Attracting Emergency Medicine-Trained Residents to Surgical Critical Care: The Implications From a Nationwide Survey of Emergency Medicine Trainees Interested in Critical Care. Crit Care Med 2026 Jan 01;54(1):66-75
Date
10/31/2025Pubmed ID
41171038DOI
10.1097/CCM.0000000000006935Scopus ID
2-s2.0-105026716339 (requires institutional sign-in at Scopus site)Abstract
OBJECTIVES: Emergency medicine (EM) surgical critical care (SCC) trained physicians offer many advantages to SCC. However, several fields of critical care (CC) compete with SCC for EM intensivists. We hypothesized that there are definable and potentially modifiable factors related to the pathway selection.
DESIGN: Cross-sectional survey.
SETTING: Four national EM societies.
SUBJECTS: EM trainees (residents and fellows).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The primary outcome included the top factors leading to pathway selection. Secondary outcomes included influential factors for entering CC and individual components of a CC fellowship that interest the EM trainee. One hundred eleven EM trainees responded-42 fellows and 69 residents. Median age was 32 (interquartile range, 30-35). Sixty-seven were matched (fellows + matched residents). Intended fields of practice: 49 anesthesiology CC (26 matched), 58 medicine CC (29 matched), two neurology CC (1 matched), six resuscitation (one matched), 15 SCC (eight matched), and five non-CC (two matched). Top factors for pathway selection included exposure to specialty units, geography and specialty multidisciplinary teams ( p < 0.05). Ease of board certification was not influential. Only 28% of trainees had exposure to EM-SCC fellowships at their residency institution and only 42% had exposure to surgical intensivists during training. However, 41% envisioned practicing in a surgical ICU. Before application season, 8.2% did not have exposure to a surgical ICU/trauma ICU/trauma service that managed their ICU patients in contrast to the 3.2% of applicants not having medical ICU exposure. The highest-ranking factor for entering CC was intellectual appeal over job opportunities and lifestyle ( p < 0.05). When assessing components of individual fellowship programs, CC knowledge, the institutional value of EM/critical care medicine, and extracorporeal membrane oxygenation exposure ranked highly.
CONCLUSIONS: Given the complexity of the modifiable barriers for EM-SCC matriculation, a multifaceted approach is necessary to increase matriculants. Interventions specific to the specialty are required at professional societal, institutional, and training program levels.
Author List
Hynes AM, Carver TW, Owodunni OP, Murali S, Gmora FL, Tisherman SA, Martin NDAuthors
Thomas W. Carver MD Professor in the Surgery department at Medical College of WisconsinAllyson M. Hynes MD Assistant Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultCareer Choice
Critical Care
Cross-Sectional Studies
Emergency Medicine
Fellowships and Scholarships
Female
Humans
Internship and Residency
Male
Surveys and Questionnaires
United States
