Article review: The EM residency conference requirement

I'm reviewing another medical education article in this week's blog. It is also from the inaugural educational supplement in Academic Emergency Medicine. I'll be running a discussion session at the 2010 CORD Academic Assembly on "Maintaining Educational Excellence in the Era of ED Crowding". I hope to also publish a consensus statement, similar to those found in this journal issue.

Article topic:
Alternatives to the EM residency conference requirement

The article reviewed here discusses the required 5 hours of weekly conference time for all EM residency programs. Is there evidence that this is the best way to teach our residents? Are there alternatives?

The current EM Residency Review Committee program requirements are:
  • Offer residents an average of at least 5 hours ⁄ week of planned educational experiences developed by the EM training program
  • Ensure that residents are relieved of their clinical duties to attend these planned experiences. The program should ensure that residents attend on average 70% of the offerings.
When they were first developed, the requirements advantageously protected the educational mission of the EM residency, especially in the setting of residents feeling the pull of clinical duties from various services. Appropriately "education" should hold equal or more weight than pure "service".

Having this weekly "protected time", however, comes with disadvantages. There are major scheduling and duty hour challenges. Additionally, the requirement places significant emphasis on quantity rather than quality of education. Who came up with the number that 5 hours/week of conference would ensure an adequately trained emergency physician?

Personally, I think the required 5 hours/week of conference time is an antiquated way of ensuring educational excellence. If you could design something better from scratch, how would you design the curriculum? The published consensus recommendations closely mirror what I believe.

The bottom-line message that I completely agree with is that the measure of success of an educational curriculum should be resident learning outcomes rather than quantity of conference hours attended.

Other consensus recommendations:
  • There should be different conference requirements for 3 vs 4 year programs. If 3 years of 5 hrs/week of didactics is sufficient education for clinical competency, why do 4 year programs have extra hours of didactics? Perhaps 4-year programs should have fewer hours/week of conference, so that the total number of hours is similar to 3-year programs.
  • 70% attendance requirement. Each program should be allowed flexibility to determine what is considered the minimum standard of education. There are unique local program and individual resident needs to consider. While more difficult to measure, learning outcomes should be more the focus rather than conference attendance.
  • Synchronous versus asynchronous learning. Programs should be allowed to take advantage of both synchronous and asynchronous teaching modalities.
What I hope is that the ACGME listens to the recommendations from this consensus statement. EM residencies need more flexibility in order to build the best-fit curricular model for their particular program.

In the end, medical education will need to evolve to match the following:
  • Program and institutional demands
  • Effective learning strategies for the current and upcoming generation
  • 21st century resources


Sadosty AT, Goyal DG, Hern HG, et al. Alternatives to the Conference Status Quo: Summary Recommendations from the 2008 CORD Academic Assembly Conference Alternatives Workgroup. Acad Emerg Med. 2009; 16:S25–S31.
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