Evolving Paradigms in Emergency Medicine Residency Programs in Taiwan: A Comparative Study of 2003 and 2021

Abstract

Background

The observational study examines the evolution of emergency medicine residency programs in Taiwan, comparing key program attributes between 2003 and 2021. To identify significant changes in emergency medicine resident program structure, educational resources, and operational aspects.

Methods

According to the previous study carried out in 2003, we conducted a comprehensive analysis of 22 specified items across four domains: contact information, training content, faculty and research, and patient care and benefits, comparing key program attributes between 2003 and 2021. Chi-Square test used for the categorical variables statistical analysis.

Results

The proportion of programs detailing faculty descriptions increased markedly from 63% in 2003 to 95% in 2021, while the mention of residency director roles rose from 4% to 32% in the same period. Conversely, the detailed enumeration of faculty numbers and elective course features saw a decline. Furthermore, the study identified stable areas, such as benefits other than salary and patient numbers, suggesting established standards or external limitations.

Conclusions

The substantial improvements in program structure and educational resources highlight ongoing efforts to enhance training quality and adapt to the changing healthcare landscape. This study contributes valuable insights into the progression of emergency medicine residency.

Introduction

The beginning of the digital age has triggered a theory shift in medical education, 1 - 3 particularly in the territory of residency program selection. As the internet becomes increasingly vital to information dissemination, emergency medicine (EM) residency program websites have emerged as important platforms connecting programs with potential applicants. 4 A pioneering study on the EM residency programs and the web in Taiwan in 2003 established the groundwork for understanding this digital transformation, 5 uncovering the growing online presence of EM programs while also noting significant gaps in content comprehensiveness and accessibility.

This integration of digital resources represents a pivotal change in the evaluation and selection process within the medical education landscape. The progress of EM alongside otolaryngology residency program websites illustrates a broader transition towards online platforms, deemed indispensable for both the programs and applicants. Analyses conducted by researchers such as Pollock et al. 6 and Svider et al. 2 have underlined an increased dependency on the internet by applicants to gather information, evaluate programs, and make informed decisions regarding their applications. The impact of these online resources has only been amplified by recent developments, particularly the COVID-19 pandemic, which has reinforced the necessity of digital platforms as critical facilitators in the residency application process. 7 - 16

Despite the establishment of an online presence by the majority of residency programs, many fail to provide a holistic digital portfolio that meets the informational needs of applicants. This is highlighted by the recent work of Pollock et al., 6 which revealed that an average EM residency program’s website in the United States omits nearly half of the content deemed important by potential applicants. These findings reflect a significant discrepancy between the available digital content and the needs of today’s applicants, emphasizing a crucial need for enhanced standardization and enrichment of online resources across EM residency programs, not just followed the traditional education evaluation program. 17

The collective insights from the foundational study on Taiwan in 2003 and subsequent research point to an imperative need for EM residency programs not only to maintain an online presence but also to optimize their use of digital platforms. This entails crafting an engaging narrative that encompasses storytelling, community engagement, and an accurate portrayal of the program’s spirit and opportunities. With a strategic approach to digital presence, residency programs can significantly strengthen their visibility, appeal to applicants, and, ultimately, refine the residency matching process.

From the literature review of these pivotal studies, the EM residency programs have been undertaken in the digital domain. To identify significant changes in program structure, educational resources, the study investigate the emergency residency programs in 2021 and compare it to the one in 2003.

Methods

This study took reference to previous study conducted in 2003 to gather data on various aspects of EM residency programs within Taiwan. 5 The data collection procedure involved searching each hospital’s webpage and locating the emergency department (ED) training program under the medical education section. To ensure comprehensive data collection, we additionally conducted online search to locate the training programs using keywords such as “hospital names” and “emergency residency training program.”

A methodical evaluation was carried out on the internet websites of each identified EM residency program, scrutinizing the presence of 22 specified items across four principal domains: contact information, training content, faculty and research, and patient care and benefits. These items encompassed an array of specifics such as program details, training hospital sites, affiliations with medical center programs, support extended by teaching hospitals, approval status conferred by the Ministry of Health and Welfare, along with comprehensive contact information. The items “contact phone,” “contact person,” “contact fax,” “contact email,” and “chairman’s email” were categorized as contact information domain; the items attributed to faculty and research domain are “residency director,” “research opportunities,” “papers published,” “faculty number,” “description of faculty,” and “chairman”; the items attributed to patient care and benefits are “pediatric exposure,” “patients number,” “lists of residents,” “EMS exposure,” “ED beds,” “combined programs,” and “benefits other than salary”; items “rotation schedule,” “feature of elective course,” “ED rotation,” and “description of didactics” are categorized under the training content domain.

Data collected in the years 2021 and 2003 were meticulously cataloged into a spreadsheet, facilitating a comparative analysis of the items of interest by deploying the Chi-Square test to ascertain statistical significance, with p -values of .05 designate as the threshold for significance. This analytical was executed employing R software, version 4.2.3.

Results

In a longitudinal study evaluating the evolution of hospital features over an 18-year span, a data-driven investigation revealed considerable fluctuations across various operational and educational dimensions. Our analysis, conducted on two distinct cohorts of hospitals in 2021 (n = 41) and 2003 (n = 27), identified critical trends and shifts in institutional characteristics pertinent to patient care, faculty composition, training frameworks, and contact modalities. The analysis results are presented in Table 1 and Fig. 1 .

Table 1 . Statistical comparison of key attributes in emergency medicine residency programs in Taiwan: 2003 vs . 2021.

EMS: emergency medical services; ED: emergency department.

Category item	2021 (41 hospitals)	2003 (27 hospitals)	Difference (%)	p -value
Contact information
Contact phone	17% (7/41)	7% (2/27)	10	0.43
Contact person	17% (7/41)	33% (9/27)	–16	0.21
Contact fax	7% (3/41)	15% (4/27)	–7	0.56
Contact email	10% (4/41)	11% (3/27)	–1	1.00
Chairman’s email	15% (6/41)	22% (6/27)	–8	0.63
Faculty and research
Residency director	32% (13/41)	4% (1/27)	28	0.01
Research opportunities	22% (9/41)	15% (4/27)	7	0.68
Papers published	17% (7/41)	19% (5/27)	–1	1.00
Faculty number	32% (13/41)	74% (20/27)	–42	0.001
Description of faculty	95% (39/41)	63% (17/27)	32	0.002
Chairman	10% (4/41)	22% (6/27)	–12	0.28
Patient care and benefits
Pediatric exposure	37% (15/41)	44% (12/27)	–8	0.70
Patients number	32% (13/41)	15% (4/27)	17	0.20
Lists of residents	24% (10/41)	22% (6/27)	2	1.00
EMS exposure	22% (9/41)	33% (9/27)	–11	0.45
ED beds	10% (4/41)	11% (3/27)	–1	1.00
Combined programs	78% (32/41)	96% (26/27)	–18	0.08
Benefits other than salary	12% (5/41)	33% (9/27)	–21	0.07
Training content
Rotation schedule	10% (4/41)	0% (0/27)	10	0.25
Feature of elective course	2% (1/41)	26% (7/27)	–23	0.01
ED rotation	51% (21/41)	44% (12/27)	7	0.76
Description of didactics	15% (6/41)	19% (5/27)	–4	0.93

Fig. 1 . Comparison of proportions per item for year 2003 and 2021.

EMS: emergency medical services; ED: emergency department.

Contact information remained relatively stable, with minor non-significant changes such as a 10% increase in “contact phone” ( p = 0.43) and a 16% decrease in “contact person” visibility ( p = 0.21).

A profound transformation was observed within the domain of “faculty and research”. Notably, there was a marked reduction in the proportion of hospitals reporting faculty number, which dropped from 74% in 2003 to 32% in 2021, reflecting a dramatic shift of –42% ( p = 0.001). Conversely, the presence of a residency director experienced an increase from a mere 4% to 32%, denoting a significant elevation of +28% ( p = 0.01). The “description of faculty” item also displayed a substantial increment, climbing from 63% to 95% (Δ = +32%, p = 0.002).

In terms of patient care and benefits, pediatric exposure, patients’ numbers, and benefits other than salary exhibited alterations, though lacking statistical significance. Notably, pediatric exposure demonstrated a marginal decline from 44% to 37% (Δ = –8%, p = 0.70). Similarly, the proportion of hospitals offering benefits other than salary saw a decrease from 33% to 12% (Δ = –21%, p = 0.07). Training content depicted a significant decrement in the “feature of elective course” category from 26% to 2% (Δ = –23%, p = 0.01). However, the “ED rotation” item experienced an increase from 44% to 51% (Δ = +7%, p = 0.76).

Discussion

The findings of this study underscore the dynamic nature of EM residency programs in Taiwan, reflecting broader trends in medical education and healthcare delivery. The significant enhancements in faculty and educational content highlight efforts towards improving the quality of medical training and fostering a more robust and research-oriented environment. However, the stability in other areas suggests a potential focus for future development, particularly in enhancing the benefits and support structures for residents, which could further attract prospective candidates and retain existing talent within the EM field.

This comprehensive analysis not only sheds light on the progress made over nearly two decades but also provides valuable insights for policymakers, educators, and healthcare administrators to identify areas of strength and opportunities for further improvement. By continuing to evolve and adapt, EM residency programs in Taiwan can aspire to meet the changing needs of the healthcare system, ensuring a well-trained workforce capable of addressing the complex challenges of emergency medical care.

Most of the literatures gave the descriptions of medicine residency program according to the general categories, such as social media use, research, and life style. 6 Little study observed the variation of medicine education about residency program. Our study provides the valuable comparison of the education items. Comparing the items between 2003 and 2021, our study presented the faculty number, description of faculty, feature of elective course, and the residency director had significant changed in the proportion. “Residency director” increased from 4% (2003) to 32% (2021), such an increase underscores the enhanced emphasis on structured leadership within residency programs. “Description of faculty” increased from 63% (2003) to 95% (2021), which may suggest an intensified focus on faculty roles and the broader visibility of faculty qualifications and achievements in institutional literature. The magnitude of this change potentially mirrors the growing priority placed on academic credentials and faculty expertise in the competitive landscape of medical education.

The percentage of surveyed hospitals reporting faculty number decreased from 74% in 2003 to 32% in 2021. This finding is statistically significant ( p = 0.001). The dramatic decrease may indicate an unreasonable phenomenon, as the information provided on websites should be comprehensive to attract potential residency students. To our knowledge, there has been little research on the changes in the public availability of information on ED residency training programs over time. This may be due to information bias, as our study could only obtain data from hospitals willing to disclose their training programs on their official websites.

The percentage of “combined programs” decreased from 96% in 2003 to 78% in 2021, which may suggest that the Ministry of Health and Welfare modified the residency training programs to enhance training quality. Similarly, “benefits other than salary” decreased from 33% in 2003 to 12% in 2021, with a p -value of 0.07, suggesting that non-salary benefits could be improved in the future to better support and encourage young doctors to pursue careers in EM. The other items also had varied between the two years, but the differences were not statistically significant, although this did not meet the threshold for statistical significance, it suggests a trend that warrants further investigation for potential implications on recruitment and retention strategies.

Collectively, the data suggest significant evolutionary trends in faculty representation and training content at the examined hospitals, with some dimensions undergoing pronounced change, while others remained comparatively static. These trends may reflect broader shifts in healthcare education, faculty development, and operational priorities, carrying implications for policy formulation and strategic planning in healthcare institutions. Conversely, items such as benefits other than salary, combined programs, patient numbers, and contact details exhibited changes that were not statistically significant, indicating areas where improvements might be less pronounced or have remained relatively stable over time. This stability might imply that while some aspects of residency programs have evolved significantly, others have maintained a consistent profile, possibly due to established standards or regulations that limit variation.

The united findings from the provided studies reveal several key areas for improvement in the digital presentation of residency programs. Despite the general acknowledgment of the importance of online resources, many program websites fall short in providing comprehensive, up-to-date information that is relevant to applicants’ needs. The analysis by Pollock et al. 6 on EM residency program websites, for instance, uncovered gaps in the availability of information related to social media use, research opportunities, and lifestyle factors, which are critical components that applicants consider when evaluating programs.

Similarly, Svider et al.’s 2 evaluation of otolaryngology residency program websites identified a lack of comprehensive information regarding application processes, incentives, and clinical training details. These gaps underscore the necessity for residency programs to reassess and enhance their online presence, ensuring that their websites are not only informative and accessible but also reflective of the program’s strengths and culture.

Furthermore, the study on viewing trends in residency program websites suggests that applicants actively seek out specific sections of websites, such as information about the program’s curriculum, faculty, and resident life. This underscores the importance of not only providing comprehensive information but also ensuring that websites are navigable and user-friendly.

There might be differences between medical center hospitals and regional medical education hospitals, or a shift between these types of institutions. However, considering the sample size of the enrolled hospitals, the study cannot adequately address this interesting question.

In conclusion, this comprehensive analysis not only sheds light on the progress made over nearly two decades but also provides valuable insights for policymakers, educators, and healthcare administrators to identify areas of strength and opportunities for further improvement. By continuing to evolve and adapt, EM residency programs in Taiwan can aspire to meet the changing needs of the healthcare system, ensuring a well-trained workforce capable of addressing the complex challenges of emergency medical care.

Limitation

The residency programs were increased after 2003, in order to keep the consistency of the items to compare, the study did not analyze the items added in the residency training after 2003. Although the compared items in Table 1 are compatible, the study cannot reveal the newly added training programs.

There were 38 hospitals with training programs in 2003, and 48 hospitals with training programs in 2021 (Taiwan Society of Emergency Medicine website, https://www.sem.org.tw/TrHospital), the representativeness of the hospitals in the study is a concerned issue. The hospitals investigated in the study were not sampled by random. Therefore, the representative of these hospitals should be considered while interpreting the results. There might be an information bias for hospitals that did not publish their training programs online, which could result in missing data for analysis.