBM SPSS with descriptive statistics, and Chi-square tests. Results: The response rate for the survey was 88% (45/51) of all EMS fellowship programs that were accredited at the time of this survey. Most programs (71%) offer a one-year EMS fellowship, with the remaining offering an optional second year. The median number of physician response vehicles per program was 1.0 (IQR 0.0–2.0), with 24% (11/45) not having a dedicated physician response vehicle. This survey identified that 118 EMS fellows have graduated since inception of the accreditation process, while 34 positions went unfilled. The median number of EMS fellow positions per program was 2.0 (IQR 1.0–2.0), with a range of 1 to 4. It was noted that 31% of programs had no female EMS faculty, and 48% of programs had no under-represented minority EMS faculty. There was a significantly larger proportion of female faculty in EM residency programs (30.5%; 949/3,107) compared to EMS fellowships (19%; 53/274), OR = 1.8, 95% CI:1.3–2.5, p < 0.0001. There was a significantly larger proportion of female fellows in EMS (56%; 66/118) vs. female residents in EM (38%; 2,193/5,777), OR" = 2.1, 95% CI:1.4–3.0, p < 0.0001. There was a significantly larger proportion of under-represented minority faculty in EM residency programs (19.7%; 786/3,978) vs. EMS fellowships (12.0%, 33/274), OR = 1.8, 95% CI:1.2–2.6, p < 0.002. Conclusion: A significant number of EMS fellowship positions have remained unfilled since implementation of an accreditation process for EMS fellowships. The percentage of females and under-represented minority faculty in EMS programs was much lower than for EM residency programs.

TF3 Medic 5 Calling: Teaching On-Line Medical Direction via Simulation

Communication failures are a key cause of medical errors and are particularly prevalent during handovers of patients between services. To explore current perceptions of effectiveness in communicating critical patient information during admission handovers between emergency medicine (EM) residents and internal medicine (IM) residents. Study design was a survey of IM and EM residents at a large urban hospital. Residents were surveyed about whether critical information was communicated during patient handovers. Measurements included comparisons between IM and EM residents about their perceptions of effective communication of key patient information and the quality of handovers. Ninety-three percent of EM residents (50 of 54) and 80% of IM residents (74 of 93) responded to the survey. The EM residents judged their handover performance to be better than how their IM colleagues assessed them on most questions. The IM residents reported that one-half of the time, EM residents provided organized and clear information, whereas EM residents self-reported that they did so most of the time (80%-90%). The IM residents reported that 25% of handovers were suboptimal and resulted in admission to an inappropriate level of care, and 10% led to harm or delay in care. The EM residents reported suboptimal communication was less common (5%). On the global assessment of whether the admission handover provided the information needed for good patient care, IM residents rated the quality of the handover data lower than did responding EM residents. There are gaps in communicating critical patient information during admission handovers as perceived by EM and IM residents. This information can form the basis for efforts to improve these handovers.

This study sought to define expert opinion on the ideal length of training (LoT) for Accreditation Council of Graduate Medical Education (ACGME)-accredited emergency medicine (EM) residency programs. A cross-sectional Web-based survey was sent to program directors (PDs) at all ACGME-accredited EM residency programs during a study period of August to October 2014. The primary outcome of ideal LoT was determined in two ways: 1) subjects provided the ideal total LoT in months and 2) then separately selected the type and number of rotations for an ideal EM residency curriculum by month, the sum of which provided an alternative measurement of their ideal LoT. We did not include vacation time. Descriptive statistics and an analysis of variance are reported. Response rate was 68.0% (108/159) with 72% of respondents (78/108) directing programs in the PGY 1-3 (36-month) format and 28% directing PGY 1-4 (48-month) programs. More than half of subjects (51.9%) have direct personal experience with both formats. When asked about ideal total LoT, PDs averaged 41.5 months (n = 107; SD = 5.5 months, range = 36-60 months). When asked to provide durations of individual clinical experiences for their ideal EM program, the sum total (n = 104) averaged 45.0 months. Results from a factorial analysis of variance revealed statistically significant effects of PDs' past training experiences: participants who trained in a 36-month program had statistically significantly lower LoT (mean = 39.2 months) than participants who trained in a 48-month program (mean = 44.5 months). There was also a statistically significant effect of current program format on ideal LoT: participants who directed a 36-month program had statistically significantly lower LoT (mean = 39.8 months) than participants who directed a 48-month program (mean = 45.8 months). PD opinion on ideal LoT averages between 36 and 48 months, but is longer when the sum of desired clinical rotations is considered. While half of the respondents reported direct experience with both PGY 1-3 and PGY 1-4 training programs, opinions on ideal LoT through both methods corresponded strongly with the length of the program the PDs trained in and the format of the program they currently direct. PD opinions may be too biased by their own experiences to provide objective input on the ideal LoT for EM residency programs.

Previous studies have demonstrated sex-specific disparities in performance assessments among emergency medicine (EM) residents. However, less work has focused on intersectional disparities by ethnoracial identity and sex in resident performance assessments. To estimate intersectional sex-specific ethnoracial disparities in standardized EM resident assessments. This retrospective cohort study used data from the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education Milestones (Milestones) assessments to evaluate ratings for EM residents at 128 EM training programs in the US. Statistical analyses were conducted in June 2020 to January 2023. Training and assessment environments in EM residency programs across comparison groups defined by ethnoracial identity (Asian, White, or groups underrepresented in medicine [URM], ie, African American/Black, American Indian/Alaska Native, Hispanic/Latine, and Native Hawaiian/Other Pacific Islander) and sex (female/male). Mean Milestone scores (scale, 0-9) across 6 core competency domains: interpersonal and communications skills, medical knowledge, patient care, practice-based learning and improvement, professionalism, and system-based practice. Overall assessment scores were calculated as the mean of the 6 competency scores. The study sample comprised 128 ACGME-accredited programs and 16 634 assessments for 2708 EM residents of which 1913 (70.6%) were in 3-year and 795 (29.4%) in 4-year programs. Most of the residents were White (n = 2012; 74.3%), followed by Asian (n = 477; 17.6%), Hispanic or Latine (n = 213; 7.9%), African American or Black (n = 160; 5.9%), American Indian or Alaska Native (n = 24; 0.9%), and Native Hawaiian or Other Pacific Islander (n = 4; 0.1%). Approximately 14.3% (n = 386) and 34.6% (n = 936) were of URM groups and female, respectively. Compared with White male residents, URM female residents in 3-year programs were rated increasingly lower in the medical knowledge (URM female score, -0.47; 95% CI, -0.77 to -0.17), patient care (-0.18; 95% CI, -0.35 to -0.01), and practice-based learning and improvement (-0.37; 95% CI, -0.65 to -0.09) domains by postgraduate year 3 year-end assessment; URM female residents in 4-year programs were also rated lower in all 6 competencies over the assessment period. This retrospective cohort study found that URM female residents were consistently rated lower than White male residents on Milestone assessments, findings that may reflect intersectional discrimination in physician competency evaluation. Eliminating sex-specific ethnoracial disparities in resident assessments may contribute to equitable health care by removing barriers to retention and promotion of underrepresented and minoritized trainees and facilitating diversity and representation among the emergency physician workforce.

After the Match

Asynchronous e-learning allows for targeted teaching, particularly advantageous when bedside and didactic education is insufficient. An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation. We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine (EM) rotation improves medical knowledge among residents and students across multiple participating centers. Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were randomized in a Solomon four-group design. The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based, interactive, peer-reviewed Flash/HTML5 modules. Postrotation testing and in-training examination (ITE) scores quantified improvements in knowledge. A 2 × 2 analysis of covariance (ANCOVA) tested interaction and main effects, and Pearson's correlation tested associations between module usage, scores, and ITE scores. A total of 256 of 458 participants completed all study elements; 104 had access to asynchronous e-learning modules, and 152 were controls who used the current education standards. No pretest sensitization was found (p = 0.75). Use of asynchronous e-learning modules was associated with an improvement in posttest scores (p < 0.001), from a mean score of 18.45 (95% confidence interval [CI] = 17.92 to 18.98) to 21.30 (95% CI = 20.69 to 21.91), a large effect (partial η(2) = 0.19). Posttest scores correlated with ITE scores (r(2) = 0.14, p < 0.001) among pediatric residents. Asynchronous e-learning is an effective educational tool to improve knowledge in a clinical rotation. Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula, particularly in clinical rotations where scheduling difficulties, seasonality, and variable experiences limit in-hospital learning.

The emergency department (ED) is a high-stakes training environment for emergency medicine (EM) residents and residents' ability to reflect and self-evaluate patient care is of critical importance. Patient care dashboards have been shown to increase adherence to quality guidelines and improve patient outcomes. The objectives of this study were: (1) to create a comprehensive list of evidence-based, psychologically safe patient care and quality metrics to include in a patient care dashboard for EM residents; (2) to design an EM patient care residency dashboard in a secure, cloud-based environment integrated with the electronic health record (EHR); and (3) to pilot the usability and acceptability of the dashboard among EM residents. We created a list of potential EM resident patient care metrics using ACGME Emergency Medicine Defined Key Index Procedure Minimums, leading EM quality indicators, and current EM dashboard literature. We surveyed PGY-1 to -4 EM residents at a single residency program for their recommendations about inclusion, exclusion, and the psychological safety of each metric. We then developed a dashboard utilizing Power BI software integrated with Epic EHR. After development, we conducted a 2-month pilot evaluation for usability and acceptability among EM residents utilizing a mixed-methods approach. We identified 41 metrics within five domains (productivity metrics, patient safety and leading quality indicators, key procedures, complex/high-acuity cases, and uncertain diagnosis) to consider for inclusion in the dashboard. Residents (n = 32/68; 47% survey completion rate) recommended inclusion of 33 metrics; among these, three were identified as moderate-high psychological risk (ED length of stay, patients per hour, death within 24 h) whereas the rest were considered low psychological risk. Based on these survey results, we created an EM resident patient dashboard using Microsoft Power BI. Over a 2-month pilot period with 16 residents, user data showed a change between each resident's prior patient care review practices and review practices when using a dashboard; specifically, there were notable variations in frequency of use, time spent per review session, number of patients reviewed per session, and data categories reviewed. Eleven of 16 residents completed the technology usability and acceptability survey, with general acceptability and few concerns on usability. Our dashboard provides individualized patient care data to EM residents related to productivity, patient safety and quality, key procedures, complex/high-acuity cases, and uncertain diagnoses. A pilot group of EM residents found the dashboard acceptable and useable. Continued research is needed to explore ideal implementation and integration of patient care dashboards in residency training.

The National Institutes of Health Stroke Scale (NIHSS) is used to assess acute stroke severity and plays a critical role in guiding treatment. There is no requirement for emergency medicine (EM) residents to be certified in NIHSS determination to assess acute stroke severity, even though they may be the primary stroke providers in future practice. We implemented NIHSS training and certification into the residency's core content in neurological emergencies. In April 2022, all EM residents and attending physicians completed a faculty-moderated, interactive NIHSS training module. In the 6-month pilot, we prospectively assessed EM and neurology residents in their NIHSS assignment, indication for thrombolytic therapy, and large vessel occlusion (LVO) diagnosis using a Qualtrics survey completed for each acute stroke activation. Mean overall NIHSS scores from EM and neurology residents were compared using Spearman's correlation. Inter-rater agreement for each clinical category and treatment decision was calculated using Cohen's κ coefficient. Twenty-nine matched EM and neurology surveys were analyzed. Mean overall NIHSS scores were similar between EM and neurology residents, 6.6 (IQR = 2, 10) and 6.7 (IQR = 1, 10), (p < 0.001), respectively, with substantial agreement between groups (84.4%, κ = 0.63). Individual NIHSS scores showed moderate to substantial agreement, except for horizontal extraocular movement (75.9%, κ = 0.30). There was fair agreement for indication for thrombolytic therapy (75.9%, κ = 0.39) and moderate agreement for LVO diagnosis and indication for embolization (82.8%, κ = 0.51). Dedicated NIHSS training was effective in teaching EM residents to assess stroke severity, with moderate to substantial agreement in individual and overall NIHSS scores, except for horizontal eye movement assessment. EM residents may benefit from focused NIHSS training to support their rapid assessment of suspected stroke patients.

We aimed to evaluate the ability of emergency medicine (EM) residents to measure tricuspid annular plane systolic excursion (TAPSE) by M-Mode ultrasound. Four EM residents with prior focused cardiac ultrasound (FOCUS) experience participated in 10 hours of hands-on training and then performed TAPSE measurements in adult patients at high risk of having pulmonary emboli (PE) between December 2020 and April 2021. Patients underwent bedside echocardiography by cardiology residents, and a CT pulmonary angiogram (CTPA) was performed to confirm the diagnosis. The agreement between EM and cardiology residents was assessed by intraclass correlation coefficient (ICC). Sixty-six patients were included (mean age=58.7 ± 16.7 years), of which 28 patients (42.8%) had positive CTPA. The mean TAPSE, measured by EM residents was 16.36 ± 1.59 mm in the PE positive group and 21.68 ± 2.87 mm in the PE negative group (P-value=<.0001). The mean ± SD TAPSE, measured by cardiology residents, was 17.7 ± 1.98 mm in the PE group and 22.5 ± 3.6 mm in the PE negative group (P-value=<.0001). There was significant agreement between EM and cardiology residents in terms of measuring TAPSE (ICC=0.91, 95% confidence interval [CI]= 0.80-0.95). The receiver operating characteristic (ROC) curves of TAPSE for diagnosing PE revealed that TAPSE, measured by EM residents, had a high level of accuracy (area under the ROC curve [AUC]=0.93, 95% CI, 0.878-0.99). EM residents can perform M-Mode TAPSE measurement in suspected PE cases after 10 hours of hands-on training. TAPSE measurement should be added to routine FOCUS protocols, especially when there is suspicion of PE.

In reply

The Next Accreditation System (NAS) of the Accreditation Council for Graduate Medical Education (ACGME) includes the implementation of developmental milestones for each specialty. The milestones include five progressively advancing skill levels, with Level 1 defining the skill level of a medical student graduate, and Level 5, that of an attending physician. The goal of this study was to query interns on how well they thought their medical school had prepared them to meet the proposed emergency medicine (EM) Level 1 milestones. In July 2012, an electronic survey was distributed to the interns of 13 EM residency programs, asking interns whether they were taught and assessed on the proposed Level 1 milestones. Of possible participants, 113 of 161 interns responded (70% response rate). The interns represented all four regions of the country. The interns responded that the rates of Level 1 milestones they had been taught ranged from 61% for ultrasound to 98% for performance of focused history and physical examination. A substantial number of interns (up to 39%) reported no instruction on milestones such as patient disposition, pain management, and vascular access. Graduating medical students were less commonly assessed than taught the milestones. Skills with technology, including "explain the role of the electronic health record and computerized physician order entry," were assessed for only 39% of interns, and knowledge (USMLE) and history and physical were assessed in nearly all interns. Disposition, ultrasound, multitasking, and wound management were assessed less than half of the time. Many entering EM interns may not have had either teaching or assessment on the knowledge, skills, and behaviors making up the Level 1 milestones expected for graduating medical students. Thus, there is a potential gap in the teaching and assessment of EM interns. Based on these findings, it is unclear who will be responsible (medical schools, EM clerkships, or residency programs) for ensuring that medical students entering residency have achieved Level 1 milestones.

Injury care is a core part of daily emergency medicine (EM) clinical practice, accounting for over one-third of emergency department (ED) visits every year.1 It also remains a formidable burden to the public’s health in the United States. The Centers for Disease Control and Prevention (CDC) reports that in 2006, 179,065 Americans died as a result of injury,2 and in 2007, 29,756,586 suffered nonfatal injuries.3 Historically, the development of the science of injury prevention and control has paralleled the evolution of the specialty of EM. This was initially nested within the context of emergency medical services (EMS) and trauma systems development. In the 1966 landmark publication, Accidental Death and Disability: The Neglected Disease of Modern Society, the National Academy of Sciences and the National Research Council detailed the first examination of the country’s burden of injury morbidity and mortality. The report outlined specific recommendations calling for EMS development and meaningful federal agency guidance and oversight.4 Along with the first federal funding to establish EMS in the late 1960s and early 1970s came the establishment of the National Highway Safety Bureau (later known as the National Highway Traffic Safety Administration [NHTSA]). This emphasis on EMS contributed to the development and organization of EDs and specialty training of emergency physicians (EPs). As the specialty of EM began to grow in the 1970s, the public’s awareness of the continued high injury-related morbidity and mortality statistics raised the urgency for policy-makers to address the nation’s injury burden. As a result, state and federal health officials and researchers began to focus their efforts on population health to accurately describe and formulate plans to address the injury burden and its impact on U.S. communities. In 1985, the first of the landmark “red books,”Injury in America: A Continuing Public Health Problem, was published.5 This report outlined the magnitude of the national injury burden, and the gaps in addressing this burden comprehensively, and provided descriptions of opportunities for medical specialties to participate in reducing this burden. Subsequent national reports6 continued to reveal the cost of injury and the challenges in addressing this public health burden. Simultaneously, EM as a specialty began to build its intentional and positive influence in the future development of injury prevention and control activities and science. Over the past two and a half decades, EM’s efforts to address injury as a public health burden have led many EPs to engage in injury prevention and control activities through participation and leadership in surveillance and research, education, and advocacy. These collective efforts have fostered growth in the body of knowledge of injury science and have helped to lessen the burden on society. As the clinical specialty treating the entire spectrum of injury occurring in children and adults, EM is uniquely positioned to contribute to the science of injury prevention and control. At a population level, EM is able to provide understanding of types of injury patterns occurring, the risk factors for their occurrence, and the outcome of the injury. In creating epidemiologic profiles of injury patterns, interventions at both the individual and the population level can be developed and examined. Within states, EM contributes to injury surveillance with external cause coding (E-codes) in the hospital ED data system. Although these data are used primarily for administrative and billing purposes, they provide important state-level external cause of injury data for measuring the impact of nonfatal injury in that state, allowing policy-makers to make data-driven decisions regarding injury prevention.7 Several large national databases that utilize ED data on injured patients are frequently accessed and used by researchers both within and outside of EM to describe a specific injury problem and discuss mechanisms for prevention and control. One database that relies solely on ED data is the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP), which is a collaborative effort between the US Consumer Product Safety Commission and the CDC’s National Center for Injury Prevention and Control.8 Data on injury-related visits are obtained by NEISS-AIP from a national stratified probability sample of hospitals in the United States and its territories with a minimum of six beds and a 24-hour ED. NEISS-AIP collects data on initial visits for all categories of injuries treated in U.S. EDs and provides data on nearly 500,000 injury-related ED visits annually. Not only does EM contribute to the database through its clinical work, but researchers within the specialty have been consumers of the data and utilize it to further describe injury patterns.9–11 Another injury surveillance database that EM contributes to is the Crash Outcome Data Evaluation System (CODES) database that is maintained by NHTSA.12 It is a statewide population-based probabilistic linkage of police reports on motor vehicle crash (MVC), EMS, and hospital/ED data. EM researchers have used this database in describing transportation injury problems.13,14 Emergency physicians now lead many regional poison control centers. These centers provide important toxicologic expertise for patient care, as well as a large amount of data on the occurrence and outcomes of poisonings that is utilized by EM and non-EM researchers.15,16 The Drug Abuse Warning Network (DAWN)17 is a public health surveillance system that monitors drug-related visits to EDs and helps communities identify emerging problems that are risk factors for intentional and unintentional injuries. EM-based injury prevention research has also had a substantive role with both interventional and translational research at the patient care level and advancing clinical preventive services. One example is EM-based randomized clinical trials in the area of screening, brief intervention, and referral to treatment (SBIRT) for alcohol use disorders that have demonstrated decreased alcohol use,18 injury,19 or risky behaviors for injury occurrence.20 This has led to type II translational research21 (bedside to community) on how to best integrate SBIRT into routine EM care.22 The ED is frequently a treatment site for victims of interpersonal violence. This has allowed EM-based researchers to contribute to the knowledge development of this problem, as well as expand research to better screen for and intervene with victims.23–25 Motor vehicle crashes are the leading cause of injury death in the first three decades of life. Caring for the entire spectrum of MVC trauma victims allows EM to develop research foci in this area of testing and interventions to decrease future injury risk26 and contributing to the clinical research of care of the injured trauma patient to prevent secondary injury. It has also allowed EM to contribute to the science involving the biomechanics of crash injury27,28 and an appropriate EMS response to reduce the occurrence of secondary injury.29,30 As a result of growing interest and leadership in injury prevention and control, several departments of EM began to organize their efforts and form injury prevention centers. These centers have had a research focus, but also have efforts directed at injury prevention education and community programs. The growing number of EM-led centers reflects the increased leadership that the specialty brings to the field of injury prevention and control. These centers31–35 have a track record of state and federal research funding for injury prevention and control research, as well as incorporating missions for education and community outreach. Several offer fellowship training in injury prevention and control for EM trainees. Instruction to EM residents on injury prevention was first addressed in 1990,36 with a short course with the goal to “provide information on motor vehicle crashes in a public health framework.” As others in EM began to publish and lecture on this topic, efforts to increase health care professional training in injury prevention increased.37 The Institute of Medicine (IOM) report “Who Will Keep the Public Healthy” noted the importance of injury prevention and control education for the well-being of the population and called for health care professional training programs to make injury prevention training a higher priority.38 EPs in training shared the same belief as the IOM and wanted more injury prevention and control education in their training. In one study, 97% of EM residents in California surveyed between 1992 and 1993 felt that injury prevention was a critical aspect of their work, and 70% felt that it was a necessary focus in their training.39 Many articles and efforts from national organizations, such as the Association of American Medical Colleges, have called for an incorporation of injury prevention and control into medical school curricula40,41 and further advancement into medical training programs, including EM. The integration of injury prevention and control and EM practice and training has continued to grow. Injury prevention and control is now recognized as integral to EM residency training, although it still needs more emphasis in the core curriculum. Medical schools are increasingly recognizing the opportunity injury has in integrating basic science, clinical care, and population health sciences for their students. There are EM-based injury control and prevention fellowships, complementing the traditional trauma surgery fellowships that exist at many academic health centers in the United States. It is important to emphasize the opportunity that EM has to advance the science of injury prevention and control and bring the various injury control stakeholders together. A good example of this can be found in the context of toxicology and poisonings. Acute injury from chemical agents continues to be a growing and significant cause of mortality and morbidity. It is now the leading cause of injury death in Americans age 35–44 years.2 EM already plays a significant national leadership role in toxicology and poison center activities. According to the American College of Emergency Physicians, there are currently more than 20 fellowships in EM toxicology. Emergency medicine leaders in disaster preparedness and response from all physical agents including chemical are also in a strong position to reduce fragmented responses and further improve our overall disaster preparedness by unifying response principles and integrating the science of injury prevention and control. The acute care research agenda of the CDC’s National Center for Injury Prevention and Control calls for case studies that further inform our abilities to address mass casualties from physical agents.42 Among the central goals of training future EM leaders, and in unison with Accreditation Council for Graduate Medical Education (ACGME) principles that guide our resident training43 is the development of professionalism and duty to society in EM trainees.44 Consistent with this, EPs have moved to purposely teach and lead by example as advocates for primary injury prevention and control programs and policies. EM leaders have also organized to educate the community and conduct important policy-relevant injury research expertise. Today, state and federal government agencies continue to seek support from EPs to provide important insights and expertise into injury-related issues that are affecting the nation. EM leaders have made and continue to make substantial contributions within these federal agencies including the CDC, the NHTSA, the Department of Health and Human Services, and the Health Resources and Services Administration. While there has been significant growth in both injury prevention and control science and EM over the past several decades, the current challenges to EM outlined in recent IOM reports45–47 appear to be daunting and potential indicators of a downturn. However, some of these same challenges reveal tangible opportunities for continued parallel growth in injury prevention and control science and EM. One of the most notable areas where such opportunity exists is within the National Institutes of Health’s creation of the Clinical and Translational Science Awards (CTSA). Understanding that each CTSA will have to be understood in its respective institutional culture and context, opportunities for collaboration and EM investigator–initiated training and research in injury prevention and control should exist. Training EPs in translational sciences has the potential to significantly enhance the capacity for future EM researcher and specialty success while advancing the science of injury prevention and control. The development and growth of injury prevention and control science and EM as a medical specialty have had paralleled success. The spectrum of leadership of EPs in injury prevention began at the bedside with the desire of EPs to deliver the very best care to injured patients. Many EPs and departments have gone beyond the doors of the ED and have been instrumental in influencing important systems of surveillance, clinical care, and health policy so that primary and secondary prevention efforts are effectively developed and implemented. Still other EPs have gone further to champion injury prevention and control in a variety of prominent leadership positions at state and federal levels. Injury research centers, with primary and collaborative EM leadership, continue to flourish nationally, with EPs partnering with colleagues in surgery, pediatrics, psychiatry, epidemiology, and other disciplines on injury research, advocacy, and policy. The future of EM leadership and growth in injury prevention and control science remains promising, with opportunities for the development and execution of robust research that will influence the public’s health in meaningful and measurable ways.