What is the recommended approach for a combined training program in family medicine (FM) and emergency medicine (EM) for healthcare professionals?

Combined Family Medicine and Emergency Medicine Residency Training

Program Structure and Duration

Combined FM/EM residency programs require a 5-year training pathway that prepares physicians for dual board certification in both specialties. 1

• These programs are distinct from categorical training in either specialty alone and represent one of five combined EM residency options currently available (EM/pediatrics, EM/internal medicine, EM/internal medicine/critical care, EM/family medicine, and EM/anesthesiology). 2
• The American College of Emergency Physicians emphasizes that these programs must have adequate, predictable, and stable funding sources to ensure an adequate supply of residency-trained specialists. 1

Educational Requirements and Curriculum

Programs must implement structured curricula with both didactic and bedside teaching, plus structured evaluation methods for residents and faculty. 1

• The curriculum should ensure comprehensive diagnostic and procedural skills across all age groups and clinical settings, reflecting the breadth required for both specialties. 1
• Training must encompass diagnostic skills affecting all organ systems in all age groups and both sexes, procedural skills including airway management, vascular access, cavity access, and wound repair, plus interpersonal skills for leadership and patient rapport. 3
• The Accreditation Council for Graduate Medical Education (ACGME) mandates that all programs have structured methods for evaluation of both residents and faculty. 3

Core Competencies and Skills Integration

The training must integrate emergency ultrasound as a mandatory skill, with residents obtaining basic psychomotor and cognitive competency during their training program. 4

• Emergency ultrasound requires at least 25 documented and reviewed cases in each core application (range 25-50 cases), with fewer cases needed for ultrasound-guided procedures (minimum 10 examinations). 4
• Training should include both didactic lessons and hands-on skill sessions with quality assurance programs to review examinations until safe clinical integration is achieved. 4

Clinical Training Environment

Programs should utilize collaborative team structures where experienced physicians supervise less-experienced clinicians, similar to critical care training models. 4

• Willing nonintensivists can be assigned to care for up to six critically ill patients each, with experienced physicians overseeing four to eight of these clinicians (up to 48 patients total, depending on experience level). 4
• The expansion of physician services may be submaximal early in training until less-experienced residents develop competence and confidence to care for patients with increasing independence. 4

Educational Methodology

A longitudinal interleaved curriculum offers substantial advantages over traditional block rotations for non-adult emergency department activities. 5

• This approach allows for "spaced retrieval" practice that enhances retention and develops clinical thinking processes important in practice. 5
• Increased continuity of clinical experience improves educational outcomes and learner satisfaction compared to traditional 1-month block rotations separated by 6-9 months. 5

Career Preparation and Outcomes

The decision to enter a 5-year combined program should be comprehensive and informed, recognizing the distinct career opportunities available to graduates. 2

• Combined training prepares physicians for practice settings requiring expertise in both comprehensive primary care and acute emergency management. 2
• Graduates are positioned to address workforce needs in rural communities and settings where dual expertise provides significant value. 3

Common Pitfalls to Avoid

• Do not structure pediatric EM, point-of-care ultrasound, or other specialized rotations as single isolated blocks early in training when retention and skill integration are suboptimal. 5
• Avoid relying solely on intensivists or experienced emergency physicians for primary management without incorporating collaborative team structures that allow skill development under supervision. 4
• Do not implement training without adequate quality assurance programs and structured evaluation methods for both residents and faculty. 1, 3