I am currently a resident of Emergency Medicine on the island, did a 1 month rotation there in July and have a few friends who are residents at that particular program, so maybe I can be of some help. The program did lose its accreditation about 15 years ago but regained it shortly after. As far as I am concerned they havent had any more problems since.
As far as the residency is concerned I loved my rotation there. The faculty is pretty cool and laid back, but the supervision is great. First year residents spend most of the year doing one, two or three month rotations in other specialties. You can choose to do them in any accredited residency in PR or the US. From second, third and fourth year residents spend most of their time in clinics and OR.
The atmosphere is great and the camaraderie was great. I didnt see evidence of unnecessary competition between residents. There is faculty 24 hours and those nights I spent on call with the residents were pretty cool. I considered Anesthesiology but decided in ER because I liked the lifestyle more, but I would definitely recommend gas to anyone considering it.