Essential Guide to Research Opportunities for EM-IM Residents

Understanding Research During EM-IM Residency

For an MD graduate entering a combined Emergency Medicine–Internal Medicine (EM-IM) program, research during residency is both an opportunity and a strategic career tool. EM-IM residents occupy a unique space at the intersection of acute, high-acuity care and longitudinal management of complex medical disease. That dual perspective makes you exceptionally well-positioned to ask impactful questions and design meaningful resident research projects.

Whether your goal is an academic residency track, fellowships (e.g., critical care, toxicology, ultrasound, health services research), or simply becoming a more analytical clinician, engaging in research during residency can:

• Strengthen your clinical reasoning and evidence-based practice
• Improve your competitiveness for academic and fellowship positions
• Build a professional network in both emergency medicine and internal medicine
• Develop skills in study design, quality improvement, and data analysis
• Make you a more thoughtful writer, teacher, and team leader

This guide focuses on how to approach research during residency as an MD graduate in an EM-IM combined program, from getting started to completing and disseminating your projects.

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How EM-IM Training Shapes Your Research Opportunities

EM-IM combined residency structures—typically five years—create distinctive opportunities and challenges for an allopathic medical school match graduate.

The EM-IM Advantage

Your dual training in emergency medicine internal medicine offers:

• Two Departments, Double the Mentors
  You have access to mentors, resources, and conferences from both EM and IM, including subspecialties (critical care, cardiology, pulmonary, hospital medicine, geriatrics, etc.).

• Broad Exposure Across Settings
  You rotate in:

  • High-acuity emergency departments
  • Inpatient wards and ICUs
  • Ambulatory clinics and continuity practices
  • Observation units and procedural areas

  This breadth gives you unique research vantage points on transitions of care, utilization, diagnostic uncertainty, and complex chronic disease.

• Bridge Between Systems
  As an EM-IM resident, you are naturally positioned to study:

  • How ED decisions impact inpatient outcomes
  • Care fragmentation between ED and clinics
  • Systems-level issues like readmissions, boarding, and follow-up failures

• Longer Program Duration
  Five years instead of three or four means more time to:

  • Start earlier and complete multi-phase or higher-impact projects
  • Build on one project over several years
  • Transition from participant to leader or mentor by senior years

Challenges to Anticipate

Research during residency also has real constraints:

• Heavy Clinical Load
  EM-IM schedules are intense. Nights, weekends, and high-acuity rotations can disrupt continuity of research work.

• Competing Priorities
  Board exams (ABIM, ABEM), procedures, leadership roles, and teaching responsibilities compete for time and energy.

• Fragmented Time
  You might switch from EM-heavy months to IM-heavy months, changing your primary environment and supervisors frequently.

The key is to design resident research projects that respect these realities—projects that are feasible in small time blocks, are well-supported by faculty, and can progress incrementally.

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Types of Research Opportunities for EM-IM Residents

Research in residency is broader than randomized controlled trials. As an MD graduate residency trainee, you can contribute meaningfully through various modalities.

1. Clinical Research

Clinical research focuses on patient-level data in real-world care.

Examples well-suited to EM-IM:

• Diagnostic Accuracy Studies

  • Evaluating rapid rule-out tools (e.g., for PE, ACS, sepsis) in ED-to-inpatient pathways
  • Comparing ED-based ultrasound findings with inpatient imaging outcomes

• Prognostic Studies

  • Identifying predictors of 30-day readmission from patients discharged from the ED vs. admitted from the ED
  • Examining which ED or early inpatient factors predict ICU upgrade or clinical deterioration

• Comparative Effectiveness

  • Comparing outcomes of different ED-based care pathways (e.g., ED observation vs. direct admission vs. discharge with close follow-up)
  • Studying different strategies for managing chronic conditions (e.g., heart failure, COPD) that frequently present to both ED and clinics

Actionable tip:
Look for existing institutional databases—ED registries, sepsis bundles, heart failure readmission datasets. As an EM-IM resident, you can often link ED visit data with inpatient and outpatient records, creating a longitudinal view that single-specialty residents may not have.

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2. Quality Improvement (QI) and Patient Safety

QI projects are especially accessible during EM-IM residency and often align well with ACGME requirements.

Project examples:

• Reducing ED Readmissions for Chronic Disease

  • Implementing standardized discharge instructions for heart failure or diabetes with automatic clinic follow-up
  • Assessing whether improved discharge communication to primary care reduces ED return visits

• Transitions of Care Between ED and Inpatient

  • Standardizing ED-to-hospitalist handoff tools to reduce admission delays and errors
  • Creating EM-IM co-management pathways for complex multimorbid patients

• Sepsis and Time-Sensitive Conditions

  • Improving door-to-antibiotic times for sepsis
  • Optimizing ED-to-ICU transfer times for high-risk patients

Actionable tip:
Design QI projects that are:

• Measurable (clear metrics and time frames)
• Aligned with institutional priorities (readmissions, throughput, sepsis bundles)
• Feasible to implement and track during your residency timeline

QI can readily produce abstracts and posters and can often be converted into publishable manuscripts.

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3. Health Services and Systems-Based Research

The intersection of EM and IM is fertile ground for health services research.

Examples tailored to EM-IM:

• Utilization and Cost Studies

  • ED utilization patterns for patients with poor access to primary care
  • Cost-effectiveness of observation unit use vs. inpatient admission

• Care Coordination and Access

  • Impact of ED-initiated clinic or subspecialty referrals on future utilization
  • Outcomes of “frequent flyer” interventions (case management, social work, telehealth follow-up)

• Operational Research

  • The impact of ED boarding on internal medicine patient outcomes
  • Effects of EM-IM resident staffing models on throughput or ICU admissions

These projects often use large datasets and may require collaboration with biostatistics or health services research faculty—common in academic residency track environments.

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4. Medical Education Research

If you enjoy teaching as a resident, education-focused research may be a strong fit.

Possible directions:

• Curriculum Development

  • Designing and evaluating EM-IM–specific curricula (e.g., managing complex chronic disease in the ED, transitions of care teaching modules)

• Simulation and Procedural Training

  • Studying simulation-based training to improve management of undifferentiated shock across ED and ICU settings
  • Comparing different models for teaching emergency procedures (intubation, central lines, ultrasound) to interns or students

• Interprofessional Education

  • Evaluating team-based learning involving nurses, pharmacists, and residents across emergent and inpatient care

Education research can be particularly appealing if you envision a career in academic medicine with a focus on teaching.

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5. Case Reports and Case Series

Case reports are often the easiest way to begin research during residency, especially during your early PGY years.

Good case candidates often involve:

• Unusual presentations of common diseases (e.g., atypical MI, subtle sepsis)
• Rare diseases first picked up in the ED and then followed inpatient
• Diagnostic dilemmas resolved through combined EM and IM thinking
• Unique management decisions (e.g., balancing ED stabilization with long-term disease considerations)

Actionable tip:
Develop a simple habit:

• Keep a secure list of “interesting cases” with brief notes and MRNs (per your institution’s privacy rules).
• Discuss these cases with a mentor monthly to identify publishable opportunities.

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Designing a Feasible Research Plan in EM-IM Residency

To make research during residency realistically achievable, you need a structured, time-aware plan that fits the rhythm of an EM-IM combined program.

Step 1: Define Your Goals Early

At the start of residency (or even during your allopathic medical school match season), clarify what you want from research:

• Fellowship-focused?
  Critical care, ultrasound, toxicology, palliative care, administration, or research fellowships often favor applicants with substantive scholarly work.

• Academic Career?
  You may want longitudinal projects, first-author publications, and presentations at major EM and IM conferences.

• Clinical Career with Scholarship?
  QI projects, select clinical studies, and occasional case reports may be sufficient, focusing on practical impact.

Write your goals down and discuss them with your program director and mentors in both departments.

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Step 2: Find the Right Mentors and Environment

As an EM-IM resident, your mentorship network is a major asset—if you cultivate it intentionally.

Ideal mentor characteristics:

• Experience with resident research projects
• A track record of publications or QI implementations
• Familiarity with EM or IM, ideally at the intersection of both
• Realistic expectations about resident time constraints

Aim for:

• Primary Research Mentor (could be EM, IM, or dual-trained EM-IM faculty)
• Methodology/Biostatistics Support (through your institution’s research office or public health department)
• Career Mentor (helping align projects with long-term plans, including academic residency track interests)

Proactively attend research meetings or conferences in both departments. Introduce yourself and express interest; most faculty welcome enthusiastic MD graduates ready to engage in research during residency.

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Step 3: Choose Projects That Match Your Stage and Bandwidth

A strategic approach over your five-year EM-IM residency might look like:

PGY-1: Exploration and Foundation

• Join an existing project as a collaborator (chart review, data collection, literature review).
• Write a case report or case series.
• Participate in or observe a QI initiative to understand the basics.

PGY-2–3: Ownership and Productivity

• Take ownership of 1–2 well-defined projects (e.g., a retrospective chart review or a structured QI project with clear metrics).
• Aim for abstract submissions to at least one EM and one IM conference.
• Begin shaping a research niche (e.g., sepsis, heart failure, health services, education).

PGY-4–5: Leadership and Mentoring

• Lead larger or more sophisticated projects (prospective cohort, multi-step QI, curricular outcomes study).
• Mentor junior residents or medical students on smaller subprojects.
• Push toward manuscript submission and multi-institution collaboration if feasible.

A common mistake is taking on an overly ambitious prospective trial without infrastructure; favor manageable projects that you can realistically finish in the context of your clinical duties.

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Step 4: Understand Study Design and Ethics

Basic literacy in research methods is essential for any MD graduate residency trainee engaging in scholarship.

Core concepts to master:

• Study types: retrospective vs prospective, observational vs interventional
• Sampling and inclusion/exclusion criteria
• Common biases in EM and IM research (selection bias, verification bias, loss to follow-up)
• Basic statistics (p-values, confidence intervals, regression, survival analysis)
• Institutional Review Board (IRB) process and human subjects protections

Most programs offer resident research seminars or journal clubs. As an EM-IM resident, try to attend sessions in both departments; each will model somewhat different approaches to evidence.

Study design literacy helps you:

• Design feasible, answerable questions
• Avoid methodological pitfalls that derail projects
• Critically appraise literature that informs your clinical decisions

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Step 5: Protect Time and Build Research into Your Schedule

Research during residency competes with clinical intensity. To avoid burnout and incomplete projects:

• Ask About Protected Time
  Some EM-IM programs or academic residency track options offer:

  • Dedicated research blocks
  • Elective rotations tailored to scholarly work
  • Reduced shifts during research months

• Use EM and IM Rotations Strategically
  Heavy ED months:

  • Focus on data collection that can be done in short blocks or between shifts.
  • Work on case reports or targeted literature reviews.

  Lighter IM or elective months:

  • Push forward with analysis, writing, and IRB submissions.

• Micro-Task Your Projects
  Break up tasks into 30–60 minute pieces:

  • “Write methods paragraph X”
  • “Extract data from 10 charts”
  • “Draft 3 bullet points for discussion section”

• Schedule Standing Research Time
  Put fixed weekly blocks on your calendar (e.g., every Thursday afternoon post-call) and treat them like clinical duties.

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Step 6: Disseminate Your Work: Posters, Presentations, and Publications

To maximize the value of research during residency:

• Submit Abstracts to Key Meetings
  Consider:

  • Emergency Medicine: ACEP, SAEM, AAEM
  • Internal Medicine: ACP, SGIM, subspecialty conferences
  • EM-IM–relevant cross-disciplinary meetings (critical care, hospital medicine, quality improvement)

• Leverage Your Dual Identity
  Some projects may fit both an EM and an IM audience, or be presented in both contexts with adjustments in framing.

• Aim for Manuscripts When Feasible
  Not every project will be publishable, but:

  • Design with publication in mind from the beginning
  • Choose target journals early (EM, IM, or general medicine)
  • Work with experienced co-authors

• Use Your Work in Future Applications
  For fellowships or academic positions, be ready to:

  • Summarize your research portfolio succinctly
  • Highlight your specific role (idea generation, design, analysis, writing)
  • Explain how your EM-IM training shaped the question and methods

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Integrating Research With Career Planning in EM-IM

Research during residency should support—not overshadow—your long-term professional goals.

Mapping Research to Career Paths

1. Academic Emergency Medicine or Internal Medicine

• Seek an academic residency track if your program offers one (e.g., protected time, formal mentorship, coursework in research methods).
• Prioritize:
  • At least one first-author publication
  • Consistent productivity (multiple abstracts, posters)
  • A coherent theme or niche (e.g., sepsis care, diagnostic reasoning, transitions of care).

2. Dual Academic Appointment (EM and IM)

• Focus on research topics bridging ED and inpatient/ambulatory care.
• Build relationships and co-authorship across both departments.
• Aim for collaborative, systems-focused projects.

3. Fellowship Pathways

• Critical Care
  • Projects involving shock, sepsis, ventilator management, ICU outcomes, ED-to-ICU transitions.
• Ultrasound
  • Research on diagnostic utility, educational interventions, or workflow integration of POCUS.
• Toxicology, Palliative Care, Administration, Global EM/IM
  • Target research to these domains early: overdose management, goals-of-care in ED, flow and throughput improvements, global health system projects.

4. Primarily Clinical Career

• Focus on:
  • Practical QI that improves your local system
  • A smaller number of high-yield projects rather than many small ones
  • Developing skills that enrich your daily practice (critical appraisal, QI methodology)

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Common Pitfalls and How to Avoid Them

• Overcommitting

  • Limit yourself to 1–2 major ongoing projects at a time
  • Say “no” when necessary; incomplete projects help no one

• Lack of Clear Roles

  • Clarify roles with co-authors at the beginning: who leads, who writes, who analyzes data

• Ignoring Timeline and Feasibility

  • Work backward from your graduation date
  • Avoid heavily prospective designs that can’t complete within your residency

• Delayed IRB Submission

  • Start IRB planning early; bureaucracy can significantly delay project start

• Not Documenting As You Go

  • Keep organized records of protocols, data dictionaries, versions of manuscripts, and decisions made

Being mindful of these pitfalls helps ensure that your investment in resident research projects leads to meaningful products.

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FAQ: Research During EM-IM Residency for MD Graduates

1. Do I need research to match into an EM-IM combined program as an MD graduate?
Research is not always mandatory, but it can strengthen your allopathic medical school match application significantly, especially for competitive EM-IM programs and those with strong academic cultures. EM-IM programs value applicants who demonstrate curiosity, comfort with complexity, and evidence-based thinking. Even small-scale student research, QI projects, or case reports can show that you understand and appreciate scholarly work.

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2. How much research is “enough” during EM-IM residency if I want an academic career?
Quality and coherence matter more than raw quantity. A typical strong academic applicant might have:

• 1–3 first- or co-first-author manuscripts (published or in advanced stages)
• Several conference abstracts/posters (ideally at both EM and IM venues)
• A clear academic narrative: “Here is the clinical question I’m interested in, here’s how I’ve studied it, and here’s where I want to take it next.”

If your residency offers an academic residency track, engaging with that track and consistently progressing on projects is often as important as the final publication count.

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3. Can I realistically do research during residency with an EM-IM schedule?
Yes, but it requires planning and boundaries. Key success factors:

• Choose feasible, well-scoped projects (retrospective studies, QI, education research).
• Use protected research time or elective blocks strategically.
• Collaborate with efficient, experienced mentors who understand EM-IM demands.
• Break work into small tasks and maintain momentum, even during busy rotations.

Many EM-IM residents successfully complete meaningful research during residency, especially when they start early and avoid overextending.

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4. Does QI “count” as research for fellowships and academic careers?
High-quality QI absolutely counts, especially when it is:

• Systematic (clear problem, baseline data, intervention, follow-up metrics)
• Well-documented and analyzed
• Disseminated (posters, presentations, or peer-reviewed QI-focused journals)

For certain fellowships (hospital medicine, quality & safety, administration, some critical care or palliative care pathways), QI may be just as valuable as traditional clinical research. For research-intensive fellowships, pairing QI with at least one more traditional study can be ideal.

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By approaching research during residency with intention—leveraging your EM-IM training, choosing feasible projects, and aligning your work with long-term goals—you can build a robust scholarly foundation that strengthens your clinical practice and opens doors in academia, fellowships, and leadership.