CORD Position Statements
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Position Statement on Board Certification and Independent Practice of Emergency Medicine
CORD firmly believes that the independent practice of emergency medicine (EM) is best performed by trained EM specialists. Successful completion of an EM residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA) is the criterion standard for a specialist in EM. Such specialists are eligible to take or have successfully completed the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM) certification.
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Position on Interactions between EM Residencies and the Pharmaceutical Industry
The Council of Emergency Medicine Residency Directors (CORD) believes that emergency medicine (EM) residents should receive training regarding conflicts of interest that may arise from the promotion and marketing efforts of industry, primarily the pharmaceutical industry. These conflicts may arise between pharmaceutical company representatives and any of the targets of their marketing, including physicians, nurses, and patients. Furthermore, EM residents should be instructed in critical appraisal methods so that unbiased judgments can be made regarding the efficacy of industry products. Residency programs should create policies that guide residents in dealing with pharmaceutical company representatives, potential conflicts of interest, and acceptable resolutions of these conflicts. CORD strongly supports the Accreditation Council for Graduate Medical Education (ACGME) white paper on the relationship between graduate medical education and industry and encourages its adoption by members.
Received May 9, 2003; accepted May 20, 2003. Address for correspondence: Sam Keim, MD: sam@aemrc.arizona. edu; or Debra G. Perina, MD: dgp3a@hscmail.mcc.virginia.edu. A related article appears on page 19. doi:10.1197/S1069-6563(03)00591-8 -
Guidelines on Residents within Closed Programs
Utilizing the unique communication available within the CORD organization, residents who may become abandoned due to impending closure of their program should be identified and assisted with placement into another EM residency program.
1. The CORD Board should be formally notified of an impending closure. CORD recommends this come from the program director, but it could also occur from the RRC, GME Administrators, Chairpersons, faculty members or residents. The CORD Board will seek to verify the information.
2. The program director, after obtaining resident permission, should send the CORD Board a formal list of all residents who will require and desire CORD’s assistance in locating additional training to complete residency preparation for ABEM certification following the programs closure.
3. The CORD Board would list the residents' names on the CORD listserv along with the program director or other appropriate faculty member’s names and contact information.
4. Program directors of potential receiving programs must request and receive approval from the RRC-ACGME prior to offering positions to any residents if a complement increase is needed. Program directors must also notify ABEM prior to accepting any residents.
Approved by CORD Board 12/20/00
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Guidelines on Resident Transfers
Residents within emergency medicine training programs on occasion desire to transfer to other programs. CORD believes that residents and residency directors should be aware that such transfers have many potential implications on individuals and programs. CORD believes that these transfers occur best within an environment that understands and attempts to address these issues. CORD believes that in general it is in the best interest of individual residents, programs and the residency program community if residents complete their entire residency within a single training program. Residents and program directors should consult with ABEM and the RRC-ACGME to ensure compliance within their policies before any transfer occurs. CORD believes the following principles should be respected with regards to residents who are contemplating a transfer between emergency medicine programs:
1. A resident should respect to the best of their ability their contractual responsibilities. The resident is vulnerable however because of the unequal relationship that exists with the program director. For this reason, the rights of the resident must be assured. It is unethical for a program director to block or interfere with the transfer of a resident from their program.
2. Residents should maintain open communication with their program director. Reasons for transfer generally fall into two categories: personal and educational. In general, the resident should communicate educational concerns with the program director in order to allow an attempt at remediation. Personal reasons are ideally communicated as well.
3. It is unethical for a program director, or designee, to contact a resident, in another program in an attempt to elicit a transfer. Established mechanisms, including the CORD listserv, SAEM residency vacancy service and periodicals are appropriate forums in which to announce vacancies.
4. Residents should not be offered positions until the current program director is made aware that a resident is contemplating a transfer.
5. Program directors should maintain open communication with the program from which the resident is contemplating departure. After proper release of information has been obtained, data regarding the resident's performance should be transferred to the program with the vacancy.
Approved by CORD Board 12/20/00
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Listserv User Guidelines
To subscribe to the CORD Listserv, CORD members should send an email to cord@cordem.org with their preferred email address. Only CORD members may subscribe and post to this list.
1. The Cord Listserv will only be used by CORD members and those approved by the Board.
2. Programs should contact the CORD office and inform the office of any changes in their program's representation so that the listserv can be updated.3. A designated "monitor" will be nominated by the President and approved by the Board to monitor the Listserv for compliance with these guidelines
4. Professional discourse will be expected. Therefore no profanity, vulgarity, or derogatory remarks will be appropriate.
5. No formal surveys should be posted on the listserv. They may be posted on Sharepoint; please see the Guidelines for CORD Sponsorship, Support, or Endorsement of Surveys and Research Projects. An email to the listserv announcing the posting of a survey on Sharepoint or another service is permitted.
6. Brief "inquires" or informal surveys about issues related to the business of Residency Administration which are 5 questions or less may be posted on the listserv. Replies should be directed to the specific individual posting the questions; not the entire listserv.
7. Questions asked by members on the Listserv should pertain to the business of developing and maintaining a residency in EM. Questions or advertisements of limited or no value to the overall membership are not appropriate for the Listserv. With the exception of those specific to CORD activities and formal advertisements for jobs; CME programs, and other such announcements may be posted on Sharepoint, and not on the listserv. Members should disclose any potential conflicts of interest or significant financial interests that exist with products or issues mentioned within any survey or discourse on the listserv.
8. Brief advertisements for available resident, faculty or fellowship positions in EM Residencies are permitted, but replies should be made directly to the institution or the sender. Announcements of new/approved programs or formation of new academic departments are also appropriate.
9. Personal message of "Congratulations" or "Thanks" should be sent directly to a specific individual,not to the entire listserv. REPLY means that every CORD member reads what is being sent. Cut and paste or retype an individual's email address into an email if you wish to convey a message that isn't intended for everyone.
10. Complaints about specific Listserv traffic, etiquette, or usage should be referred to the Listserv monitor via the CORD Office (cord@cordem.org) and NOT via the Listserv itself.
11. Members are cautioned on the use of "automatic reply/out of office" mechanisms. If inappropriately set up they can disable not only the Listserv but members’ computers as well. The CORD office will unsubscribe members from the listserv if such mechanisms are used. Please note, when responding to a posting "Reply" means that every CORD member gets to read what you send. Cut and paste the individual's e-mail address if you wish to convey a message that isn't intended for everyone to read.
12. Inappropriate use of the Listserv will result in a warning from the Listserv monitor; further inappropriate use will result in referral to the Board for possible removal from the Listserv.
Last revised 4/09
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Guidelines for CORD Involvement in Joint Organizational Projects
Requests for joint cooperative involvement should come to the CORD Board. In general, such involvement should be central to CORD’s mission. If approved, involvement in cooperative ventures should include equal representation of all parties. Agenda, timeline, and any financial responsibilities for cooperative ventures should be formally approved in advance by the CORD Board. Endorsement of any outcomes, publications or products will result only after review at completion by the CORD Board. Such relationships will end at completion of the stated agenda or at the discretion of the CORD Board.
Approved by CORD Board 12/20/00
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Position Statements on Advanced Life Support Course
Emergency Medicine residency directors are faced with an ever-expanding breadth of knowledge and skills to teach in their curriculum. Over the last decade the number of "Advanced Life Support" courses (ATLS, ACLS, APLS, PALS, NALS) has continued to grow. Mandated attendance of such courses has proven problematic from both a time and a financial standpoint. In addition, the information may not be as up to date or applicable as the program director would like. Our graduates continue to encounter mandated certification in order to join medical staffs or obtain ED clinical privileges, an archaic practice dating to the days when untrained practitioners were the norm in the ED.
The CORD Board of Directors has developed two position statements addressing the dilemma of "merit badge" medicine. The first applies to our graduates as they seek medical staff appointments or clinical privileges. The second addresses our teaching institutions in which mandated attendance may be encountered as a prerequisite for our EM residents’ participation in a clinical training venue.
Graduates:
The CORD believes that Emergency Department patient care is best provided by specialists who have successfully completed an accredited residency program in Emergency Medicine. Such individuals are trained to a much more rigorous standard than found in such courses. For this reason, CORD recommends that such courses not be required for medical staff appointments or clinical privileges for ABEM/ABOEM certified or EM residency trained physicians.
Teaching Institutions:
There has been a proliferation of Advanced Life Support Courses and certification, with over 8 such courses with content applicable to EM. The course contents are routinely taught to EM residents as a portion of their core curriculum in EM. For this reason, CORD does not support mandated attendance or certification as a prerequisite for participation in selected clinical residency requirements or rotations. The appropriate preparation for such curriculum elements is best determined on a local level by the EM residency director.
These position statements should not be interpreted as a blanket condemnation of all merit badge courses. Program directors may choose to examine the course content on a case by case basis for their less experienced EM residents, and decide if the course fits their curriculum needs.
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Position Statement on Moonlighting
CORD believes that ED patient care is best provided by specialists who have successfully completed an accredited residency program in emergency medicine. Residents should not engage in the independent practice of emergency medicine.
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Product Use by Members
From time to time, the Council of Emergency Medicine Residency Directors (CORD) develops products.
These products are the work of the membership. The following policy will apply to product use:1. CORD materials are the property of CORD and their use will be governed by this policy.
2. CORD materials are copyrighted and cannot be reproduced or used except with written permission of the CORD Board of Directors.
3. CORD products may be used only by CORD members. Members may not forward or copy the products for non-members.
4. CORD members may use the products for educational purposes for emergency medicine residents, medical students and faculty.
5. CORD members may not use CORD products for any activity outside of their residency, including those for which they receive compensation of any kind.
6. Questions about this policy should be referred to the CORD office.
7. This policy may be changed by the CORD Board.
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Guidelines for Ethical Participation in the Match
1. All Emergency Medicine residency programs must participate in the National Resident Matching Program (NRMP). The only exceptions are those programs that are approved by the RRC for EM after the interview season is over, or those that have expanded and have received accreditation to do so too late to include those additional positions in the Match. These programs would be allowed to fill the new positions after the unmatched applicants are notified.
2. All available positions must be included in the Match.
3. No guarantees may be given by a program to an applicant.
4. No program director may tell an applicant that he or she will hold back a position from the Match or add a position outside the Match if the applicant drops out of the NRMP.
5. All NRMP guidelines must be followed.
6. Alleged violations of these guidelines will be investigated by the CORD Committee on the Ethical Participation in the NRMP under the direction of the Board of Directors.
7. Programs that violate the guidelines will be subject to sanctions at the discretion of the Board of Directors.
8. Appropriate exceptions will be made for those candidates in the military and military programs.
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Guidelines for CORD Sponsored Surveys
CORD receives many requests for assistance with, and support for, sponsorship, or endorsement of surveys of emergency medicine residency programs. Therefore, the CORD Board has developed the following guidelines: As the organization representing all emergency medicine program directors, CORD is uniquely qualified to assist in the performance of surveys relating to resident education. CORD's Board of Directors will consider requests from the membership for sponsorship of surveys and research projects involving program directors, residents or other related groups. The decision to sponsor, support, or endorse a project will be based upon the following guidelines:
As the organization representing all emergency medicine program directors, CORD is uniquely qualified to assist in the performance of surveys relating to resident education. CORD's Board of Directors will consider requests from the membership for sponsorship of surveys and research projects involving program directors, residents or other related groups. The decision to sponsor, support, or endorse a project will be based upon the following guidelines:
1. Surveys and/or projects should be developed by committees or task forces of the organization and should be consistent with their overall goals.
2. Surveys and projects may be sponsored either independently or in conjunction with other emergency medicine organizations. If joint sponsorship with another organization is desirable, it is the responsibility of the project developers to apply for appropriate support, endorsement, or sponsorship from that organization.
3. Requests for sponsorship, support, or endorsement of a proposed survey should be submitted in writing to the Board of Directors. Requests should include a brief description of the rationale for the proposed survey and the perceived benefit to the organization or its membership. A detailed budget should describe costs related to printing, mailing, data analysis and publication as well as any other expenses associated with the project. A copy of the survey or research instrument should also accompany the request for sponsorship, support, or endorsement.
4. Task forces or committees receiving sponsorship, support, or endorsement will be expected to issue a follow-up report to the Board of Directors and the membership. When appropriate, publication in a peer-reviewed journal is desirable.
5. Credit for authorship of published research results should be based upon accepted principles governing authorship of scientific publications. CORD's sponsorship of published survey results should be noted in the acknowledgments accompanying publications.
6. The CORD listserv is not the appropriate venue to post the survey, the Sharepoint IS the appropriate and best method to distribute or post surveys for CORD member participation, and a brief email to the listserv announcing the posting on Sharepoint is permitted. Sharepoint will have a section for CORD endorsed survey and research instruments, and a separate section for brief, non-CORD endorsed surveys.
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Statement on Resident Participation in Air Medical Transportation
CORD believes that resident safety is of paramount importance in all training settings and that an air medical experience may place residents at higher risk. CORD believes that emergency medicine residents must understand air medical transportation of patients including selection, EMS medical direction, flight capability and safety, and flight physiology and CORD recognizes that some programs have established an area of excellence in this training. CORD does not believe that flight experience is required to gain an adequate level of understanding. Programs that do request or allow residents to fly on rotary aircraft should be certain that the aircraft are certified and maintained according to the highest standards promulgated by the appropriate credentialing boards. Programs should also ensure that residents are educated into the risks of air medical transport prior to their first flight.