title: Level I trauma certification and emergency medicine resident major trauma experience.
abstract: OBJECTIVE
  American College of Surgeons (ACS) and Residency Review Committee for Emergency Medicine (RRC-EM) guidelines conflict regarding the role of emergency physicians in directing major trauma resuscitations. This article describes the impact of ACS level I trauma certification on emergency medicine (EM) resident trauma experience.
  
  
  METHODS
  A written survey and a follow-up letter were sent to all 101 EM program directors as of August 16, 1994. The survey addressed demographics and trauma experience at hospitals designated by the RRC-EM as primary training sites.
  
  
  RESULTS
  There were 95 (94%) survey respondents. Estimates of the percentage of trauma resuscitations directed by EM residents were significantly lower at level I centers (52% +/- 27%, 95% CI 45-59%) than they were at non-level I centers (70% +/- 30%, 95% CI 58-82%) (p < 0.01). There was no significant difference in trauma census between level I and non-level I centers. Of 14 respondents who said they were cited by the RRC-EM for inadequate trauma experience, ten (71%) were in ACS level I trauma centers (p = 1.0). Twelve of the 14 respondents cited for inadequate trauma experience were in either the Northeast or the Midwest.
  
  
  CONCLUSIONS
  EM residents direct a smaller percentage of major trauma resuscitations at ACS level I hospitals than they do at non-level I facilities. This finding is not offset by an increased trauma census at level I facilities and may be more pronounced in the Northeast and the Midwest.
authors.affiliation: SAEM Residency Committee, Lansing, MI, USA. jhowel102@gumedlib.dml.georgetown.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Howell
authors.forename: D
authors.initials: D
authors.lastname: Savitt
authors.forename: D
authors.initials: D
authors.lastname: Cline
authors.forename: C D
authors.initials: CD
authors.lastname: Chisholm
authors.forename: K
authors.initials: K
authors.lastname: Kleinschmidt
mesh_terms: D002568:Certification; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003625:Data Collection; D004501:Education, Medical; D004521:Educational Measurement; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D013038:Specialization; D014947:Wounds and Injuries