# Perceived Strengths and Gaps of Critical Care Fellows Across Emergency Medicine and Other Specialties

## TL;DR

Emergency medicine-trained doctors entering critical care fellowships have strengths in diagnostics and resuscitation but may need more training in areas like ventilator management compared to peers from other specialties.

## Contribution

This study identifies specialty-specific competency differences in critical care trainees, offering insights for tailored educational strategies.

## Key findings

- Emergency medicine (EM) fellows outperformed internal medicine peers in intubation, vascular access, and point-of-care ultrasound.
- Internal medicine fellows scored higher in ventilator management, palliation, and renal physiology.
- Tailoring curricula to address specialty-specific gaps could improve overall critical care training outcomes.

## Abstract

Emergency physicians pursuing critical care training must enter fellowships designed for internal medicine, anesthesiology, or surgery trainees. In this study we aimed to assess how emergency medicine (EM)-trained fellows are perceived by critical care fellowship leadership compared to their peers and to identify specialty-specific strengths and gaps that may inform targeted educational approaches.

We conducted a national, cross-sectional survey of program directors and associate/assistant directors of Accreditation Council of Graduate Medical Education-accredited critical care fellowships. Respondents rated the baseline competence of incoming fellows across 11 core critical care domains using a 5-point Likert scale. We compared competency ratings across residency training backgrounds using linear mixed models, accounting for clustering and adjusting for rater specialty where appropriate.

Of 429 distributed surveys, 118 (27.5%) were completed. Our respondents represented internal medicine-based fellowships (63, 53%), surgical fellowships (32, 27%), and anesthesia fellowships (23, 20%). On a 5-point Likert scale ranging from 1 = “Not competent” to 5 = “Very competent,” EM-trained fellows were rated significantly higher than their internal medicine-trained peers in intubation (3.93 vs 1.86, P < .01); vascular access (3.72 vs 2.52, P < .01); point-of-care ultrasound (3.80 vs 2.52, P < .01); surgical critical care (2.39 vs 1.99, P < .01); and neurologic emergencies (2.59 vs 2.10, P < .01). Fellows trained in internal medicine were rated higher in ventilator management (2.54 vs 2.06, P < .01); palliation (3.05 vs 2.08, P < .01); and renal physiology/acid-base disturbances (3.18 vs 2.40, P < .01). Slightly different patterns emerged when comparing EM to surgery and anesthesiology trainees, where EM-trained fellows were rated similarly or lower in procedural domains but demonstrated more robust competence in organ-specific physiology and ultrasonography. These patterns remained largely consistent in sensitivity analyses adjusting for rater specialty.

Critical care fellows who trained in EM bring distinct strengths in diagnostics and resuscitation to critical care training, but their educational needs may differ from those of peers within specialty-specific fellowships. Tailoring curricula to address these differences can help ensure all trainees achieve proficiency across core domains.