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Emergency medicine residency programs scarcely share their scholarly requirements and resources publicly, while some program leaders say they are unclear about what their accreditors and institutions expect of them.

That's according to a new study by researchers at the University of Maryland School of Medicine in Baltimore that examined how these programs implement scholarly activity mandates.

Reporting at the American College of Emergency Physicians (ACEP) annual meeting, Diane Kuhn, MD, PhD, a Maryland resident, led a group that found most of the 257 program websites they analyzed included no or minimal information about scholarly requirements and resources. Themes emerging from interviews with program leaders included the lack of clear expectations, as well as frustration with limited resources to conduct research.

"We all have these unclear expectations," said co-author R. Gentry Wilkerson, MD, clinical research director and assistant residency director of the Emergency Medicine Department. "We don't know what accreditors want."

Among the websites the team analyzed, only 108 (42%) specifically cited a scholarly requirement and 67 (26%) merely noted that a requirement existed. "Well-developed descriptions" were found on only 15% of the sites, the researchers reported.

"If I were a medical student going through [residency applications] today, I'd be very frustrated," Wilkerson said, adding that applicants already have limited interactions with residency programs now, due to typical virtual-only interview processes.

Other themes that emerged in the interviews included challenges in applying standardized expectations across a residency population with varying interests and abilities in research, and varying guidance from their own departments and hospitals.

"I have talked to people all across the country and we know we have a much higher expectation from our residents than a lot of other people," one leader told the researchers. "I think the hardest thing is just a matter of clear-cut, equal requirements for everyone," said another.

Wilkerson said he and his colleagues were surprised to learn there was so much frustration by program leaders -- especially those at small programs with more limited research resources.

Some leaders indicated they were afraid of their identity being revealed because they were speaking about their own institutions as well as the Accreditation Council for Graduate Medical Education, Wilkerson noted, adding that the team had to reassure them that their anonymity would be preserved.

Although the overall results were not a surprise, they were still alarming, Wilkerson said. "Residents don't come with a lot of know-how" regarding constructing research projects. "A program has to provide those resources to get it done."

The limited resources hinder research and "it harms the specialty," he said, explaining that leaders said that many residents want to take on big projects, but are inhibited by the lack of resources. "We need to empower residents with the tools needed," Wilkerson said.

"A framework for scholarly activity curricula in the future should emphasize transparency in practices and information-sharing across [emergency medicine residency programs]," the researchers wrote in presentation slides shared with MedPage Today.

In addition to analyzing the websites, the researchers in Fall 2019 analyzed the survey results from 113 residency programs and interviewed eight program leaders.

The researchers conducted framework analysis of the interviews, applying a grounded theory approach.

MedPage Today did not attend the presentation; ACEP did not make live presentations accessible to media, either in-person or virtually.

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