Wednesday, June 30, 2021

EM/IM Combined Residency: What up with that?

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This post was peer reviewed.
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Authors: Kyla Rakoczy
MS-3, University of Miami Miller School of Medicine

Kasha Bornstein, MD, MPH
PGY-1, LSU New Orleans Internal Medicine/Emergency Medicine

Choosing a specialty is one of the most daunting tasks of medical school. Pursuing an emergency medicine residency affords a fast-paced, often unpredictable environment with a diversity of patients unique to the specialty, while the life of an internist involves rounding, longitudinal patient care, and long contemplative sessions pertaining to pathophysiology and diagnosis. A combined Emergency Medicine (EM)/Internal Medicine (IM) residency program may allow for the best of both worlds. There are currently eleven, and soon to be twelve, programs that offer a combined five-year program. Required exposures in EM include experience performing invasive procedures, critical care experience, pediatric exposure, and emergency preparedness, while the IM aspect requires completion of rotations through IM subspecialties including oncology, cardiology, and infectious disease, with clinic opportunities in neurology, rheumatology, and endocrinology, as well as an additional four months dedicated specifically to pediatrics.[1] Graduates of the combined degree may choose to work solely in either field, enter a subspecialty, pursue additional fellowship experience in critical care, or engage in research.[2] The most popular fellowship pursued by combined training candidates is critical care (CC), and there are five all-inclusive combined EM/IM/CC programs in the United States. This path involves seventy-two months split between emergency medicine and internal medicine with additional experience in the critical care setting.[3] Upon completion of this challenging six-year period, residents are eligible for triple-board certification. Many triple-certified physicians choose to divide their time between the emergency department (ED) and intensive care unit (ICU) for extra variability in their careers, staying sharp in both the high acuity and physiological management of the most ill and complex patients.