Why/how is the RRC-EM different from every other specialty?

[rxfudd]

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So the standard answer on these forums to the question "What are the top programs in EM?" is that they're all top notch, high quality programs - largely because the RRC "has strict control of" and "keeps tight watch over" EM residencies. It's also been implied that this is not true for other specialties, resulting in some shady programs here and there.

My question is, what does this exactly mean? These are very general statements that I've always just taken for granted as being true, but what does it really mean to have strict control or keep a tight watch? And why/how is this so different from, say, internal medicine or surgery? Why exactly is it that makes the RRC-EM so different from everyone else?

 

[bulgethetwine]

So the standard answer on these forums to the question "What are the top programs in EM?" is that they're all top notch, high quality programs - largely because the RRC "has strict control of" and "keeps tight watch over" EM residencies. It's also been implied that this is not true for other specialties, resulting in some shady programs here and there.

My question is, what does this exactly mean? These are very general statements that I've always just taken for granted as being true, but what does it really mean to have strict control or keep a tight watch? And why/how is this so different from, say, internal medicine or surgery? Why exactly is it that makes the RRC-EM so different from everyone else?

The main reason is that compared to other generalist specialties (peds, med, family, gen surg) there are fewer EM programs. Plus, it's a new specialty... so it's not like you have 80 years of unwieldy history, politics and status quo to address.

 

[rxfudd]

I guess I'm looking for specifics. I assume their "tight control" has to do with making sure everything is up to snuff on their visits every 5 years (checking on faculty presence in the ED, procedure logs, pt populations and volumes, didactics, resident wellness, off service rotations, etc). Even so, I don't undestand why this would be any different from how the RRC would monitor a program in ANY field, EM or not - but there are clearly programs that are considered weak in IM and surgery, whereas there are apparently none in EM.

 

[EctopicFetus]

rxfudd to be fair programs have their different strengths and weaknesses. Some are better at Peds some are better at US others at EMS. Some see more trauma than others and of those some dont see much penetrating and others not much blunt.

 

[rxfudd]

rxfudd to be fair programs have their different strengths and weaknesses. Some are better at Peds some are better at US others at EMS. Some see more trauma than others and of those some dont see much penetrating and others not much blunt.

I definitely agree, but the impression I've gotten from these forums is that on the whole, you'll be an excellently trained EM physician wherever you go. It seems to be a standard response that fit is one of the most important factors in EM, and rest assured that the programs are more alike than different (apparently courtesy of the RRC-EM). This seems to be very different from what a lot of my friends who went into other specialties seem to think about their own fields, where there are some programs that are glaringly inferior to others. I'm just curious what the RRC does, specifically, to prevent this from happening in EM.

 

[BKN]

I guess I'm looking for specifics. I assume their "tight control" has to do with making sure everything is up to snuff on their visits every 5 years (checking on faculty presence in the ED, procedure logs, pt populations and volumes, didactics, resident wellness, off service rotations, etc). Even so, I don't undestand why this would be any different from how the RRC would monitor a program in ANY field, EM or not - but there are clearly programs that are considered weak in IM and surgery, whereas there are apparently none in EM.

Much of your list is exactly what our RRC does. If your really interested in understanding this, read the rule books. At www.acgme.org you can see the program requirements. If you read them, I think the things that will stand out are that EM is unique in requiring around the clock on-site supervision of patient care by faculty, a much higher number of core faculty than other specialties (1 per 3 residents), a tightly defined curriculum and diadactics, faculty scholarly activity, resident scholarly activity, pt volume, types of cases, and resuscitation numbers.

If you look at IM for example, the requirements are just as long but less specific, supervision is less defined and "key faculty" to resident ratios much less strict (for exmple 4 for 75 residents).

E.P. tend to be be very pragmatic, controlling and mathematical. Our RRC members are no different than the rest of us.

As for "weak programs" check out the public section of the same website in the subhead called accreditation decisions. You can find each program's status and review cycle. The ACGME has made policy/determination that the exact citations should be given to the institution only. The thinking is that the detailed problems are most likely to be fixed if they don't end up in the paper. Key personnel would be spending their time defending themselves and the institution, rather than the fixing the problems.

Anyway, if the program has either intial or continued accreditation, the RRC has determined that the program substantially meets the program requirements. At present there are no EM programs listed on probationary or withdrawn status.

Everything else is just opinion.

 

[rxfudd]

Much of your list is exactly what our RRC does. If your really interested in understanding this, read the rule books. At www.acgme.org you can see the program requirements. If you read them, I think the things that will stand out are that EM is unique in requiring around the clock on-site supervision of patient care by faculty, a much higher number of core faculty than other specialties (1 per 3 residents), a tightly defined curriculum and diadactics, faculty scholarly activity, resident scholarly activity, pt volume, types of cases, and resuscitation numbers.

If you look at IM for example, the requirements are just as long but less specific, supervision is less defined and "key faculty" to resident ratios much less strict (for exmple 4 for 75 residents).

This is exactly what I was looking for, thanks BKN. The EM program requirements are pretty interesting, there were a lot of items I didn't realize were officially required. Also interesting to compare them with the reqs for medicine and surgery.