Bernard P. Chang, MD PhD FACEP
Associate Dean of Faculty Health, Columbia University 
Vice Chair of Research
Department of Emergency Medicine

Closing the Gap: How Emergency Medicine Can Build a Stronger Academic Future

Emergency Medicine (EM) is a unique specialty—fast-paced, interdisciplinary and built on the principle of being ready for anything at any time. EM physicians thrive on solving complex clinical problems, often in resource-limited settings. Yet, when it comes to scholarly activity, many EM faculty feel ill-equipped and unsupported. A team of Emergency Physicians, led by one of NYACEP’s own (Dr. Nidhi Garg) recently published a “National Needs Assessment of Emergency Medicine Faculty Regarding Scholarly Activity Practices and Support,” in JACEP open, shining a spotlight on this disconnect and offering a roadmap to build a stronger academic foundation for EM. The findings highlight significant challenges faced by EM faculty who want to contribute to research and academic growth. It also provides actionable recommendations for institutions to foster a culture where scholarship can flourish. The study, conducted as a comprehensive national survey, aimed to evaluate the state of scholarly activity among EM faculty, identify barriers to academic success and assess the effectiveness of existing support systems. A total of 1,210 emergency medicine faculty members from academic and community settings across the United States participated, making this one of the most extensive surveys on the topic to date. Respondents were asked to provide detailed feedback on their experiences with scholarly activity, available institutional support, and perceived obstacles.

The results reveal a specialty grappling with systemic challenges but also poised for growth and innovation. Here we’ll dive into some of the study’s high level findings, exploring the broader implications for the field and perhaps raise a call to action for leaders in Emergency Medicine.

Time: The Greatest Barrier

It’s no secret that emergency physicians lead some of the busiest lives in medicine. Between unpredictable shift schedules, clinical demands, teaching responsibilities and administrative duties, it’s a constant race against the clock. The study confirmed what many in the field already know: time—or the lack of it—is the single greatest barrier to scholarly activity.

Over 70% of faculty surveyed cited insufficient protected time as the primary obstacle to engaging in research, writing and academic projects. This challenge isn’t just a matter of poor time management; it’s systemic. Emergency physicians often work irregular hours, leaving little room for the focused effort required to pursue meaningful research.

One survey respondent described the situation succinctly: “We are always in triage mode. It’s hard to focus on long-term goals like research when the immediate demands of patient care are so consuming.”

Inconsistent Support Systems

Beyond time constraints, the study highlighted a significant disparity in the resources available to EM faculty. Faculty at larger academic medical centers reported greater access to research funding, mentorship and infrastructure compared to their colleagues in smaller institutions or community settings. This inequity exacerbates the challenges faced by early-career researchers or those practicing in under-resourced environments.

While many academic centers offer programs designed to support scholarly activity, their implementation and effectiveness vary widely. Some faculty benefit from structured mentorship and dedicated research teams, while others feel they are left to navigate the complexities of academic medicine alone.

The study also revealed a gap in training. Many faculty expressed a need for skill-building opportunities, particularly in research methodologies, grant writing and manuscript preparation. These skills are critical for producing high-quality academic work but are often underemphasized in EM training programs.

Opportunities for Change

Despite these challenges, the study offers hope. Its recommendations provide a clear path forward to support and sustain scholarly activity in Emergency Medicine. Key strategies include:

1. Protected Time for Research:
   Institutions must recognize that time is the foundation of scholarship. Policies that provide faculty with protected research time—whether through flexible scheduling, grant-funded positions or departmental support—are essential. Protected time isn’t just a perk; it’s a necessity for building a robust academic culture.
2. Structured Mentorship Programs:
   Mentorship plays a critical role in academic success. The study highlights the need for formal mentorship initiatives that pair junior faculty with experienced researchers. These programs can provide guidance, foster collaboration and help early-career physicians navigate the complexities of academic medicine.
3. Skill Development Workshops:
   Regular training sessions on research design, data analysis and grant writing can empower faculty to take their scholarly pursuits to the next level. These workshops should be tailored to the unique needs of EM physicians, taking into account their clinical schedules and professional backgrounds.
4. Leveraging Technology:
   The study also points to the potential for innovative solutions, such as tele-research platforms and collaborative networks. By pooling resources and expertise across institutions, EM faculty can overcome many of the barriers associated with time and resource limitations.

Editorial Reflections: A Personal Call to Action

As an EM physician and academic leader, I’ve seen firsthand the tension between clinical excellence and scholarly ambition in our field. Emergency Medicine is, by nature, a dynamic and ever adapting specialty. Our work is immediate, fast-paced and often unpredictable. But this doesn’t mean we can’t plan for the long term—especially when it comes to research and academic growth.

The challenges identified in this study resonate deeply with my own experiences. Time, as the survey makes abundantly clear, is the most precious resource for faculty. Without it, even the most motivated researchers struggle to sustain meaningful academic work. Departments and institutions must prioritize mechanisms to safeguard research time, whether through departmental grants, adjusted clinical schedules or creative solutions like shared research sabbaticals.

Mentorship is another area where Emergency Medicine can and must do better. A good mentor can be the difference between a promising idea that fizzles out and one that turns into a landmark study. Structured mentorship programs, supported by institutions and professional organizations, should be a cornerstone of our academic culture.

Finally, Emergency Medicine has always been a field that thrives on innovation. We excel at thinking outside the box to solve complex clinical problems—why not apply that same ingenuity to academic medicine? Whether it’s through collaborative research networks, data-sharing initiatives or cutting-edge analytic tools, we have the potential to revolutionize how scholarship is conducted in our specialty.

Building a Legacy of Scholarship

The implications of this study extend far beyond individual faculty members. They challenge us to rethink how we define and support success in Emergency Medicine. By investing in our faculty’s academic potential, we’re not just helping them succeed—we’re advancing the field as a whole.

Research in Emergency Medicine has the power to shape the future of healthcare. From innovations in patient care to systemic improvements in hospital operations, the impact of scholarly activity extends far beyond the walls of the ED. But for this potential to be realized, we need to create an environment where scholarship is not just possible but encouraged and celebrated.

This is a pivotal moment for Emergency Medicine. The challenges are real, but so are the opportunities. Moving forward, we can build a culture of scholarship that empowers faculty, improves patient care and solidifies Emergency Medicine’s place as a leader in academic medicine.

Joseph Basile, MD MBA FACEP
Chair, Department of Emergency Medicine 
Medical Director, Clinical Operations
Staten Island University Hospital
Chair, New York ACEP Practice Management Committee

Chris McStay, MD MBA FACEP
Vice Chair of Clinical Operations
Associate Professor of Emergency Medicine
Columbia University Vagelos College of Physicians & Surgeons

Ben-Zion Rotter, MD
The Dr. Lorna M. Breen EM Healthcare Administration Fellow 
Clinical Instructor
Department of Emergency Medicine
NewYork-Presbyterian, Columbia University

Mahesh Polavarapu, MD
Columbia University Medical Center-NYP Hospital
Medical Director, NYP-Westchester Emergency Department
Director, Dr. Lorna M. Breen Emergency Medicine Fellowship in Healthcare Administration
Assistant Professor of Emergency Medicine

The Case for Tracking Hallway Use as a Key Performance Indicator

In recent decades, Emergency departments (EDs) have increasingly relied on metrics to track and improve patient care. The Emergency Department Benchmarking Alliance was formed in 1994 and, in 2006, held their first summit to standardize operations measures.¹ Since then, regulators at the Center for Medicaid and Medicare Services and Joint Commission have adopted several of these measures into their reporting and accreditation frameworks, with an emphasis on throughput metrics.¹ CMS mandates the reporting of Left-Without-Being-Seen (LWBS) rates, median time spent in the department for discharged and admitted patients, as well as time-based measures of care related to STEMI, stroke, and sepsis.²

These standardized measures help align department goals and facilitate process improvement. When surveyed, administrators have expressed that time-based metrics help them better understand departmental performance and identify areas for improvement.³ At the same time, increased focus on throughput metrics has pushed departments to move patients out of the waiting room and coincided with a significant rise in hallway use.^4,5

One of our community sites has experienced this balancing act firsthand. Over the past few years, we improved our performance on key metrics, including reducing LWBS rates from over 5% to below 2%. However, this success came with a sharp increase in the use of hallway spaces for patient care. Additionally, while throughput measures improved, patient satisfaction scores declined for most domains. This is a pattern echoed across the country.⁶ Increasingly, critical aspects of patient care—like gathering histories, performing exams and communicating results—are happening in hallways. These makeshift spaces, borne of necessity, are not only unsatisfactory and uncomfortable for patients but can also introduce risks to patient safety.

The harms of ED crowding and hallway use are well documented. Hallway care compromises patient privacy, diminishes care quality, increases violence and moral harm to providers and erodes trust between providers and patients.^4,7,8 Studies have linked increased hallway use to increases in diagnostic errors, hospital length of stay, preventable disability, re-admission, and even mortality.^5,8–10 Despite these significant risks, hallway use remains a largely unmeasured aspect of ED performance.

The drivers of ED crowding—and the resulting hallway use—are multifactorial. After an initial decline in ED volumes following the first wave of the COVID-19 pandemic, patient volumes have rebounded, with year-over-year growth largely driven by older patients.^11,12 These individuals often require more complex evaluations, longer treatments and are more likely to need inpatient admission.^4,5 Additionally, the increasing availability of advanced testing and treatment modalities means that even treat-and-release patients often require longer ED stays before discharge.

Structural changes in healthcare have exacerbated these challenges. National shortages of nurses and support staff, reduced primary care availability and hospital bed reductions have strained EDs across the country.^5,13 While many of these issues lie outside the direct control of our specialty, how we utilize our space remains firmly within our scope.

If metrics are to truly reflect the quality of our care, it is imperative that we begin measuring hallway use. This data would provide a more complete understanding of patient flow and care quality, highlighting an issue too easily tolerated. Incorporating hallway use as a key metric would allow us to guide care delivery more thoughtfully and redesign workflows to better balance efficiency with patient dignity and safety.

While hallway use may be unavoidable, it should be minimized and reserved for transitional moments—such as waiting for evaluation or results—not for the delivery of core clinical care. Sensitive conversations, physical exams and the communication of results should occur in private spaces whenever possible. Measuring hallway use could drive process improvements, ensuring that private spaces are prioritized for these critical aspects of patient care.

Beyond guiding internal changes, hallway use metrics could serve as a compelling advocacy tool for systemic reform. There is no standardized measure of ED crowding.^4,14,15 Despite years of reporting length of stay for admitted patients, meaningful progress on boarding has been limited. By quantifying the extent of hallway care we can provide administrators with a more vivid picture of ED crowding and its effects on both patient experience and outcomes. These metrics would enrich and strengthen the case for increased resources and support.

By expanding the scope of what we measure, we can refocus on the fundamentals of safe, patient-centered care. Hallway use metrics offer an opportunity to address the costs of crowding and advocate for solutions that improve the experience and outcomes for patients and providers alike.

Laura Melville, MD MS
Associate Research Director
SAFE Medical Director
NewYork-Presbyterian Brooklyn Methodist Hospital
Chair, New York Research Committee

Bernard P. Chang, MD PhD FACEP 
Associate Dean of Faculty Health, Columbia University 
Vice Chair of Research
Department of Emergency Medicine

Fentanyl has become a defining challenge in the world of substance use and emergency care. Originally a key player in opioid pain management, this synthetic opioid has infiltrated the illicit drug supply at an alarming rate. Its presence now extends beyond opioids like heroin into nonopioid substances, such as cocaine and methamphetamine, dramatically increasing the risk of overdose for unsuspecting users. For emergency departments (EDs), which often serve as the first point of contact for individuals experiencing drug-related crises, this development is reshaping the way we approach care.

A recently published study in Annals of Emergency Medicine, led by Dr. Dana Sacco, including those within New York ACEP’s research committee provides important insights into the scope of fentanyl adulteration, highlighting the deep connection between clinical work and academic inquiry. Their findings not only underscore the hidden dangers in the drug supply but also emphasize the critical role of emergency physicians in addressing this public health crisis.

A Hidden Epidemic

Between April 2022 and January 2024, researchers conducted a study at two New York City EDs: an academic medical center and a community hospital, both in northern Manhattan. Together, these sites see more than 145,000 patient visits annually, making them ideal locations to observe urban drug use trends.

The team enrolled 229 patients who arrived at the ED with symptoms linked to drug use, including overdose, intoxication or psychosis. Each participant provided a urine sample for fentanyl testing and self-reported the substances they believed they had used in the prior 24 hours. Many anticipated their results would align with their reports, but the testing revealed a far more complex reality.

Among those who knowingly used opioids, 89% tested positive for fentanyl. Of these, an astonishing 90% were unaware they had consumed fentanyl, highlighting the pervasive and hidden nature of its presence in the drug supply. But the surprises didn’t end there. Nearly a quarter of patients (24.5%) who believed they had used only nonopioid substances, such as cocaine or methamphetamine, also tested positive for fentanyl. For these individuals—who lack opioid tolerance—the risks are exponentially higher.

The findings reflect a grim reality: fentanyl has become a universal contaminant in the drug supply, creating dangers not only for those who intentionally use opioids but also for unsuspecting individuals using other substances.

Complex Challenges of Polysubstance Use

The study also revealed that many patients weren’t using fentanyl—or any other substance—in isolation. More than 80% of opioid users and nearly 60% of nonopioid users reported consuming multiple substances. Cocaine was the most common co-used drug in both groups, adding another layer of complexity to overdose management and treatment planning.

This trend toward polysubstance use complicates the already challenging task of providing care in the ED. When patients mix opioids with stimulants like cocaine, the risks of overdose and adverse interactions increase. Clinicians must consider the broader picture of substance use patterns when treating these patients, tailoring their interventions to address these overlapping risks.

The Role of the Emergency Department

For many individuals experiencing substance use crises, the ED is not just a place of treatment—it is their only contact with the healthcare system. This places emergency physicians in a unique position to intervene, educate, and support harm reduction.

One of the study’s key takeaways is the critical importance of patient education. Many of the patients who tested positive for fentanyl were unaware they had been exposed to it. This lack of awareness represents an opportunity for clinicians to provide information about the risks of fentanyl and tools that can help mitigate them. Fentanyl test strips, for instance, allow users to test their drugs for the presence of fentanyl before use, empowering them to make safer choices.

Beyond education, harm reduction strategies must be integrated into standard ED care. Providing naloxone kits, distributing fentanyl test strips, and discussing overdose prevention can save lives. These simple interventions, paired with clear and empathetic communication, have the potential to make a significant impact.

Building Beyond the ED

While emergency physicians can do much to address this crisis, broader systemic changes are essential. The ubiquity of fentanyl in the drug supply is a public health issue that requires coordinated efforts across healthcare, policy, and community organizations. Policymakers must invest in harm reduction initiatives, expand public education campaigns, and support research into effective interventions.

This study also highlights the need for further exploration of fentanyl-related challenges. For instance, how can harm reduction tools like test strips be most effectively distributed in EDs? What interventions are most likely to engage patients with polysubstance use? Answering these questions will require collaboration and innovation across multiple sectors.

Looking Ahead

Dr. Sacco emphasizes that addressing fentanyl adulteration requires a multifaceted approach. The ED plays a pivotal role, not just in responding to overdoses but in preventing them. Emergency physicians are uniquely positioned to lead the charge in harm reduction, advocacy and education. The fentanyl crisis is complex, but with research like this, we are gaining the knowledge needed to act. By integrating harm reduction strategies into clinical practice and engaging with patients about the risks they face, emergency physicians can make a meaningful impact. This study is not just a call to action—it’s a reminder of the vital role emergency medicine plays in addressing one of the most urgent public health challenges of our time.

Carlton C. Watson, MD MS
Chair, Emergency Medicine Resident Committee
PGY-3
Vassar Brothers Medical Center

Christopher J. Karnicki, MD MS
Emergency Medicine, PGY-2
SBH Health System – Bronx

Sophia Lin, MD FPD-AEMUS
Assistant Professor of Clinical Emergency Medicine and Clinical Pediatrics
Director of Emergency Ultrasound
Department of Emergency Medicine
Weill Cornell Medicine

Sarah Smetana, MD
Medical Education Fellow
University of Rochester Medical Center

Lindsey Picard, MD
Assistant Professor of Emergency Medicine and Pediatrics
Assistant Program Director of Emergency Medicine Residency
Director of Medical Student Electives
Co-Director of Medical Education Fellowship
University of Rochester Medical Center

“Trust the Process”: Faculty and Former Resident Perspectives on Remediation

Remediation, a word that some residents may equate to failure, stigma or anxiety, has developed into a process that emergency medicine residents at the University of Rochester Medical Center (URMC) can speak openly about and feel supported by faculty invested in their professional growth and success. This discussion will present a former resident’s perspective on our remediation process, followed by a faculty member’s perspective on building this process over the last three years.

Resident Experience

As a first-year resident, it was not uncommon to hear multiple senior residents openly talk about being on remediation. The culture surrounding remediation seemed open, casual and low-pressure. Many residents would be on it temporarily and then get off the following year with no issues or impact on their permanent record. Residents entered the program knowing that falling below a predetermined threshold on the yearly in-service training exam (ITE) would automatically result in being placed on ITE remediation. Since the program published this policy in advance, residents had clarity about their expectations. They would not be left wondering why they later got an email stating they were on remediation. If placed on remediation, residents had a clear and defined goal to work towards in terms of demonstrating knowledge competency on the ITE the following year. Removing the uncertainty about why a resident was placed on remediation emphasized that a standard was unmet. Falling short of this standard was not a personal flaw or a failure to be ashamed of but simply an acknowledgment that a resident needs more support and dedicated time to improve that competency area.

While many residents on remediation come from failing to meet this objective standard, some are placed on remediation due to clinical or professional competency deficiencies as determined by faculty and staff feedback. The reasons for placement on clinical or professional remediation may be more nuanced, but regardless of the remediation type, this creates a cohort of residents who share the remediation experience. This shared experience decreases feelings of isolation and encourages residents to overcome competency roadblocks, like their peers before them, if placed on remediation. Encouragement comes from this group of peers but also through multiple faculty members who are involved with this process. All residents on remediation are assigned to a faculty advisor to help set learning goals, strategize study plans and schedule regular check-ins to ensure objectives are met. The assigned faculty members are readily available and are integral to supporting students toward success.

After graduating from this program this past summer, my perspective on remediation has shifted and I am confident speaking openly about my own remediation experience. Along with many of my peers, I found myself placed in ITE remediation my first year; however, instead of feeling any negative emotion, I saw remediation for what it was – a knowledge deficiency. I was not caught off guard, I was not alone and I knew I could improve my performance the next time. I knew I had not performed well due to a lack of dedication towards preparing as external factors were competing for my attention. Entering this low-pressure remediation process helped highlight a deficiency in my knowledge and forced me to set a specific goal to achieve. Despite no longer being on remediation the following year, I stayed dedicated to proving I knew my material. The framework I developed for balancing work and studying stayed with me throughout my years of training, leading me to this past fall, where I felt confident taking the boards and passing on my first attempt. Remediation provided a safety net of accountability and attention that sparked my intrinsic motivation for success. My faculty mentor and peers added security and support and promoted a safe place for learning and developing as a physician. While in the past I may have considered remediation to be intimidating or to provoke negative thoughts, I found that it provided a positive impact on my resident experience and career.

Remediation Director

Agreed, remediation is such a simple word that it can have an intimidating connotation. As the faculty director of remediation for the emergency medicine residency program at URMC, one of my main goals is to dispel this negative implication of the idea of remediation. Residents can be a part of two main types of remediation during their training: in-service training exam (ITE) remediation and clinical and/or professional remediation (i.e., academic warning). I am heavily involved in my role as faculty director of remediation and as one of the assistant program directors for the residency. At URMC, we value our residents, their education and their remediation journey, so much so that a core faculty member is assigned as the faculty director of remediation. This ensures a dedicated point person for the residents to reach out to and use as a resource, as the core faculty member’s academic responsibilities are focused on the residents’ overall educational success.

After taking over the faculty director of remediation position three years ago, I have adapted and redesigned the remediation process here at URMC. Initially, the outgoing remediation director told me that there were typically 5-6 residents per year on ITE remediation. She passed along her approach and resources that have been useful. Remediating 5-6 residents a year felt very doable and I was eager to start, but after the first ITE exam since taking over, to my surprise, the number of residents per year doubled (11). With this drastic increase in residents needing remediation, the time commitment I had foreseen for myself in this new role had significantly changed. Using the former director’s guidance, my initial approach to remediation was to meet with each resident and follow up periodically throughout the year to ensure their compliance with the study plan we had created and as a resource for their questions. I soon realized that this approach would not be sustainable year to year with higher resident numbers requiring remediation and that one person overseeing 11 residents’ academic performance alone was not feasible without help. This motivated me to change our residency’s approach to ITE remediation.

Several different aspects of residency remediation could benefit from revamping our former approach. Meeting with residents once shortly after they “failed” the ITE and following up periodically throughout the year was a cookie-cutter approach to remediation as a whole. Yes, in my experience, many residents placed on remediation simply did not study or take the exam seriously enough to pass the ITE. These individuals likely benefit from the cookie-cutter approach to remediation as they just need to be held accountable for their time and studying. Yet, another subset of residents on remediation will need more than just an accountability partner. Initial meetings with each resident placed on remediation are crucial; this allows one-on-one time with me to address the issue or issues that impacted their ITE score. Additionally, each resident is sent a list of questions before this initial meeting about their current study approach, past testing experiences, learning style, etc., to facilitate a constructive discussion during this initial meeting. Taking the rest of the remediation process steps further and making the remediation approach personalized to each resident is a key component to redesigning ITE remediation.

In brainstorming how to approach remediation best going forward, there were new goals to focus on: managing more residents than previously anticipated for their ITE remediation, developing numerous individualized study plans for residents on remediation and intervening early in residency. Staying current on the resources residents use and what is out there is key to providing our residents with the best to succeed in residency and beyond. Textbooks are still helpful in understanding foundational knowledge for emergency medicine. Yet, podcasts, lecture videos and online resources are becoming more readily available and comprehensive in their emergency medicine information. Our residency provides each resident with an annual question bank subscription that ensures access to practice board/ITE questions to facilitate active studying and learning. Rising PGY3 residents placed on remediation receive a national board review course completed during an elective week of their third year. Given the growing number of resources out there due to technology and the internet, it is stressed to residents that using too many resources can be just as detrimental as not using any at all, causing what I like to call “resource fatigue.”

During my second year as remediation director, I implemented the team approach to remediation by creating a small team involving junior and senior faculty members. This team meets in the spring each year to discuss each resident, identify their current struggles with ITE studying and then generate individualized study plans for each resident. Everyday struggles identified include one or a combination of the following: medical knowledge, executive functioning skills, time management, test-taking skills and life outside of residency (health issues, family needs, etc.). After this spring meeting, each team member would be assigned 1-2 residents on remediation and act as their point person for the upcoming academic year regarding their remediation process. Working closely with the residents as APD and clinically, I was able to place residents with specific faculty members from the remediation team that would best serve them, whether it be personality compatibility, faculty with similar struggles in the past and their ability to relate, additional educational training by certain faculty members, etc.

As for intervening earlier in residency, interns were the main focus of these interventions. Our interns have 5 weeks of orientation, including lectures, skill labs and clinical shifts. I added a lecture to this orientation time that addresses how to study as a resident, stressing that residency is a whole new ballgame compared to their time as a medical student and also focusing on all the resources we offer here at URMC. Additionally, a mock ITE exam has been added to the orientation time to help residency leadership and the interns identify who may benefit from early intervention from the remediation team. This lecture and mock ITE in orientation have prompted interns to schedule meetings with me to develop a study approach early in their intern year rather than waiting to “fail” the ITE in February. Additionally, in December each year, starting in 2022, residency leadership, including myself, implemented a mandatory mock ITE for all residency years, after which, pending the results, I would reach out and offer my assistance to residents with their current study approach and how to modify it for the upcoming months best leading up to the actual ITE.

Interestingly, the number of residents requiring ITE remediation has remained high. As previously mentioned, my first year was 11; my second and third years were 12 and 11, respectively. Most residents come off remediation the following year and the success rate has varied between roughly 60-72% since starting as remediation director. Since implementing this process, a total of 16 PGY1 residents did not meet the expected ITE score and were placed on ITE remediation. Of these, 10 residents met the standard set for the PGY2 year ITE and were removed from remediation. Seven PGY2 residents were placed on ITE remediation with 5 residents meeting expectations. The two PGY2 residents who did not meet the expected ITE score were on remediation during their entire time as residents and required much more assistance and resources compared to the other residents on remediation, i.e. extra meetings with faculty and follow up and an additional meeting with our university undergrad campus’ Center for Excellence in Teaching and Learning that specializes in test-taking skills. Although “passing” ITE scores are not required for graduation, this process may be informative to individual residents as they prepare to take their EM boards. It is unclear why the resident numbers on remediation remain high, yet after seeing the ABEM board pass rate this year for 2024 graduates, there seems to be a national trend. So why are more residents on remediation now compared to the board pass rate drop this year? This is a question many PDs and APDs are struggling with right now. Our residency leadership team and I have tried to brainstorm different possibilities; for example, these residents were heavily affected by the COVID pandemic, more medical schools are passing/failing now rather than a graded curriculum, step examinations are now pass/fail, residents may be struggling with the transition to residency, study resources and techniques used in medical school are not translating into residency/boards studying, etc. The list can continue as this is a multifactorial problem. By considering these factors and knowing that the educational landscape is ever-changing these days, residency leadership and I have been flexible and adaptable in our approach to ITE remediation. We are always discussing new ways to serve our residents and their academic success best.

In conclusion, how do I approach making remediation less intimidating and a more positive experience? My three main approaches include normalizing remediation, openness among residents and the team approach. Starting in my first meeting with residents, I always stress that remediation is not a punishment and that I am here mainly as a resource to help them succeed academically as a resident. Normalizing that many residents have been placed on remediation over the years and perform well on their boards after residency is a comfort to most residents. Knowing that others before them went through this also helps them feel comfortable talking with other current residents as a support throughout the process. Remediation is confidential for the residents, yet here at URMC, the residents are very open and confide in each other with this information. Generally, it is known by the residency as a whole, by the residents’ choice, who is on remediation and who is not. This openness creates a supportive learning environment that is conducive to collaboration. I have had the privilege of setting up group study sessions for residents with faculty members to meet and discuss the faculty member’s approach to board-style questions and give advice on their study habits and resources. Lastly, the team approach to remediation; by creating a faculty remediation team, the residents get a more well-rounded approach to their study plans and coaching throughout the year on their ITE remediation. Remediation is a team sport that takes buy-in from all parties, residents and faculty alike; here at URMC, we take this very seriously to ensure the best outcome for our residents’ academic success year in and year out.

Maria Tama, MD