Advocacy & Position Statements

  • Compensated Time for Faculty Academic Administration and Teaching Involvement

    Originally approved June 2019

     

    A joint policy statement of the American College of Emergency Physicians, American Academy of Emergency Medicine, American Academy of Emergency Medicine Resident and Student Association, American Board of Emergency Medicine, American College of Osteopathic Emergency Physicians Graduate Medical Education Committee, American Osteopathic Board of Emergency Medicine, Association of Academic Chairs of Emergency Medicine, Council of Emergency Medicine Residency Directors, Emergency Medicine Residents’ Association, Society for Academic Emergency Medicine, and the Society for Academic Emergency Medicine Resident and Medical Students

     

    Emergency medicine is unique in that it provides 24-hour clinical care for a diverse range of high-acuity, life-threatening illnesses and requires direct, continuous, on-site faculty supervision of residents. Because a substantial portion of residency education consequently occurs outside the domain of regular clinical shifts, protection of core faculty educational time is essential. Core faculty have been defined as those faculty who work clinically and devote the majority of their professional efforts to emergency medicine graduate medical education (GME).1 Program leadership and core faculty are critical to the success of the training missions of emergency medicine residency and fellowship programs. Core faculty require compensated time to engage in necessary residency education, administration, and scholarly activities outside of the clinical environment; without protected time for core faculty to accomplish this, the quality of emergency medicine residency training and clinical care may decline. At a minimum, all emergency medicine core faculty should be allocated protected time per the 2017 Accreditation Council for Graduate Medical Education (ACGME) Emergency Medicine Common Program Requirements: emergency medicine core faculty clinical hours should be limited to no more than 28 hours per week or 1344 hours per year, whichever is fewer.1

    1. Program Requirements for GME in Emergency Medicine – ACGME [Internet]. Program Requirements for GME in Emergency Medicine – ACGME. 2017 [cited 2019 Feb 27];Available from:   https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/110_emergency_medicine_2017-07-01.pdf

    1. The term “Emergency Physician” should only be used to refer to one of the following:
      1. Graduates of ACGME- or AOA-accredited Emergency Medicine residency programs who are ABEM or AOBEM board eligible or board certified.
      2. Those physicians who completed training in another specialty and who received ABEM or AOBEM certification before the closure of the practice pathways and are currently certified by either of those bodies; and physicians who applied through the practice pathways before their closure and are currently designated as board eligible by ABEM or AOBEM.
      3. Graduates of ACGME- or AOA-accredited programs in pediatrics who also completed a Pediatric Emergency Medicine fellowship that was accredited by the ACGME or AOA.
      4. Retired physicians who met the above definitions during their careers.
    1. The term “Emergency Medicine Resident Physician” should only be used to refer to current resident physicians serving in an ACGME/AOA accredited Emergency Medicine Residency working in an emergency department as part of their education.
    2. Fellows in an ACGME- or AOA-accredited Pediatric Emergency Medicine fellowship working in an emergency department as part of their education are “Pediatric Emergency Medicine Fellow Physicians.”
    3. Physicians who have not met the above criteria and who practice in an Emergency Department should be identified as “(other specialty physician) providing emergency care”, “emergency care provider” or “physician working in the emergency department.”

    Approved by the CORD Board 3/31/2014

  • CORD firmly believes that the independent practice of emergency medicine (EM) is best performed by graduates from emergency medicine residency training programs. 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. Emergency medicine physicians who may practice independently are eligible to take or have successfully passed the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM) certification.


    Reaffirmed by CORD Board 10/30/2017

  • 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

    Approved by CORD Board 3/5/2013

  • 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 Advanced Life Support courses referenced above. 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 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 Advanced Life Support 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.

    Reaffirmed by the CORD Board 3/5/2013

  • 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.

    Reaffirmed by the CORD Board 3/5/2013

  • CORD’s formal position on the current ACGME resident duty hour requirements, including impact analysis, from CORD’s perspective, on costs and impact of implementation.   

    • CORD supports the concept of resident duty hour requirements to promote a supportive educational environment with resident well-being and patient safety.
    • CORD has concerns about the effect of resident duty hour requirements on patient safety, transitions of care, quality of training and costs.
    • CORD believes resident duty hours should be revised to better support the educational experience for trainees.
    • CORD recommends that the ACGME should establish specialty-specific duty hour requirements for all specialties.

    CORD’s formal recommendations regarding dimensions of resident duty hours requirements, and justification (wherever possible) for these recommendations with evidence.

    • CORD supports duty hours that will enhance patient safety and resident wellness.
    • CORD recommends the ACGME provide more flexibility in duty hours to provide for resident scheduling flexibility and professional development.
    • CORD recommends absolving residency programs of monitoring external moonlighting hours.
    • CORD recommends revising duty hours to promote professional citizenship, patient accountability and academic service.

    Approved by the CORD Board 1/30/2016

  • 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.

  • 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. 

    Reaffirmed by the CORD Board 3/5/13

    1. CORD members and their staff should consider all written electronic communications from applicants to be confidential and not for distribution beyond the program personnel involved in resident selection unless permission is granted by applicant.
    2. The dissemination of negative information about an applicant to outside parties is improper unless contained in a letter of recommendation or in response to a direct question from another program.
    3. Any serious concerns regarding professionalism, related to an applicant may be brought to the attention of the Dean of Student Affairs at the applicant's school with a request that the Dean investigate the matter and notify as appropriate the programs the applicant has sent their information to.

    Approved by the CORD Board 3/5/2013

  • The American Board of Emergency Medicine(ABEM)defines the standards for the specialty of Emergency Medicine. Certification by ABEM supersedes the need for any additional certifications sometimes required for medical staff privileges or disease-specific care center designations, such as that needed for trauma or stroke centers. Herein, ABEM and supporting Emergency Medicine organizations oppose any requirement of additional short courses or topic-specific continuing education for ABEM and AOBEM-certified emergency physicians, who are in good standing with their medical staff, and who are participating in Maintenance of Certification, or Osteopathic Continuous Certification, or any future program to ensure continued Board Certification.

     

    Emergency Medicine organizations provide high quality opportunities for continuous professional development in advanced resuscitation, trauma care, stroke care, cardiovascular care, procedural sedation, pediatric care, and airway management.

     

    The knowledge, skills, and abilities needed for the care of the acutely ill and injured are sufficiently described in The Model of the Clinical Practice of Emergency Medicine (EM Model), and are ensured by obtaining and maintaining ABEM certification. The EM Model is the foundational document for designing an Emergency Medicine residency curriculum, and is also the document on which ABEM bases the content of its initial certification and continuous certification (ConCert™) examinations. Residency training in the Model and subsequent oral and written assessments are far more rigorous than any of the topic-specific continuing education courses (i.e., ACLS, PALS, ATLS, etc.)

     

    An ABEM-certified physician has successfully passed a secure, comprehensive written examination that includes questions about airway management, pharmacotherapy, cardiovascular care, and trauma care with an emphasis on critical and emergent conditions. If the physician successfully passes the written examination, she or he must then take an oral examination. The ABEM Oral Certification Examination is a highly reliable test that requires the physician to demonstrate the diagnostic evaluation and treatment of complex clinical conditions.

     

    The ABEM Maintenance of Certification Program is a rigorous program of continuous professional development that contains content critical to the practice of Emergency Medicine. The ConCert™ Examination is a high-stakes, psychometrically valid, secure, and comprehensive examination weighted toward high acuity conditions. The ABEM Maintenance of Certification program includes content pertaining to procedural sedation, cardiovascular care, airway management, trauma care, stroke management, and pediatric acute care. For the Lifelong Learning and Self-Assessment (LLSA) test requirement, ABEM-certified emergency physicians are required to read 10-15 articles for each test yearly. The content and rigor of the ABEM LLSA requirements exceed the knowledge and skills that could be gained from any of the aforementioned short courses.

     

    ABEM-certified physicians who are active in the ABEM Maintenance of Certification program should not be required to obtain additional certification or content-specific educational requirements. For physicians who are not board certified in Emergency Medicine, completion of periodic, short courses in focused content areas of Emergency Medicine may be valuable. Nonetheless, additional short courses or certifications are unnecessary for ABEM and AOBEM-certified emergency physicians.

    Approved by the CORD BOD 10/18/2017

  • Founded in 1989, the Council of Emergency Medicine Residency Directors (CORD) has served to promote the free exchange of ideas and solutions to challenges faced by Emergency Medicine educators. CORD has long recognized that supporting our educators and trainees goes far beyond professional and academic resources and associations. In this capacity, CORD was formed also with the goal of developing a close-knit community of clinician educators and program coordinators for the purpose of providing a personal and supportive community of practice.

    To further support and expand upon the founding values of CORD, in 2015 the Resilience Committee was formed with the purpose of focusing on the wellbeing of our residents and educators. The goals of the committee are to: 

    • Promote a culture of wellness among faculty and residents.
    • Develop best practices for resilience and coping techniques during residency.
    • Establish a strategy to support residency programs that have had residents or faculty die by suicide.
    • Provide curricular resources on wellness and long-term career satisfaction.
    • Establish a network for faculty and residents interested in advancing wellness in emergency medicine.
    • Promote research and scholarship in wellness. 

    Since its inception, the Resilience Committee has been able to achieve several milestones for promoting well-being within the Emergency Medicine education community, including: ongoing collaborative efforts with the American Foundation for Suicide Prevention and the Take 5 to Save Lives Campaign; establishing a continually updated database of Wellness Champions at institutions across the country; creating modules and curricula for residency programs on wellness topics; developing best practices for assessing resident wellness; inspiring collaborative research efforts between institutions; and innovating wellness training programs for residents. 

    CORD is fully committed to addressing the professional and personal issues which lead to EM physician unwellness within academic medicine as well as promoting practices at all levels of administration that support EM physician well-being for lifelong practice.

    Approved by the CORD BOD 11/14/2017

Advocacy

Recent Correspondence & Issues Addressed by the Board of Directors

Dream Act Health Professionals Statement of Support

Health professions organizations have come together to support legislation that would provide a pathway to citizenship for undocumented young people and those approved for Deferred Action for Childhood Arrivals (DACA)

Letter to Congress

 

Coalition to Oppose Medical Merit Badges
Earlier this year, in partnership with all of the major Emergency Medicine (EM) organizations, CORD was proud and honored to support an initiative opposing medical institutions that require board certified EM physicians to: (1) maintain certification in various resuscitation courses, and (2) to have mandatory short-course continuing medical education for various subspecialty areas such as stroke and trauma.
 
Like many of the other EM initiatives of which CORD has been a part, we believe that by banding together, we can continue to advance our specialty by speaking with one voice. The following letter is being sent on behalf of the CORD Board of Directors.

Coalition to Oppose Medical Merit Badges Letter

(4/3/17)


Joint Organization letter regarding VA Policy - Out of Operating Room Airway Management (OORAM) Certification for non-anesthesiologists

Letter to Veterans Administration

(6/29/16)


CORD Response Letter to ACGME regarding Duty Hours

Letter to ACGME

(1/30/2016)


Joint Organization letters regarding Doximity Medical Student Survey

Letter to US News

Letter to Doximity 

(9/12/14)


The ACGME has proposed revisions to the common program requirements for resident duty hours

CORD response to ACGME proposed revisions (8/9/10)

Joint EM response to ACGME proposed revisions


CORD was asked to offer recommendations for revising the ABEM policy on credit for prior training (6/11/10)

Response from ABEM to CORD recommendations


NRMP Policy Change


Background for Definition of Emergency Physician