Your Ultimate Guide to Researching EM-IM Combined Residency Programs

Understanding EM-IM Combined Programs Before You Start Researching

Emergency Medicine-Internal Medicine (EM-IM) combined programs are unique, demanding, and rewarding—and they’re also relatively few in number. Before you build a program research strategy, you need a clear sense of what these programs are designed to produce and what that means for your own goals.

What is an EM-IM Combined Program?

EM-IM combined programs are five-year, ACGME-accredited training tracks that allow you to complete full residency training in both Emergency Medicine and Internal Medicine. Graduates are board-eligible in both specialties and can sit for both certifying examinations (ABEM and ABIM in the U.S., depending on your location and boards).

These programs are structured to:

• Provide robust training in high-acuity, undifferentiated care (EM)
• Build deep skills in longitudinal, complex medical management (IM)
• Prepare graduates to function at the interface of acute and chronic care—ED, ICU, hospital medicine, or complex systems roles

Why This Matters for How You Research Residency Programs

Because EM-IM combined tracks are smaller and more specialized than categorical EM or IM programs, researching them requires:

• Broader thinking: You’re not just evaluating Emergency Medicine; you’re also evaluating Internal Medicine—and how the two are integrated.
• Closer scrutiny: A small number of residents per year amplifies the importance of culture, mentorship, and fit.
• Career-focused questions: Not all EM-IM combined programs are the same; some lean more academic, others more community, some stronger in critical care, others in administration or education.

Recognizing this at the outset helps you frame what you’re actually looking for when evaluating residency programs, instead of passively reacting to what programs highlight on their websites.

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Step 1: Clarify Your Personal and Career Goals

Before you open a single program website or spreadsheet, you should be crystal clear about your own goals. Otherwise, you’ll be overwhelmed by noise and marketing language and struggle to distinguish between “good” and “good for you.”

Key Questions to Ask Yourself

Use these prompts to define what you want from an EM-IM combined training:

1. Career Destination

   • Do you envision practicing primarily:
     • In the ED?
     • As a hospitalist?
     • In critical care?
     • In outpatient complex care (e.g., transitions clinic, HIV primary care, addiction medicine)?
     • A hybrid role (e.g., 50% ED, 50% inpatient)?
   • Are you leaning toward:
     • Academic medicine (research, teaching, leadership)?
     • Community practice and high-volume clinical work?
     • Administrative roles (ED director, quality/safety, informatics)?

2. Fellowship Interests

   • Are you considering:
     • Critical care
     • Ultrasound
     • Toxicology
     • EMS
     • Palliative care
     • Sports medicine
     • Research/clinical scholar fellowships
   • Do you want a program with a strong track record of placing graduates into these fellowships?

3. Training Environment

   • Large quaternary academic center vs. community academic hybrid
   • Patient population diversity, safety-net environment, and pathology breadth
   • Trauma volume, cardiac volume, ICU exposure, and procedural opportunities

4. Geography and Lifestyle

   • Regions you’re willing to live in for 5 years
   • Proximity to family/significant other(s)
   • Cost of living and call/shift structure that fits your personal life and wellness needs

5. Culture and Support

   • Do you thrive in high-intensity, competitive environments, or in more collaborative and nurturing cultures?
   • How important are mentorship, diversity and inclusion, and wellness initiatives?

Write your answers down. This “personal mission statement” becomes the lens for how to research residency programs meaningfully and avoid being swayed solely by prestige or name recognition.

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Step 2: Build a Structured Program Research Strategy

Once you know what you’re looking for, the next task is to develop a deliberate program research strategy instead of bouncing randomly between websites or hearsay.

2.1 Know Where EM-IM Combined Programs Exist

EM-IM combined programs are limited in number and concentrated at certain institutions. Use these sources to identify them:

• Official EM-IM combined residency lists:
  • Specialty societies or combined EM-IM program consortium pages (often maintained by existing EM-IM programs)
• ERAS / AAMC / NRMP tools:
  • Filter by specialty for EM-IM combined programs
• Residency search databases:
  • FREIDA (AMA), EMRA Match, and similar guides—look specifically for “Emergency Medicine-Internal Medicine” or “Combined EM IM”

Create a master spreadsheet with:

• Program name and institution
• City/state
• Number of EM-IM residents per year
• Contact info and program website links

This becomes your working document.

2.2 Define Your Evaluation Categories

To compare and evaluate residency programs consistently, set up columns in your spreadsheet for categories that matter to you. For EM-IM combined applicants, consider including:

1. Program Structure and Identity

   • Length: 5 years (confirm)
   • EM-IM leadership (dedicated combined program director?)
   • Integration vs. separation of EM and IM training
   • Percentage of time in EM vs. IM by year

2. Clinical Exposure and Volume

   • ED annual volume and acuity
   • Number and types of ICUs (medical, cardiac, neuro, trauma)
   • Trauma level of main hospital (Level 1 vs others)
   • Inpatient vs outpatient IM balance
   • Night float, call structure, and shift schedule

3. Combined Identity and Culture

   • Number of EM-IM residents in the program total
   • How EM-IM residents are perceived (fully integrated? “Odd ones out”?)
   • Access to both EM and IM resident communities
   • Presence of EM-IM faculty role models

4. Education and Mentorship

   • Combined didactics vs separate EM and IM conferences
   • Availability of EM-IM specific curriculum
   • Formal mentorship programs for combined residents
   • Scholarly project requirements and support

5. Fellowship and Career Outcomes

   • Where recent graduates ended up:
     • Clinical roles (community vs academic)
     • Fellowships (type and institution)
     • Leadership positions (chief residents, medical directors, etc.)

6. Research and Academic Opportunities

   • Access to research in EM and IM
   • Protected research time (if any)
   • Support for conference presentations and publications

7. Diversity, Wellness, and Support

   • Diversity among residents and faculty
   • Formal wellness initiatives
   • Support for parental leave, part-time options, or customized pathways (if available)

8. Logistics and Location

   • Geography and climate
   • Cost of living
   • Salary and benefits
   • Moonlighting opportunities for senior residents (if allowed)

Not all columns will be equally important to you, but having them allows for systematic comparison when evaluating residency programs later.

2.3 Prioritize Your Criteria

Assign each category a rough importance rating (e.g., 1–3: Essential, Important, Nice-to-have). For example:

• Essential: Strong ED volume and acuity; robust ICU experience; supportive culture toward EM-IM residents
• Important: Academic opportunities, fellowship record, geographic region
• Nice-to-have: Specific niche electives (e.g., wilderness medicine) or moonlighting

This helps you interpret your data meaningfully, so you don’t treat every difference between programs as equally critical.

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Step 3: Deep-Dive Research Using Publicly Available Information

Now that you have a map and a strategy, start your program research in layers, moving from general to specific.

3.1 Start with Official Program Websites

Program websites are your first and most obvious data source. For EM-IM combined programs, focus on:

1. Program Overview Page

   • Mission statement—does it mention combined training explicitly?
   • Emphasis on academics vs community service vs leadership
   • Any language about the role of EM-IM in the institution

2. Curriculum and Rotations

   • Rotation schedule (by year) for EM-IM track:
     • Time spent in ED, inpatient wards, outpatient clinics, ICUs
     • Integrated rotations (e.g., observation medicine, ED-based ICU)
   • Longitudinal experiences (clinic continuity, research blocks)
   • EM-IM specific rotations (e.g., ED-based observation units, transitional care clinics)

3. Resident Roster and Bios

   • How many EM-IM residents per class?
   • Where they went to medical school (signals geographic diversity and competitiveness)
   • Their stated interests (e.g., critical care, global health, QI, education)

4. Faculty and Leadership

   • Is there a dedicated EM-IM program director or associate director?
   • Faculty who are dual trained or who specifically mentor EM-IM residents
   • Presence of EM-IM graduates now on faculty

5. Fellowship and Graduate Outcomes

   • Lists of recent EM-IM graduate destinations:
     • Type of practice
     • Fellowships and locations
   • Evidence that EM-IM residents achieve goals similar to yours

As you review each site, populate your spreadsheet. Note not just facts, but also impressions of tone, priorities, and culture.

3.2 Use National Databases and Match Tools

Beyond websites, use tools like:

• FREIDA / EMRA Match / AAMC tools
  • Confirm program size and case volumes (if reported)
  • See any additional metrics: duty hours, call frequency ranges, training settings
• Institutional GME websites
  • Info on benefits, salaries, parental leave, and wellness resources
  • Hospital-level stats: bed counts, ICU capacity, trauma designation

These resources help quantify what program websites sometimes leave vague.

3.3 Leverage Published and Informal Online Content

Combined EM-IM programs are small, but many have some footprint beyond their formal website:

• Program newsletters or blogs

  • Highlight resident achievements, new curricula, and culture

• Social media (Twitter/X, Instagram, LinkedIn)

  • Look for:
    • How often EM-IM residents appear (vs only categorical EM or IM)
    • Tone of resident posts—are they enthusiastic, burned out, collegial?
    • Highlights of EM-IM-specific activities or retreats

• Podcasts and webinars

  • Some EM or IM podcasts interview EM-IM residents or PDs; these can give insight into program philosophy and expectations.

Use these to round out your picture of each program’s character and day-to-day environment.

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Step 4: Go Beyond the Website – Direct Intel and Networking

The most accurate picture of a program often comes from people currently living it. Knowing how to research residency programs effectively means intentionally seeking these perspectives.

4.1 Talk to Your Home Institution and Mentors

If your school has EM or IM departments:

• Meet with EM and IM faculty advisors:
  • Ask which EM-IM programs they know well.
  • Inquire if any recent graduates matched into EM-IM and where.
  • Request introductions to alumni or contacts at combined programs.

Even if your school doesn’t have EM-IM, EM and IM faculty often relocate from institutions with such programs and can offer “insider” perspectives.

4.2 Contact Current EM-IM Residents

This is one of the most valuable steps in evaluating residency programs, especially combined ones.

How to approach:

• Look up EM-IM residents on program websites or LinkedIn.
• Send a courteous, concise email:
  • Introduce yourself and your interest in EM-IM.
  • Mention specific questions not easily answered from websites.
  • Ask if they’d be open to a brief 15–20 minute conversation.

Questions to ask:

• “How integrated do you feel between EM and IM?”
• “What’s it like to be an EM-IM resident socially and culturally?”
• “How supportive are EM and IM leadership when EM-IM needs diverge from categorical expectations?”
• “How flexible is the program if your fellowship or career interests evolve?”
• “What are the biggest strengths and biggest pain points of the program for EM-IM residents specifically?”

Take notes immediately after each conversation and record key impressions in your spreadsheet.

4.3 Attend Virtual Open Houses and Info Sessions

Many EM-IM combined programs host:

• Virtual open houses
• Interest group sessions at national EM or IM conferences
• Zoom Q&A panels with current residents and faculty

These events are invaluable to:

• Observe how leadership interacts with residents.
• See how often EM-IM is foregrounded versus treated as an afterthought.
• Ask targeted questions about your interests (e.g., critical care, research, global health).

Prepare questions ahead of time, tied to your key priorities, so you don’t default to generic queries.

4.4 EM and IM National Organizations

Look for:

• EMRA (Emergency Medicine Residents’ Association) EM-IM resources
• ACP or other IM society subgroups that include combined-trained physicians
• Conference sessions about dual training, transitions to practice, or fellowship pathways from EM-IM

These can offer both macro-level perspectives on the training model and micro-level details on specific programs.

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Step 5: Compare, Rank, and Refine Your List

By this point, you should have substantial qualitative and quantitative data. The next part of your program research strategy is to turn that into a usable application and rank list.

5.1 Create a Shortlist Based on Core Fit

Start trimming your overall list to a focused set of programs that:

• Align with your career goals (e.g., strong ICU focus if you want critical care)
• Fit your geographic constraints or preferences
• Demonstrate clear support and visibility for EM-IM residents

You might segment your list into:

• Top Priority (ideal fit)
• Solid Choices (good fit with some trade-offs)
• Reach or Wildcards (less perfect fit but still potentially valuable)

5.2 Compare Programs Systematically

Use your spreadsheet and consider a simple scoring system for each key category (e.g., 1–5). For each program, evaluate:

• Clinical exposure: Does it offer the breadth and depth you desire in both EM and IM?
• Combined culture: Are EM-IM residents valued and visible?
• Mentorship and support: Is there robust, tailored guidance?
• Fellowship and career outcomes: Are graduates doing what you hope to do?
• Lifestyle and sustainability: Are duty hours and culture compatible with a 5-year dual-residency commitment?

Avoid over-emphasizing any single metric (e.g., reputation alone). Remember that “best” is highly individual.

5.3 Identify Red Flags and Green Flags

While evaluating residency programs, be alert to patterns that may indicate trouble—or exceptional strength.

Potential red flags for EM-IM applicants:

• EM-IM residents barely mentioned, with no clear structure for combined didactics or mentorship.
• Inconsistent or missing info about EM-IM curriculum.
• Current or former residents hint at chronic scheduling conflicts between EM and IM with little institutional support.
• Very small number of EM-IM residents with no visible alumni outcomes.

Potential green flags:

• Dedicated EM-IM leadership and clear combined curricula.
• Strong presence of EM-IM residents and faculty in education, QI, research, or leadership roles.
• Transparent tracking of graduate outcomes and fellowship placements.
• Culture described as collaborative, with EM and IM departments visibly aligned around supporting EM-IM.

5.4 Revisit Your Goals

Before finalizing your list, compare your impressions with your original goals:

• Does your list include programs that can realistically get you where you want to go?
• Are you over-weighting prestige over training fit or vice versa?
• Is there adequate diversity in program type and region to protect you in the Match?

Refine until you feel your list balances aspiration, realistic fit, and safety.

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Step 6: Use Interviews and Second-Look Experiences to Validate Your Research

Once interviews begin, your research doesn’t stop—it just shifts from data-gathering to validation.

6.1 Test Your Hypotheses

Approach each interview with a list of program-specific questions based on your earlier research:

• “I noticed your EM-IM residents spend X months in ICU—how does that compare with categorical IM residents?”
• “Can you tell me about how EM-IM residents are incorporated into both EM and IM educational conferences?”
• “What have your recent EM-IM graduates gone on to do in terms of careers and fellowships?”

You’re not starting from scratch; you’re confirming whether the reality matches the image you formed.

6.2 Talk to Multiple People

At interviews or second-look events, try to speak with:

• Current EM-IM residents at different PGY levels
• Categorical EM and IM residents
• EM-IM program leadership (and, if possible, EM and IM PDs separately)

Compare perspectives. Consistency is reassuring; large discrepancies warrant scrutiny.

6.3 Trust Both Data and Gut

You’ve done rigorous research. In the end, when ranking, blend:

• Objective findings (curriculum, case mix, outcomes, structure)
• Subjective impressions (did you feel welcomed? respected? excited?)
• Personal needs (geography, social support, wellness)

Your goal is not just to match—it’s to thrive for five demanding years and beyond.

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Frequently Asked Questions (FAQ)

1. How early should I start researching emergency medicine-internal medicine combined programs?

Ideally, begin serious program research by the end of your third year of medical school, especially if you’re planning EM and IM rotations early in fourth year. However, you can start preliminary exploration even earlier:

• MS2–early MS3: Learn what EM-IM combined training entails, talk with mentors, attend virtual sessions.
• Mid–late MS3: Begin building your program list and spreadsheet, exploring websites and online resources.
• Early MS4: Refine your list, contact residents, and align your away rotations (if applicable) with likely target programs.

The more niche your interests (e.g., EM-IM with a strong critical care or research focus), the earlier you should start.

2. How many EM-IM combined programs should I apply to?

Because EM-IM combined slots are limited, most applicants apply broadly, commonly to all or nearly all EM-IM programs unless constrained by geography. Factors that guide your final number:

• Your overall competitiveness (USMLE/COMLEX scores, clinical performance, letters, research).
• Geographic constraints and flexibility.
• Whether you are also applying to categorical EM or IM as parallel plans.

Discuss your specific situation with an advisor experienced in EM or IM; they can help calibrate the appropriate number.

3. What’s the best way to learn how supportive a program is toward EM-IM residents?

The most reliable approach is a combination of:

• Direct conversations with current EM-IM residents at various levels.
• Careful attention to:
  • Whether there is dedicated EM-IM leadership.
  • How often EM-IM appears in program materials and social media.
• Targeted interview questions about:
  • Scheduling conflicts between EM and IM.
  • Access to mentors in both departments.
  • Flexibility for research or fellowship preparation.

You’re looking for evidence that EM-IM isn’t just an add-on, but an integrated, valued component of the program.

4. Should I also research categorical EM and IM programs if I’m set on EM-IM?

Yes. Even if you are strongly drawn to EM-IM combined training, it’s wise to:

• Understand the EM and IM departments independently, because your clinical experience and culture will depend heavily on each.
• Consider whether you want a parallel application strategy to categorical EM or IM programs as a backup, especially if you have geographic or personal constraints.

Knowing the strengths and culture of the categorical EM and IM programs where EM-IM sits will help you judge overall fit and long-term satisfaction.

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By approaching your search for EM-IM combined programs with a clear sense of your goals and a structured, layered program research strategy, you transform an overwhelming process into a deliberate, informed, and empowering one. Your future training will shape your career for decades—investing time now in thoroughly evaluating residency programs is one of the highest-yield decisions you can make.