Do we really need an extra year? 3 vs 4 year EM residency

Review Author: Melissa Kirk, DO

Why is this a consideration?

Emergency Medicine residency started in 1972 as a 2 year program. Over the years, it became a 3 year and then 4 year program. It transitioned from a 4 year back to 3 year program in 2008. While 4 year EM programs exist, they are largely the minority now making up about 20% of programs. It has been hypothesized that increasing program length would increase scholarly activity and allow residents to gain academic appointments and leadership roles post graduation. The latest update includes the ACGME implementing all EM programs becoming 4 years long, beginning with implementation in 2027. This study focuses on comparing EM residents who underwent 3 versus 4 year programs and long term outcomes.

What would change with an increase in program length?

There would be a heavier focus on academics and research in 4 year programs due to extra time. There would likely be more off-service rotations as well. It is reportedly more difficult to obtain an academic attending physician position following a 3 year program without residency versus a 4 year program. Long term, more programs would be expected to close due to inability to afford an extra class of residents and teaching physicians. The hope is that this would create better quality EM residency programs. There is also the push to prepare residents for the increasing complexity of emergency medicine with the additional year of training. Is this what is best with a recently declining interest in the specialty as a whole and the current physician shortage? We can expect one entire year with no graduating emergency medicine physicians in 2030.

How was this tested?

Retrospective analysis was used in a particular residency program with 95 graduates divided into 2 groups; those that underwent 3 year program length versus those that underwent a 4 year program. The focus was on comparing first attending job positions.

What were the results?

While 44% of 4 year program graduates obtained an academic position, only 28% of 3 year program graduates did. Residents from 3 and 4 year EM residency programs had the same likelihood of producing scholarly work, but those from 4 year programs produced more publications. The paper concluded with the statement that those seeking academic productivity and leadership positions should consider 4 year programs.

What were the limitations?

This study focused one a single residency program with a small sample group. It did not comment on the percentage of residents that had no desire to obtain an academic attending physician position. There is limited literature on the topic overall. There still remains a large argument as to which residency program length is best.

Reference:

Ehmann MR, Klein EY, Kelen GD, Regan L. Emergency Medicine Career Outcomes and Scholarly Pursuits: The Impact of Transitioning From a Three-year to a Four-year Niche-based Residency Curriculum. AEM Educ Train. 2020 Feb 5;5(1):43-51. doi: 10.1002/aet2.10435. PMID: 33521490; PMCID: PMC7821060.

Read the full article here.