1. Career Outcomes of Graduates of EM/IM and EM/IM/CC Residency Programs
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Nathaniel Scott MD; Adam Rodos MD; Carissa Tyo MD; Christian Coletti MD; Christy Carter MD; Daniel Martin MD MBA
Abstract
Background
Methods
Results
Results cont.
Discussion
Background
The most recent effort examining the career outcomes of graduates of Emergency Medicine / Internal Medicine (EM/IM) residency programs was published 9 years ago. Previous literature lacks a detailed description of the clinical practice of EM/IM graduates. Outcomes for Emergency Medicine / Internal Medicine / Critical Care (EM/IM/CC) graduates have never been described. A current understanding is important for medical students, residents, program leadership, and institutions supporting these programs.
Objectives
The objective of this study is to provide an updated and detailed description of the career outcomes of EM/IM and EM/IM/CC graduates, including current clinical practice, frequency of fellowship training, practice setting, board certification status in EM and IM, and satisfaction with training.
Methods
This study is a cross-sectional survey. Select questions from previous studies were utilized. Content validity evidence was established by expert review and response process validity was established by use of pilot participants. All graduates from EM/IM and EM/IM/CC training programs through 2017 were eligible. Statistics are descriptive. The study was approved by the institutional review board at Hennepin County Medical Center.
Results
158 EM/IM and 24 EM/IM/CC graduates responded, constituting a response rate of 63% for graduates with available contact information. 12 training sites are represented. 34% of EM/IM graduates entered fellowships, of which critical care and pulmonary/critical care were most frequently chosen. After training, 70% entered academic positions. 95% plan to continue board certification in EM; 86% plan to continue in IM. Table 1 describes current clinical practice. 87% report being “extremely satisfied” with their residency training. 90% feel that obtaining a position with both IM and EM clinical practice required “somewhat” or “much more” effort than a position with either one alone.
Conclusions
Graduates report high rates of satisfaction with their training. Fellowship training in critical care and academic practice are frequently chosen. EM-only and practice in both EM and IM is common. Most EM/IM/CC graduates practice in both an EM and ICU setting. Limitations include a lower-than-desired response rate, missing contact information, and possible overrepresentation of graduates in academic practice.

2. Career Outcomes of Graduates of EM/IM and EM/IM/CC Residency Programs
Nathaniel Scott MD; Adam Rodos MD; Carissa Tyo MD; Christian Coletti MD; Christy Carter MD; Daniel Martin MD MBA
Abstract
Background
Methods
Results
Results cont.
Discussion
Background
Timeline
1989: ABEM and ABIM created guidelines for combined training in EM/IM
1999: EM/IM/CC guidelines are established
2009: Most recent study of EM/IM graduates published
2010: ABEM and ABIM reach agreement enabling EM grads to achieve board certification in IM-CCM
A systematic process to assess the practice patterns of graduates does not exist.
The 2009 study indicates that 55% of EM/IM graduates practice in EM only, 37& do a combination of EM and IM
Practice patterns of EM/IM/CC grads are unknown
Objectives
Provide an updated and detailed description of the career outcomes of EM/IM and EM/IM/CC graduates
- current clinical practice
- frequency of fellowship training
- practice setting
- board certification status in EM and IM
- satisfaction with training.
Methods
Design: Cross-sectional survey
Question development: Select questions from previous studies were utilized. Content validity evidence was established by expert review and response process validity was established by use of pilot participants.
Inclusion criteria: All graduates from EM/IM and EM/IM/CC training programs through 2017 were eligible.
The study was approved by the institutional review board at Hennepin County Medical Center.

3. Career Outcomes of Graduates of EM/IM and EM/IM/CC Residency Programs
Nathaniel Scott MD; Adam Rodos MD; Carissa Tyo MD; Christian Coletti MD; Christy Carter MD; Daniel Martin MD MBA
Abstract
Background
Methods
Results
Results cont.
Discussion
Survey Response
158 EM/IM and 24 EM/IM/CC graduates responded, constituting a response rate of 63% for graduates with available contact information.
12 training sites are represented
Table 1. Graduation years of survey respondents
Years Since Graduation
Range
Number of Respondents
Percent
0-5 years 72
40%
6-10 years 48
26%
11-15 years 33
18%
16-20 years 23
13%
21-25 years 3 2%
25+ years
prior to 1993
182

4. Career Outcomes of Graduates of EM/IM and EM/IM/CC Residency Programs
Nathaniel Scott MD; Adam Rodos MD; Carissa Tyo MD; Christian Coletti MD; Christy Carter MD; Daniel Martin MD MBA
Abstract
Background
Methods
Results
Results cont.
Discussion

5. Career Outcomes of Graduates of EM/IM and EM/IM/CC Residency Programs
Nathaniel Scott MD; Adam Rodos MD; Carissa Tyo MD; Christian Coletti MD; Christy Carter MD; Daniel Martin MD MBA
Abstract
Background
Methods
Results
Results cont.
Discussion
Discussion
A current understanding of graduate outcomes is important for medical students, residents, program leadership, and institutions supporting these programs.
Main findings 
Graduates report high rates of satisfaction with their training.
EM/IM graduates frequently enter critical care training fellowship programs
Graduates enter academic practice at a much higher rate than graduates of categorical EM training programs
EM-only and practice in a combination of EM and IM is common.
Most EM/IM/CC graduates practice in both an EM and ICU setting.
Study Limitations
Lower-than-desired response rate
Data is self-report
Missing contact information
Possible overrepresentation of graduates in academic practice and other populations.
Future Directions
Further opportunities exist to explore in a more detailed manner how EM/IM training impacts clinical practice, academic productivity, leadership roles
A better understanding of characteristics of applicants who match in to combined practice will additionally inform outcomes
Development of ongoing database of graduates
References
Katz ED, Katz JT. Careers of graduates of combined emergency medicine/internal medicine programs. Acad Emerg Med. 2002;9:1457–9. 
Kessler CS, Stallings LA, Gonzalez AA, Templeman TA. Combined Residency Training in Emergency Medicine and Internal Medicine: An Update on Career Outcomes and Job Satisfaction. Academic Emergency Medicine. 2009;16:894–9. 
Lubavin BV. The Effect of Emergency Medicine Residency Format on Pursuit of Fellowship Training and an Academic Career. Acad Emerg Med. 2004;11:938–43.