Dual Residency Guidelines Open New Doors for Students

It's likely medical students soon will have the option of matching to combined family and emergency medicine residency programs as a result of guidelines (PDF file: 6 pages / 32.1 KB. More about PDFs.) recently approved by the American Board of Family Medicine and American Board of Emergency Medicine.

The guidelines, announced by ABFM and ABEM March 24, allow hospitals and other residency sponsors with accredited programs in family and emergency medicine to offer combined residency training that leads to dual board certification. Programs could launch combined residency training programs as early as July.

When first discussed in 2005, 72 family medicine residency programs expressed interest in offering this type of dual training, according to Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education. He expects at least three or four programs to launch dual training in 2006.

Dual family and emergency residency training is a resource for residents who plan careers that combine family and emergency medicine, such as in rural practices where family physicians often staff emergency departments, said Pugno.

The dual residency approval will help preserve family physicians' role in emergency departments, ensure medical coverage of EDs in underserved areas and address emergency medicine's desire for board-certified ER directors, according to Mark Belfer, D.O., director of the family medicine residency program at Akron General Medical Center in the Northeastern Ohio Universities College of Medicine hospital consortium. Belfer served on the AAFP Commission on Education during the ABFM-ABEM discussions.

"The reason (these guidelines) came about was because several family physicians in rural areas were getting shut out of emergency rooms where they'd been working for years," he said. "ABEM's goal is to have all emergency rooms staffed by board-certified emergency medicine doctors."

The guidelines stipulate that graduates of combined training programs can sit for certification in each specialty and practice as family physicians, emergency medicine physicians, or both. They also can enter subspecialty training programs approved by either board or undertake research.

Approved programs must provide 30 months of training under the direct supervision of each specialty, according to the guidelines, for a total of 60 months of training. Six months of training should be provided under each specialty in the first year. Continuous assignments in one specialty should not be less than three months or more than six months in that specialty.

"The curriculum must assure a cohesive, planned educational experience and not simply comprise a series of rotations between the two specialties," the guidelines say. "Duplication of clinical experiences between the two specialties should be avoided."