From leadership research to district action: A Decade Later: Trends in Fellowship Training and Secondary Board Certification Among Emergency Medicine Residency Leaders

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Introduction Residency program leaders shape the academic pipeline in emergency medicine (EM). We assessed current demographics and postgraduate training among EM residency leadership in the United States. Methods We conducted a national, cross-sectional survey of all Accreditation Council for Graduate Medical Education–accredited EM residency program leadership via an online, confidential questionnaire. Primary outcomes were the prevalence of any postgraduate fellowship training and any secondary board certification (ie, additional board certification beyond EM) as a complementary marker of advanced credentialing distinct from fellowship training. Programs were grouped by National Resident Matching Program (NRMP) region. Results We received 103 program responses (35.9%). Any fellowship training was reported by 25.5% of program directors (PD), 40.0% of associate program directors (APD), and 42.8% of assistant PDs. Compared with the 2014–2015 national survey, fellowship training increased from approximately 20–25% to 40–43% among APD and assistant PDs, while remaining similar among PDs (~25% previously vs 26% currently). Any secondary board certification was reported by 8.8% of PDs, 5.0% of APDs, and 8.2% of assistant PDs. Medical education was the most common fellowship (n = 54), followed by ultrasound (n = 24), toxicology (n = 16), simulation (n = 15), pediatric EM (n = 11), critical care (n = 7), emergency medical services (n = 5), and administration (n = 3). Programs in the western United States reported the highest proportions of leaders with either fellowship or secondary certification across roles. Conclusion Postgraduate fellowship and secondary board certification remain uncommon overall among EM residency leaders, but fellowship completion is more prevalent among junior leaders compared with a decade earlier. These data provide an updated, role-specific snapshot to inform leadership development and workforce planning.

Study methods

We conducted a national, cross-sectional survey of all ACGME–accredited EM residency programs in the United States. The sampling included each categorical EM residency identified through Emergency Medical Residents Association Match and program/department websites at the time of survey launch. Only ACGME–accredited programs were included (N = 287). Eligible respondents were PDs, APDs, assistant PDs, or a designated program administrator who could report leadership characteristics for their program. Length of time in residency leadership reflected cumulative tenure in leadership roles regardless of whether service occurred at a single or multiple institutions. This study received an exempt determination from the Northwell Health Institutional Review Board.

Limitations

This study has several limitations. The first is the survey response rate. We received 103 responses from 287 ACGME–accredited EM residency programs (35.9%), with 101 complete submissions (35.2%). A response rate in this range raises the possibility of nonresponse bias if programs with particular characteristics (eg, greater emphasis on fellowship training, specific leadership structures, or certain regions) were more or less likely to participate. Although this risk cannot be excluded, similar response rates are common in national surveys of EM educators and residency leadership and have been used to describe workforce characteristics when methodological transparency is maintained.- The absolute sample size is large and includes programs from all NRMP regions, as well as a mix of program lengths, sizes, and institution types, supporting descriptive generalizability. Key directional patterns replicate prior national observations (eg, higher fellowship prevalence among junior leaders and low overall rates of secondary board certification), which bolsters confidence that the principal signals are not artifacts of selective response. We do not make population-level causal claims, and our conclusions are framed accordingly. Ultimately, these analyses are descriptive rather than inferential. We do not draw causal conclusions, and our findings should be interpreted accordingly. As a preliminary nonresponse check, the respondent pool reflected all NRMP regions and both 36- and 48-month formats in proportions consistent with national profiles.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one recurring leadership practice described in the source. Map its participants, incentives and constraints to a district setting, then design a small reversible staff pilot with an accountable owner. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Record implementation fidelity, staff review time, task quality and unintended burdens against a baseline. Use a comparison team where feasible and document alternative explanations before expanding. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Danielle Langan; Lindsay Shogan; Shorok E Hassan; William Caputo; Abbas Husain; Jerel Chacko; Amin Mohamadi; Josh Greenstein; Barry Hahn. A Decade Later: Trends in Fellowship Training and Secondary Board Certification Among Emergency Medicine Residency Leaders. Western Journal of Emergency Medicine (2026-09-09). https://doi.org/10.5811/westjem.54378

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.