2016 Model of the Clinical Practice of Emergency Medicine

In 1975, the American College of Emergency Physicians and the University Association for Emergency Medicine (now the Society for Academic Emergency Medicine; SAEM) conducted a practice analysis of the emerging field of Emergency Medicine. This work resulted in the development of the Core Content of Emergency Medicine, a listing of common conditions, symptoms, and diseases seen and evaluated in emergency departments. The Core Content listing was subsequently revised four times, expanding from 5 to 20 pages. However, none of these revisions had the benefit of empirical analysis of the developing specialty but relied solely upon expert opinion.

Following the 1997 revision of the Core Content listing, the contributing organizations felt that the list had become complex and unwieldy, and subsequently agreed to address this issue by commissioning a task force to re-evaluate the Core Content listing and the process for revising the list. As part of its final set of recommendations, the Core Content Task Force recommended that the specialty undertake a practice analysis of the clinical practice of Emergency Medicine. Results of a practice analysis would provide an empirical foundation for content experts to develop a core document that would represent the needs of the specialty.

Following the completion of its mission, the Core Content Task Force recommended commissioning another task force that would be charged with the oversight of a practice analysis of the specialty - Core Content Task Force II.

The practice analysis relied upon both empirical data and the advice of several expert panels and resulted in The Model of the Clinical Practice of Emergency Medicine (EM Model). The EM Model resulted from the need for a more integrated and representative presentation of the Core Content of Emergency Medicine. It was created through the collaboration of six organizations:

  • American Board of Emergency Medicine (ABEM)
  • American College of Emergency Physicians (ACEP)
  • Council of Emergency Medicine Residency Directors (CORD)
  • Emergency Medicine Residents’ Association (EMRA)
  • Residency Review Committee for Emergency Medicine (RRC-EM)
  • Society for Academic Emergency Medicine (SAEM)

As requested by Core Content Task Force II, the six collaborating organizations reviewed the 2001 EM Model in 2002-2003 and developed a small list of proposed changes to the document. The changes were reviewed and considered by 10 representatives from the organizations, i.e., the 2003 EM Model Review Task Force. The Task Force’s recommendations were approved by the collaborating organizations and were incorporated into the EM Model. The work of the Task Force was published in the June 2005 Annals of Emergency Medicine and Academic Emergency Medicine.

The six collaborating organizations reviewed the 2002-2003 EM Model in 2005 and developed a small list of proposed changes to the document. The changes were reviewed and considered by nine representatives from the organizations, i.e., the 2005 EM Model Review Task Force. The Task Force’s recommendations were approved by the collaborating organizations and were incorporated into the EM Model. The work of the Task Force was published in the October 2006 Academic Emergency Medicine and December 2006 Annals of Emergency Medicine.

The next regular review of the EM Model occurred in 2007. The 2007 EM Model Review Task Force recommendations were approved by the collaborating organizations and were incorporated into the EM Model. The work of the Task Force was published in the August 2008 Academic Emergency Medicine and online-only in the August 2008 Annals of Emergency Medicine.

The fourth review of the EM Model occurred in 2009. The 2009 EM Model Review Task Force recommendations were approved by the collaborating organizations and were incorporated into the EM Model. The work of the Task Force was published in the January 2011 Academic Emergency Medicine and online-only in Annals of Emergency Medicine.

The fifth review of the EM Model occurred in 2011. The 2011 EM Model Review Task Force recommendations were approved by the collaborating organizations and were incorporated into the EM Model. The work of the Task Force was published online-only in the July 2012 Academic Emergency Medicine.

The sixth review of the EM Model occurred in 2013, with the addition of a seventh collaborating organization, the American Academy of Emergency Medicine (AAEM). The 2013 EM Model Review Task Force recommendations were approved by the collaborating organizations and were incorporated into the EM Model. The work of the Task Force was published online-only in the May 2014 Academic Emergency Medicine.

In 2014, the collaborating organizations made the decision to review the EM Model on a three-year review cycle. The seventh review of the EM Model occurred in 2016. The 2016 EM Model Review Task Force recommendations were approved by the collaborating organizations and are incorporated into this document. The full 2016 EM Model was published online in the March 2017 Journal of Emergency Medicine.

There are three components to the EM Model: 1) an assessment of patient acuity; 2) a description of the tasks that must be performed to provide appropriate emergency medical care; and 3) a listing of medical knowledge, patient care, and procedural skills. Together these three components describe the clinical practice of Emergency Medicine (EM) and differentiate it from the clinical practice of other specialties. The EM Model represents essential information and skills necessary for the clinical practice of EM by board-certified emergency physicians.

Patients often present to the emergency department with signs and symptoms rather than a known disease or disorder. Therefore, an emergency physician’s approach to patient care begins with the recognition of patterns in the patient’s presentation that point to a specific diagnosis or diagnoses. Pattern recognition is both the hallmark and cornerstone of the clinical practice of EM, guiding the diagnostic tests and therapeutic interventions during the entire patient encounter.

The Accreditation Council for Graduate Medical Education (ACGME) has implemented the ACGME Outcome Project to assure that physicians are appropriately trained in the knowledge and skills of their specialties. The ACGME derived six general (core) competencies thought to be essential for any practicing physician: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.1 The six general competencies are an integral part of the practice of Emergency Medicine and are embedded into the EM Model. To incorporate these competencies into the specialty of EM, an Emergency Medicine Competency Task Force demonstrated how these competencies are integrated into the EM Model.

The EM Model is designed for use as the core document for the specialty. It provides the foundation for developing future medical school and residency curricula, certification examination specifications, continuing education objectives, research agendas, residency program review requirements, and other documents necessary for the functional operation of the specialty. In conjunction with the EM Model, these six core competencies construct a framework for evaluation of physician performance and curriculum design to further refine and improve the education and training of competent emergency physicians.

The 2016 review of the EM Model resulted in significant changes and clarifications, including a comprehensive review and revision of category 17, Toxicologic Disorders. This review emphasized integrating “clinical intuition” in the treatment of toxicologic emergencies into the document, focusing on what the practicing emergency physician needs to know. In addition, the Task Force attempted to bring the EM Model into alignment with the ABEM Knowledge, Skills, and Abilities (KSAs) document.  The complete updated 2016 EM Model can be found on the websites of each of the seven collaborating organizations.

1 Accreditation Council for Graduate Medical Education (ACGME). ACGME Core Competencies. (ACGME Outcome Project Website). Available at http://www.acgme.org/outcome/comp/compCPRL.asp

2 Chapman DM, Hayden S, Sanders AB, et al. Integrating the Accreditation Council for Graduate Medical Education core competencies into The Model of the Clinical Practice of Emergency Medicine. Ann Emerg Med. 2004;43:756-769, and Acad Emerg Med. 2004;11:674-685.

Download the 2016 Model of the Clinical Practice of Emergency Medicine