Advantages of a Three-year Residency

In the early 1980s, the specialty was grappling with the decision to lengthen EM residency from 24 to 36 months. The American College of Emergency Physicians commissioned the “Length of Training Report,” which assessed likely resident clinical experience for 283 important clinical entities during a 24 month residency. Based in part on this analysis, the minimum requirement for EM residency training was lengthened to 36 months under the tutelage of EM faculty. A later comparison of one program’s resident clinical experience showed that, even with 36 months of training, the average resident would not meet these requirements for 50.5% of the diagnoses. Furthermore, when resident experience was compared to the then-current Core Concept document that included 554 clinical diagnoses, it was determined that the average resident would not see any of 22.7% of these diagnoses in a three-year period. For another 37% of these diagnoses, there were not enough of them so that each resident would see even one, even if they were evenly distributed. All told, 60% of Core Content diagnoses could not possibly be taught through personal case-management experience for each resident.1 Basically, common things present commonly, and rare diagnoses are truly rare.