Establishing Minimum Patient Volume Requirements for Emergency Medicine Residencies.

Background: The current ACGME EM program requirements (PR) use an annual minimum patient volume of 30,000 at the primary clinical site as a proxy to ensure sufficient clinical exposure for residents. As a part of the major revisions, the PR writing group proposes a modification of this requirement to define a minimum number of patient visits/resident during training using aggregate volumes from all EM rotation sites. Establishing this threshold intends to ensure that individual resident minimum encounter goals can be achieved by the end of residency through verification of adequate resources in the form of patient visits. Methods: Using minimum values, it was determined that the current patient visits/resident is 3000. We used ACGME program information to calculate the aggregate ED patients/resident for each program by multiplying the weekly ED volume at each site by the number of weeks spent in EM rotations then dividing by the approved complement. Results: Of the 282 programs (223 3-year and 59 4-year programs), 72.7% (205/282) had less than 5000, 51% (144/282) had under 4000, and 24.1% (68/282) had less than 3000 patient visits/resident (mean 4507.8, median 4219.5). Almost 25% of 4-year programs (14/59) were below 3000. With adjusted calculations to 3-year programs to account for an additional 31 weeks of EM as they transition to the proposed 4-year format, 28.2% (63/223) of programs fell below 5000, 9.4% (21/223) below 4000, and 0.9% (2/223) below 3000 patient visits/resident. Conclusions: The PRWG determined that 3000 patient visits/resident aggregated across all sites during training should be the minimum resource as this is what most programs are currently providing, and it's consistent with the current PR. Although the ACGME isn't currently tracking patient encounters, the proposed PR will likely support the foundation of patient experiences geared towards an ideal target of 5000 patient encounters/resident.