# Staffing Patterns of Non-ACGME Fellowships with 4-Year Residency Programs: A National Survey

## TL;DR

This study explores how emergency medicine fellowships at institutions with four-year residency programs hire and supervise three-year graduates.

## Contribution

The study provides new insights into staffing patterns and challenges in non-ACGME fellowships with four-year residency programs.

## Key findings

- Most non-ACGME fellowships hire three-year EM graduates and allow them to supervise residents.
- Not hiring three-year graduates is linked to fewer recruitment options and smaller applicant pools.
- Departments often cite training quality and resident complaints as reasons for not hiring three-year graduates.

## Abstract

Emergency medicine (EM) is one of few specialties with variable training lengths. Hiring a three-year graduate to continue fellowship training in a department that supports a four-year residency program can lead to conflicts around resident supervision. We sought to understand hiring and clinical supervision, or staffing, patterns of non-Accreditation Council for Graduate Medical Education (ACGME) fellowships hosted at institutions supporting four-year residency programs.

We performed a web-based, cross-sectional survey of non-ACGME fellowship directors (FD) hosted at institutions supporting four-year EM residency programs. We calculated descriptive statistics. Our primary outcome was the proportion of programs with four-year EM residencies that hire non-ACGME fellows graduating from three-year EM residencies.

Of 119 eligible FDs, 88 (74%) completed the survey. Seventy FDs (80%) indicated that they hire graduates of three-year residencies. Fifty-six (80%) indicated that three-year graduates supervise residents. Most FDs (74%) indicated no additional requirements exist to supervise residents outside of being hired as faculty. The FDs cited department policy, concerns about quality and length of training, and resident complaints as reasons for not hiring three-year graduates. A majority (10/18, 56%) noted that not hiring fellows from three-year programs negatively impacts recruitment and gives them access to a smaller applicant pool.

Most non-ACGME fellowships at institutions with four-year EM programs recruit three-year graduates and allow them to supervise residents. This survey provides programs information on how comparable fellowships recruit and staff their departments, which may inform policies that fit the needs of their learners, the fellowship, and the department.