ArticleJournal of the American College of Emergency Physicians open2026
Comparison of Emergency Medicine Resident and Attending Physician Approval Rates in Online Medical Control: A 10-year Retrospective Analysis.
Article in Journal of the American College of Emergency Physicians open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
2 authors.
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Abstract
Objectives: We assessed whether emergency medicine residents, after completing a structured 4-hour training program and supervised proctoring, demonstrate decision making in online medical control comparable with that of board-certified attending physicians. Methods: This was a retrospective cross-sectional study of online medical direction calls to the University Medical Centre of El Paso, the emergency medical services (EMS) base station for the El Paso Fire Department. First-year residents completed a 4-hour curriculum covering EMS systems, protocols, ethics, communication, and simulation, followed by 5 supervised calls. We analyzed all online medical control encounters between August 2016 and August 2025. Calls lacking a binary approval outcome were excluded. Approval/disapproval rates were compared between residents and attendings using Fisher's exact test for small samples, chi-square tests for overall comparisons, and 2-proportion z-tests for large categories. Odds ratios (ORs) with 95% CIs were calculated. Equivalence testing applied a prespecified margin of ± 3%. Results: Of 10,492 calls, 8405 were eligible. Residents (n = 6589) approved 93.4% of requests versus 93.1% for attendings (n = 1816) (χ Conclusion: Emergency medicine residents trained with a focused 4-hour curriculum and limited supervised experience performed online medical control duties at a level statistically and clinically equivalent to attending physicians across a decade of real-world EMS consultations. This model provided a practical and efficient way to include residents in EMS medical direction roles, supporting both system capacity and residency education.
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