Date of Award

January 2026

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Arjun K. Venkatesh

Abstract

Background: The evolution of Emergency Medicine (EM) residency programs over the past two decades has been marked by significant growth and changes in clinical practice environments. Concerns have emerged regarding whether recently founded programs, non-teaching status programs, and for-profit institutions provide adequate training for EM residents. This study evaluates EM training programs using clinical education outcomes such as clinical volumes, acuity exposure, and board pass rates based on key program characteristics including founding year, teaching status, hospital ownership, and program duration.Methods: We conducted an observational analysis of linked datasets encompassing EM residency data from the Accreditation Counsil for Graduate Medical Education and American Board of Emergency Medicine with hospital data from the American Hospital Association, the Trauma Information Exchange Program, The Joint Commission, Det Norske Veritas, Accreditation Commission for Health Care, and state-level stroke accreditations. We characterized the clinical work environments of EM residencies and evaluated outcomes including emergency department (ED) volume by primary site and program volume per resident, acuity exposure, and board pass rates. Linear regressions were conducted to examine associations between program founding year, Council of Teaching Hospital (COTH) status, ownership status, and program length. Results: Our analysis of 288 residency programs revealed significant variability based on program characteristics. Linear regression analysis showed that recently founded programs (n = 124) had a significantly lower primary site annual patient volume by 23,489 patients (β = -23,489, 95% CI: -39,702 to -7276, p<0.001). COTH-affiliated programs (n = 139) had significantly higher volumes by 36,537 patients (β = 36,537, 95% CI: 20,810 to 52,265, p<0.001). Non-profit programs (n = 187) and government programs (n = 68) did not show significant differences in patient volume compared to for-profit programs (n = 33) (β = 19,481, 95% CI: -8345 to 47,306, p>0.05 and β = 9907, 95% CI: -12,743 to 32,557, p>0.05, respectively). Acuity exposure analysis demonstrated that newer programs were associated with 45.1% less Level I trauma exposure (β = -45.1, 95% CI: -53.1 to -37.1, p<0.001), and COTH-affiliated programs had 41.1% more exposure (β = 41.1, 95% CI: 32.9-49.3, p < 0.001). Non-profit programs and government programs demonstrated significantly higher exposure compared to for-profit programs (β = 21.3, 95% CI: 6.07 to 36.6, p<0.001 and β = 34.5, 95% CI: 18.4 to 50.7, p<0.001, respectively). Board pass rates were significantly lower for recently founded programs by 11 percentage points for the QE (β = -11, 95% CI: -14.0 to -8.8, p<0.001), and 2.6 percentage points for the OCE (β = -2.6, 95% CI: -4.1 to -1.0, p=0.001), while COTH-affiliated programs achieved significantly higher QE pass rates (β = 6.1, 95% CI: 3.8-8.4, p<0.001) and OCE pass rates (β = 1.6, 95% CI: 0.4-2.8, p=0.011). Government programs had significantly higher OCE pass rates compared to for-profit programs (β = 2.9, 95% CI: 0.35 to 5.4, p=0.026) but did not show significant differences in QE pass rates (β = 4.6, 95% CI: -0.22 to 9.5, p>0.05). Non-profit programs demonstrated higher QE (β = 2.0, 95% CI: -2.6 to 6.5, p>0.05) and OCE pass rates (β = 2.0, 95% CI: -0.42 to 4.3, p>0.05), though the associations were non-significant. Conclusions: Our findings indicate significant variability in the training environments of EM residency programs, in which recently founded, non-teaching status, and for-profit programs demonstrated lower clinical volumes, less high-acuity exposure, and lower board pass rates. These insights underscore the need for enhanced support and potentially stricter accreditation criteria to ensure consistent and robust training experiences across all EM residency programs. Future efforts should focus on targeted improvements to maintain the quality of EM training and uphold a competent emergency medical workforce.

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