{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T07:47:06Z","timestamp":1776930426353,"version":"3.51.2"},"reference-count":0,"publisher":"California Digital Library (CDL)","issue":"2","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Western Journal of Emergency Medicine"],"abstract":"<p>Introduction: 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. Methods: 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. Results: 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 = \u201cNot competent\u201d to 5 = \u201cVery competent,\u201d EM-trained fellows were rated significantly higher than their internal medicine-trained peers in intubation (3.93 vs 1.86, P &amp;lt; .01); vascular access (3.72 vs 2.52, P &amp;lt; .01); point-of-care ultrasound (3.80 vs 2.52, P &amp;lt; .01 ); surgical critical care (2.39 vs 1.99, P &amp;lt; .01); and neurologic emergencies (2.59 vs 2.10, P &amp;lt; .01). Fellows trained in internal medicine were rated higher in ventilator management (2.54 vs 2.06, P &amp;lt; .01); palliation (3.05 vs 2.08, P &amp;lt; .01); and renal physiology\/acid-base disturbances (3.18 vs 2.40, P &amp;lt; .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. Conclusion: 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.<\/p>","DOI":"10.5811\/westjem.48854","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T23:50:06Z","timestamp":1772495406000},"source":"Crossref","is-referenced-by-count":0,"title":["Revealing the Emergency Medicine Difference: Leveraging Specialty-Specific Strengths to Optimize Critical Care Training"],"prefix":"10.5811","volume":"27","author":[{"given":"Lia Ilona","family":"Losonczy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Feltes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy B","family":"Richards","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Odolil","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junfeng","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aryana","family":"Kavuri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam","family":"Hafez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alisa","family":"Dewald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitin","family":"Seam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2026,3,2]]},"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"link":[{"URL":"https:\/\/escholarship.org\/content\/qt3ww6h953\/qt3ww6h953.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T07:11:51Z","timestamp":1776928311000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/3ww6h953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":0,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,3,13]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.48854","relation":{},"ISSN":["1936-9018"],"issn-type":[{"value":"1936-9018","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]}}}