Emergency Medicine Training Programs Research Articles

Emergency medicine in Egypt: Current situation and future prospects

Introduction Emergency medicine is in the early development phase in Egypt. It was first registered in 2001 and although there are about 250 physicians finished their training in the specialty, less than 20 still work in Egypt and others moved to work through the world, mainly to Arab Gulf region. There is not a specialty society in emergency medicine, although there is an Egyptian Society of Intensive Care Medicine and Trauma (ESICT) with an interest in emergency medicine. Emergency care The Emergency Medical Services Department of the Ministry of Health (MOH) is involved in the pre-hospital aspects of emergency medicine. Over the past three years, the MOH has acquired approximately 1200 new full equipped ambulances greatly expanding its pre-hospital capabilities and response. This service provider through basic life support practitioners. In the meantime, personnel within the MOH continue to provide Hospital Emergency departments through the country with new equipment and episodic short training programs for staff in the care of trauma patients and cardiac life support. Emergency medicine training programs The Egyptian specialty board is a 4year formal training program is considered the leader institute in emergency medicine training in Egypt which started early of 2001 with more than 200 graduates until now. The most disadvantage of the program is lacking of specialist trainers and it mainly depends on skilled personnel from other specialities in each hospital, most of them are unaware of the specialty curriculum and updated guidelines in Emergency medicine. There are three university hospitals give academic master degree in Emergency medicine but they are away behind the basic training requirements although they have good approved curriculum did not come to real practice yet. The future Although Egypt was one of the first countries outside USA which considered Emergency medicine as specialty, immigration of trained Emergency physicians, leaving the positions for unqualified personnel from other specialities and lacking of resources had affected the specialty badly. For Emergency to move forward, we should depend on specialists to build the emergency society with annual international conference and local policies and guidelines and outreach programs to rural and borders regions.

Characterization of the Council of Emergency Medicine Residency Directors' Standardized Letter of Recommendation in 2011-2012

The Council of Emergency Medicine Residency Directors (CORD) introduced the standardized letter of recommendation (SLOR) in 1997, and it has become a critical tool for assessing candidates for emergency medicine (EM) training. It has not itself been evaluated since the initial studies associated with its introduction. This study characterizes current SLOR use to evaluate whether it serves its intended purpose of being standardized, concise, and discriminating. This retrospective, multi-institutional study evaluated letters of recommendation from U.S. allopathic applicants to three EM training programs during the 2011-2012 Electronic Residency Application Service (ERAS) application cycle. Distributions of responses to each question on the SLOR were calculated, and the free-text responses were analyzed. Two pilots, performed on five applicants each, assisted in developing a strategy for limiting interrater reliability. Each of the three geographically diverse programs provided a complete list of U.S. allopathic applicants to their program. Upon randomization, each program received a list of coded applicants unique to their program randomly selected for data collection. The number of applicants was selected to reach a goal of approximately 200 SLORs per site (n = 602). Among this group, comprising 278 of 1,498 applicants (18.6%) from U.S. allopathic schools, a total of 1,037 letters of recommendation were written, with 724 (69.8%) written by emergency physicians. SLORs represented 57.9% (602/1037) of all LORs (by any kind of author) and 83.1% (602/724) of letters written by emergency physicians. Three hundred ninety-two of 602 SLORs had a single author (65.1%). For the question on "global assessment," students were scored in the top 10% in 234 of 583 of applications (40.1%; question not answered by some), and 485 of 583 (83.2%) of the applicants were ranked above the level of their peers. Similarly, >95% of all applicants were ranked in the top third compared to peers, for all but one section under "qualifications for emergency medicine." For 405 of 602 of all SLORs (67.2%), one or more questions were left unanswered, while 76 of all SLORs (12.6%) were "customized" or changed from the standard template. Finally, in 291 of 599 of SLORs (48.6%), the word count was greater than the recommended maximum of 200 words. Grade inflation is marked throughout the SLOR, limiting its ability to be discriminating. Furthermore, template customization and skipped questions work against the intention to standardize the SLOR. Finally, it is not uncommon for comments to be longer than guideline recommendations. As an assessment tool, the SLOR could be more discerning, concise, and standardized to serve its intended purpose.

Three-year emergency medicine training program in The Netherlands: first evaluation from the residents' perspective.

BackgroundThe Netherlands’ 3-year training in Emergency Medicine (EM) was formally approved and introduced in November 2008. To identify areas for improvement, we conducted the first evaluation of this curriculum from the residents’ perspective.MethodsA questionnaire was composed on ten aspects of the curriculum. It contained multiple-choice, open and opinion questions; answers to the latter were classified using the Likert scale. The questionnaires were mailed to all enrolled residents.ResultsWe mailed questionnaires to all 189 enrolled residents, and 105 responded (55.6%). Although they were satisfied with their training overall, 96.2% thought it was currently too short: 18.3% desired extension to 4 years, 76.0% to 5 and 1.9% to 6 years. Nevertheless, residents expected that they would function effectively as emergency physicians (EPs) after finishing their 3-year training program. Bedside teaching was assessed positively by 35.2%. All rotations were assessed positively, with the general practice rotation seen as contributing the least to the program. According to 43.7%, supervising EPs were available for consultation; 40.7% thought that, in a clinical capacity, the EP was sufficiently present during residents’ shifts. When EPs were present, 82.5% found them to be easily accessible, and 66.6% viewed them as role models. In the Emergency Medicine Departments (EDs) with a higher number of EPs employed, residents tended to perceive better supervision and were more likely to see their EPs as role models. While residents were stimulated to do research, actual support and assistance needed to be improved.ConclusionAlthough overall, the current training program was evaluated positively, the residents identified four areas for improvement: (1) in training hospitals, trained EPs should be present more continuously for clinical supervision; (2) bedside teaching should be improved, (3) scientific research should be facilitated more and (4) the training program should be extended.

Creation and implementation of an emergency medicine education and training program in Turkey: an effective educational intervention to address the practitioner gap

BackgroundThe specialty of Emergency Medicine has enjoyed recognition for nearly 20 years in Turkey. However, the majority of underserved and rural Turkish emergency departments are staffed by general practitioners who lack formal training in the specialty and have few opportunities to increase emergency medicine-specific knowledge and skills.MethodsTo address this “practitioner gap,” the authors developed a four-phase comprehensive emergency medicine education and training program for general practitioners practicing in government hospitals in Turkey.ResultsFrom April 2006 until June 2009, 42 courses were taught by 62 trainers across seven regions in Turkey. A total of 2,262 physicians were trained. The mean course pre-test score for all regions was 42.3 (95% CI 39.8 to 44.7). The mean course post-test score was 70.1 (95% CI 67.2 to 72.9). The difference between the mean scores was 27.8 (95% CI 25.3 to 30.4, P <0.0001), reflecting an improvement of 65.7%.ConclusionsA partnership between an academic emergency medicine department and an emergency medicine society to implement country-wide training of physicians practicing in public emergency departments can serve as a successful model for capacity-building global emergency medicine endeavors.

A review of published literature on emergency medicine training programs in low- and middle-income countries

BackgroundThe objective of this review is to identify and critically evaluate the published literature on emergency medicine (EM) training programs in resource-limited health-care settings in order to provide insight for developing EM training programs in such health systems.MethodsA literature search was conducted up to the end of April 2011 using MEDLINE, EMBASE, The Cochrane Library, EBM Reviews, Healthstar and Web of Science databases, using the following search terms: Emergency Medicine, Emergency Medicine Services, Education Training Residency Programs, Emergency Medical Systems and Medical Education, without limitation to income countries as outlined in the World Bank World Trade Indicators classification 2009-2010 (World Trade Indicators Country Classification by Region and Income, July 2009-July 2010). As the intent of the review was to identify and critically evaluate the literature readily available (published) to LMICs developing EM programs, the gray literature was not searched.ResultsThe search yielded 16 articles that met the final inclusion criteria. As the majority of articles provide a narrative description of the processes and building blocks used in developing the residency programs reported, we present our results in narrative format. By providing a summary of the lessons learned to date, we hope to provide a useful starting point for other resource-limited settings interested in establishing emergency medicine specialty training programs and hope to encourage further information exchange on this matter.ConclusionsThe results of the review indicate that EM training is in its infancy in resource-constrained health-care systems. There are few detailed reports of these programs successes and limitations, including efforts to optimize graduate retention. Despite the paucity of currently published data on the development of EM residency training programs in these settings, this review demonstrates the need for encouraging further information exchange to aid in such efforts, and the authors make specific recommendations to help guide future authors on reporting on such efforts.

American Board of Emergency Medicine Report on Residency Training Information (2012-2013), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency programs and the residents in those programs. We present the 2013 annual report on the status of US emergency medicine training programs.

Emergency departments in The Netherlands: is there a difference in emergency departments with and without emergency physicians? a cross-sectional web-based survey.

BackgroundThere is a growing interest in emergency departments (EDs) and the development of emergency medicine in The Netherlands. In the last decade several policy reports have stated that the quality of emergency care should be improved and that emergency physicians (EPs) play a large role in the quality improvement. The Netherlands Society of Emergency Physicians (NVSHA) has developed an emergency medicine training program, which has been nationally recognized since 2009. Nevertheless, not all EDs are staffed with EPs yet. This study aimed to explore differences between Dutch EDs with EPs and those without EPs.MethodsA cross-sectional web-based survey was performed on data over the year 2008 or 2009 in all 105 Dutch hospitals with an emergency department. We documented which ED-specific courses were attended by physicians working in the ED (list of 3 courses) and which clinical audit activities were implemented (list of 6 activities). The choice of courses and clinical audits was based on those mentioned in published quality reports and in national debates on emergency care. We compared EDs with and without EPs. The final analysis was based on a linear regression analysis, controlling for ED size and having an EP training program. We considered P < 0.05 significant.ResultsOur survey’s response rate was 67%. EPs worked significantly more often in larger EDs. The linear regression analysis shows that the total number of courses attended by physicians was on average 0.51 higher (P = 0.000) in EDs with EPs than in EDs without EPs, and the total number of implemented clinical audits was on average 0.49 higher (P = 0.008). After controlling for potential confounders, the effect of both the composite number of courses attended (P = 0.001) and the composite number of implemented clinical activities (P = 0.032) remained significant.ConclusionThis study shows that EPs are significantly more present in larger EDs and in EDs where there is more continuing professional education and where there are more clinical audit activities. Our findings suggest that the presence of emergency physicians is positively associated with the quality of emergency care, but prospective research is required to examine causality.

Technology‐enhanced Simulation in Emergency Medicine: A Systematic Review and Meta‐Analysis

Technology-enhanced simulation is used frequently in emergency medicine (EM) training programs. Evidence for its effectiveness, however, remains unclear. The objective of this study was to evaluate the effectiveness of technology-enhanced simulation for training in EM and identify instructional design features associated with improved outcomes by conducting a systematic review. The authors systematically searched MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Original research articles in any language were selected if they compared simulation to no intervention or another educational activity for the purposes of training EM health professionals (including student and practicing physicians, midlevel providers, nurses, and prehospital providers). Reviewers evaluated study quality and abstracted information on learners, instructional design (curricular integration, feedback, repetitive practice, mastery learning), and outcomes. From a collection of 10,903 articles, 85 eligible studies enrolling 6,099 EM learners were identified. Of these, 56 studies compared simulation to no intervention, 12 compared simulation with another form of instruction, and 19 compared two forms of simulation. Effect sizes were pooled using a random-effects model. Heterogeneity among these studies was large (I(2) ≥ 50%). Among studies comparing simulation to no intervention, pooled effect sizes were large (range = 1.13 to 1.48) for knowledge, time, and skills and small to moderate for behaviors with patients (0.62) and patient effects (0.43; all p < 0.02 except patient effects p = 0.12). Among comparisons between simulation and other forms of instruction, the pooled effect sizes were small (≤ 0.33) for knowledge, time, and process skills (all p > 0.1). Qualitative comparisons of different simulation curricula are limited, although feedback, mastery learning, and higher fidelity were associated with improved learning outcomes. Technology-enhanced simulation for EM learners is associated with moderate or large favorable effects in comparison with no intervention and generally small and nonsignificant benefits in comparison with other instruction. Future research should investigate the features that lead to effective simulation-based instructional design.

Development of emergency medicine in Rwanda

Abstract Rwanda, known as the Land of a Thousand Hills, is a small, East African country that was the site of the devastating 1994 genocide. In the past 18years, this post-conflict country has made tremendous progress in rebuilding itself and its health infrastructure. The country has recovered or surpassed many of its pre-1994 health levels, including reduction in HIV/AIDS prevalence, under-five mortality and road traffic accidents. Nevertheless, Rwanda continues to face a high burden of disease. The leading causes of mortality in Rwanda include complications of HIV/AIDS and related opportunistic infections, severe malaria, pulmonary infections, and trauma, and are best managed with emergency and acute care services. However, health care personal resources remain significantly lacking, and there is currently no emergency medicine-trained workforce. The Rwandan government, partnering with international organizations, has launched a campaign to improve human resources for health, and as a part of that effort the creation of training programs in emergency medicine is now underway. The Rwandan Human Resources for Health program can serve as a guide to the development of similar programs within other African countries. The emergency medicine component of this program includes two tracks: a 2-year postgraduate diploma course, followed by a 3-year Masters of Medicine in Emergency Medicine. The program is slated to graduate its first cohort of trained Emergency Physicians in 2017.

Mechanical Ventilation Practices of Turkish Emergency Physicians: A National Survey

Introduction: Our objective is to ascertain the mechanical ventilation management skill perception levels of EPs and infrastructural condition of EDs in respect of mechanical ventilation, in Turkey. Materials and Methods: In Turkey, a survey aimed at all EPs was conducted. The contents of the survey form were consisted of 4 main titles. Socio-demographic characteristics, situation of the personnel and technical infra-structure in the ED, Emergency Medicine Training Program and post graduate trainings and solution suggestions. Their perception level was evaluated with a 10 cm Visual Analogue Scale. Results: 400 emergency physicians participated in the study (response rate = 70.5%). The mean of emergency physicians’ perception on whether or not the personnel and technical infrastructure for mechanical ventilation management are adequate, in the institutions where they work was found out to be, respectively, 3.2±2.4 cm and 3.4±2.4 cm. It was determined that %75.5 of the participants had no education on mechanical ventilation management during their emergency medicine education program. The mean value of perception levels on the number of mechanical ventilation practice adequacy during emergency medicine education program was established to be 4.6±2.2 cm and the mean value of perception levels on knowledge and skills about mechanical ventilation management was established to be 5.4±2 cm. It was determined that, during mechanical ventilation, 29.5% of EPs not used any one of sedative agents and 30.2% of them not used any one of paralyzing agents. It was also determined that, frequently midazolam (30.7%) was used for sedation, fentanyl (50.7%) for analgesia and vecuronium (27%) as neuromuscular blocker. Conclusion: The skill perception level of emergency physicians on mechanical ventilation management is low. Mechanical ventilation management educations in emergency medicine education programs and infrastructural conditions of emergency departments in respect of mechanical ventilation were both considered as inadequate by emergency physicians.

Emergency Medicine in Guyana: Lessons from Developing the Country's First Degree-conferring Residency Program

Introduction:Academic departments of emergency medicine are becoming increasingly involved in assisting with the development of long-term emergency medicine training programs in low and middle-income countries. This article presents our 10-year experience working with local partners to improve emergency medical care education in Guyana.Methods:The Vanderbilt Department of Emergency Medicine has collaborated with the Georgetown Public Hospital Corporation on the development of Emergency Medicine skills followed by the implementation of an emergency medicine residency training program. Residency development included a needs assessment, proposed curriculum, internal and external partnerships, University of Guyana and Ministry of Health approval, and funding.Results:In our experience, we have found that our successful program initiation was due in large part to the pre-existing interest of several local partners and followed by long-term involvement within the country. As a newer specialty without significant local expertise, resident educational needs mandated a locally present full time EM trained attending to serve as the program director. Both external and internal funding was required to achieve this goal. Local educational efforts were best supplemented by robust distance learning. The program was developed to conform to local academic standards and to train the residents to the level of consultant physicians. Despite the best preparations, future challenges remain.Conclusion:While every program has unique challenges, it is likely many of the issues we have faced are generalizable to other settings and will be useful to other programs considering or currently conducting this type of collaborative project.

Optimizing global health experiences in emergency medicine residency programs: a consensus statement from the Council of Emergency Medicine Residency Directors 2011 Academic Assembly global health specialty track

BackgroundAn increasing number of emergency medicine (EM) residency training programs have residents interested in participating in clinical rotations in other countries. However, the policies that each individual training program applies to this process are different. To our knowledge, little has been done in the standardization of these experiences to help EM residency programs with the evaluation, administration and implementation of a successful global health clinical elective experience. The objective of this project was to assess the current status of EM global health electives at residency training programs and to establish recommendations from educators in EM on the best methodology to implement successful global health electives.MethodsDuring the 2011 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly, participants met to address this issue in a mediated discussion session and working group. Session participants examined data previously obtained via the CORD online listserve, discussed best practices in global health applications, evaluations and partnerships, and explored possible solutions to some of the challenges. In addition a survey was sent to CORD members prior to the 2011 Academic Assembly to evaluate the resources and processes for EM residents’ global experiences.ResultsRecommendations included creating a global health working group within the organization, optimizing a clearinghouse of elective opportunities for residents and standardizing elective application materials, site evaluations and resident assessment/feedback methods. The survey showed that 71.4% of respondents have global health partnerships and electives. However, only 36.7% of programs require pre-departure training, and only 20% have formal competency requirements for these global health electives.ConclusionsA large number of EM training programs have global health experiences available, but these electives and the trainees may benefit from additional institutional support and formalized structure.

Emergency Medicine Resident Anesthesia Training in a Private vs. Academic Setting

BackgroundAirway management is an essential part of any Emergency Medicine (EM) training program. Academic centers typically provide training to many learners at various training levels in a number of medical specialties during anesthesiology rotations. This potentially creates competition for intubation procedures that may negatively impact individual experiences. ObjectivesWe hypothesized that residents would report higher numbers of intubations and improved educational value in a private practice, rather than an academic, anesthesiology rotation. MethodsEM residents’ anesthesiology training was evaluated pre and post a change in training setting from an academic institution to a private practice institution. Outcome measures included the number of self-reported intubations, resident ratings of the rotation, and the number of positive comments. Residents’ evaluation was measured with: a 14-item evaluation; subjective comments, which two blinded reviewers rated as positive, negative, or neutral; and transcripts from structured interviews to identify themes related to training settings. ResultsThe number of intubations increased significantly in the private practice setting (4.6 intubations/day vs. 1.5 intubations/day, p < 0.001). Resident evaluations improved significantly with the private practice experience (mean scores of 3.83 vs. 2.23, p-values <0.05). Residents’ impressions were also significantly higher for the private practice setting with respect to increased educational value, greater use of adjunct airway devices, and directed teaching. ConclusionsNumber of intubations performed and residents’ rating of the educational value were more favorable for a private practice anesthesiology rotation. Alternative settings may provide benefit for training in areas that have competition among trainees.

17 Developing a Taxonomy of “Problem Residents”

The term “problem resident” is commonly used in graduate medical education. The studies to date have defined the problem resident as “a trainee who demonstrated a significant enough problem that requires intervention by someone of authority.” This definition is broad to the point of being nonspecific and does not reflect the diversity of problem residents encountered in emergency medicine training programs.

24 Simulation and Medical Student Participation Augment Fidelity in a Resident-As-Teacher Course

Physician-as-teacher courses improve perceived teaching skills and are increasingly common in emergency medicine training programs. A novel approach, including medical students and simulation laboratory experience, improves realism and adds value to a resident-as-teacher (RAT) course.

Report on Residency Training Information (2011-2012), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2012 annual report on the status of US emergency medicine training programs.

Factors That Influence Medical Student Selection of an Emergency Medicine Residency Program: Implications for Training Programs

An understanding of student decision-making when selecting an emergency medicine (EM) training program is essential for program directors as they enter interview season. To build upon preexisting knowledge, a survey was created to identify and prioritize the factors influencing candidate decision-making of U.S. medical graduates. This was a cross-sectional, multi-institutional study that anonymously surveyed U.S. allopathic applicants to EM training programs. It took place in the 3-week period between the 2011 National Residency Matching Program (NRMP) rank list submission deadline and the announcement of match results. Of 1,525 invitations to participate, 870 candidates (57%) completed the survey. Overall, 96% of respondents stated that both geographic location and individual program characteristics were important to decision-making, with approximately equal numbers favoring location when compared to those who favored program characteristics. The most important factors in this regard were preference for a particular geographic location (74.9%, 95% confidence interval [CI] = 72% to 78%) and to be close to spouse, significant other, or family (59.7%, 95% CI = 56% to 63%). Factors pertaining to geographic location tend to be out of the control of the program leadership. The most important program factors include the interview experience (48.9%, 95% CI = 46% to 52%), personal experience with the residents (48.5%, 95% CI = 45% to 52%), and academic reputation (44.9%, 95% CI = 42% to 48%). Unlike location, individual program factors are often either directly or somewhat under the control of the program leadership. Several other factors were ranked as the most important factor a disproportionate number of times, including a rotation in that emergency department (ED), orientation (academic vs. community), and duration of training (3-year vs. 4-year programs). For a subset of applicants, these factors had particular importance in overall decision-making. The vast majority of applicants to EM residency programs employed a balance of geographic location factors with individual program factors in selecting a residency program. Specific program characteristics represent the greatest opportunity to maximize the success of the immediate interview experience/season, while others provide potential for strategic planning over time. A working knowledge of these results empowers program directors to make informed decisions while providing an appreciation for the limitations in attracting applicants.

Perceptions of graduates from Africa's first emergency medicine training program at the University of Cape Town/Stellenbosch University

Africa's first postgraduate training program in emergency medicine (EM) was established at the University of Cape Town/Stellenbosch University (UCT/SUN) in 2004. This study of the UCT/SUN EM program investigated the backgrounds, perceptions, and experiences of its graduates. This was a cross-sectional descriptive study. The study population was the 30 graduates from the first four classes in the UCT/SUN EM program (2007-2010). We employed a scripted interview with a combination of closed and open-ended questions. Data were analyzed using the thematic method of qualitative analysis. Twenty-seven (90%) graduates were interviewed. Initial career goals were primarily (78%) to practice EM in a nonacademic clinical capacity. At the time of the interview, 52% held academic positions, 15% had nonacademic clinical positions, and 33% had temporary positions and were looking for other posts. The three most commonly cited strengths of their program were diversity of clinical rotations (85%), autonomy and procedural experience (63%), and importance of being pioneers within Africa (52%). The three most commonly cited weaknesses were lack of bedside teaching in the ED (96%), lack of career options after graduation (74%), and lack of preparation for academic careers (70%). The lessons identified from structured interviews with graduates from Africa's first EM training include the importance of strong clinical training, difficulty of ensuring bedside teaching in a new program, the necessity of ensuring postgraduation positions, and the need for academic training. These findings may be useful for other developing countries looking to start EM training programs.

Conceptual Framework for International Pediatric Emergency Medicine Physician Exchange Programs

The global interest in emergency medicine (EM) is driven by economic expansion, growing population needs for urgent and emergent outpatient care, and advances in medical technologies. This interest facilitated establishment of EM as a specialty in many countries across the globe. International emergency medicine (IEM) is now incorporated into many EM residency training programs. On the other hand, pediatric emergency medicine (PEM), an established subspecialty with well funded infrastructure for research and education in the North America, has limited global involvement. To date, the care of acutely ill or injured children in many developed and underdeveloped countries is delivered by generalists with limited resources. While many PEM physicians are involved, on a personal level, in providing education and training to improve pediatric emergency care in underdeveloped countries, there is no organized and well funded infrastructure to support these activities. Furthermore, there is no outcome data to demonstrate the value of these interventions. International pediatric emergency medicine (IPEM) has already been conceptualized through various collaborative efforts. This article describes a physician exchange program as a tool to develop IPEM further. If developed systematically with proper infrastructure in place, a physician exchange program may lead to successful creation of dedicated PEM programs being led by physicians from their own countries. Furthermore, this would create a global network of PEM community with reciprocal exchange of thoughts, ideas, protocols, pathways implementable for developing infrastructure, and research.

Diversity in Emergency Medicine Education: Expanding the Horizon

An emergency medicine (EM)-based curriculum on diversity, inclusion, and cultural competency can also serve as a mechanism to introduce topics on health care disparities. Although the objectives of such curricula and the potential benefits to EM trainees are apparent, there are relatively few resources available for EM program directors to use to develop these specialized curricula. The object of this article is to 1) broadly discuss the current state of curricula of diversity, inclusion, and cultural competency in EM training programs; 2) identify tools and disseminate strategies to embed issues of disparities in health care in the creation of the curriculum; and 3) provide resources for program directors to develop their own curricula. A group of EM program directors with an interest in cultural competency distributed a preworkshop survey through the Council of Emergency Medicine Residency Directors (CORD) e-mail list to EM program directors to assess the current state of diversity and cultural competency training in EM programs. Approximately 50 members attended a workshop during the 2011 CORD Academic Assembly as part of the Best Practices track, where the results of the survey were disseminated and discussed. In addition to the objectives listed above, the presenters reviewed the literature regarding the rationale for a cultural competency curriculum and its relationship to addressing health care disparities, the relationship to unconscious physician bias, and the Tool for Assessing Cultural Competence Training (TACCT) model for curriculum development.