Because emergency medicine is a broad-based specialty, there is much leeway in the structure of resident education. The monthly block curriculum is a major determinant of the overall residency training experience. The purpose of our study was to define the block curricula of the accredited emergency medicine residencies in the 1986-87 academic year. In a mail-confirmed telephone survey of residency directors, monthly block rotation data were obtained for 187 postgraduate years in 66 (98%) of 67 approved residencies; identified were 51 individual rotations in nine areas. The PG1 year, present in 47 (71%) of 66 residencies, resembled the flexible internship. Rotations in obstetrics-gynecology, medicine, pediatrics, and surgery accounted for 50% of PG1 year training time. Adult emergency department experience was 21% of PG1 year. In the PG2-4 (PG2+) years, 56% of clinical time was spent in the adult or pediatric ED (mean, 6.6 months per year). Electives and surgery rotations each accounted for 11% of PG2+ years training time. Emergency medicine-related areas and critical care rotations each accounted for 7% of the PG2+ years training time. Besides time spent in the ED and on electives, the most highly weighted individual rotations in the PG2+ years were orthopedic surgery, trauma surgery, and emergency medical services. Nearly all programs offered rotations in the adult ED, a surgical subspecialty, critical care, and an elective during residency training. The percentage of rotations requiring direct supervision by emergency physicians increased threefold by the PG4 year. Off-service rotations dropped 15-fold during the PG4 year relative to the PG1 year.(ABSTRACT TRUNCATED AT 250 WORDS)
Curriculum Emergency Medicine