Mastering Research During Emergency Medicine-Internal Medicine Residency

Why Research Matters in EM-IM Residency

Emergency Medicine–Internal Medicine (EM IM combined) residency programs are uniquely positioned at the intersection of acute care and longitudinal management. That dual perspective creates rich opportunities for impactful scholarly work—but it also presents real challenges in time, structure, and mentorship.

Research during residency is no longer “optional” at many academic programs, especially if you’re considering:

• An academic residency track or future faculty position
• Competitive fellowships (critical care, cardiology, toxicology, ultrasound, etc.)
• Leadership roles in quality improvement, administration, or education
• Dual-boarded careers that bridge the ED and inpatient/clinic settings

In EM-IM, research can be a powerful differentiator. It signals that you can think systematically about clinical problems, work on teams, and complete complex projects despite unpredictable schedules.

This guide will walk you through:

• How research fits into EM-IM training
• Common types of resident research projects that work well for EM-IM
• Step‑by‑step guidance to start and complete a project
• How to realistically balance research with a demanding combined schedule
• Ways to leverage research for fellowship, jobs, and long‑term academic success

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How Research Fits Into EM-IM Training

The Dual-Board Advantage

Being trained in both emergency medicine and internal medicine gives you:

• Broad patient exposure: From undifferentiated ED presentations to complex chronic disease on the wards and in clinic.
• Multiple clinical environments: ED, ICU, step-down, inpatient floors, continuity clinic, and sometimes observation units.
• Cross-disciplinary collaboration: You naturally interact with multiple departments—cardiology, pulmonary/critical care, hospital medicine, surgery, neurology, and more.

This breadth is ideal for research during residency. You can ask questions like:

• What happens to ED sepsis patients after hospital admission and discharge?
• How does ED boarding affect inpatient outcomes for complex medical patients?
• Which ED interventions meaningfully alter long-term chronic disease control?
• How do transitions of care from the ED to inpatient teams impact readmission rates?

These are questions that single-specialty trainees often struggle to study in a holistic way.

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Program Expectations and Structures

Many emergency medicine internal medicine programs build in protected scholarly time, though this varies.

Common structures include:

• Dedicated research blocks (e.g., 2–4 weeks per year during PGY-2–4)
• Longitudinal half-days during clinic blocks for academic projects
• An academic residency track with extra mentorship, coursework (e.g., epidemiology, statistics), and project milestones
• Scholarly activity requirements: Abstract presentation, poster, manuscript submission, or QI project completion.

When you start residency:

1. Ask early about requirements and opportunities

   • “What counts as scholarly activity here?”
   • “How many projects do successful EM-IM residents usually complete?”
   • “Are there structured paths for an academic residency track?”

2. Clarify expectations by PGY year

   • PGY-1: Exposure, idea generation, initial collaborations
   • PGY-2: Project selection, IRB, data collection
   • PGY-3–4: Data analysis, presentations, manuscripts
   • PGY-5 (if applicable): Leading projects, mentoring juniors

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Research vs. QI vs. Education Scholarship

All three can fulfill scholarly requirements but differ in goals and methods:

• Research: Designed to produce generalizable knowledge (e.g., new findings on ED sepsis resuscitation). Usually requires IRB approval and a formal protocol.
• Quality improvement (QI): Focused on improving local processes or outcomes (e.g., decreasing door-to-antibiotic times). Uses PDSA cycles and may or may not require IRB oversight.
• Education scholarship: Developing and evaluating curricula, simulation, or assessment tools (e.g., EM-IM transition-of-care curriculum).

In an EM-IM combined program, you may be able to:

• Turn a QI project into publishable research (e.g., multi-cycle QI with rigorous evaluation).
• Study the educational process of dual training (e.g., outcomes of EM-IM training pathways).
• Combine these approaches in multi-component projects.

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Types of Research Projects That Work Well for EM-IM Residents

1. Retrospective Chart Reviews

Why they’re popular:
They use existing data, are usually feasible on a resident timeline, and can answer clinically relevant questions.

EM-IM-friendly examples:

• Outcomes of ED patients with acute heart failure admitted to medicine versus observation units.
• Predictors of 30‑day readmission among ED discharges with COPD exacerbation.
• Comparing ED workup and inpatient outcomes for chest pain in patients with vs. without established cardiology follow-up.

Actionable tips:

• Pick a narrow, focused question first: “Among adults presenting to the ED with DKA, what factors are associated with ICU admission?”
• Work with a mentor who has done chart reviews to structure variables, definitions, and data collection.
• Plan realistic sample size based on your timeline and data availability.

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2. Prospective Observational Studies

These are more complex but can be powerful.

Examples:

• Observing adherence to sepsis bundles from ED presentation through inpatient care.
• Tracking functional status and healthcare utilization after ED admission for syncope.
• Implementing a bedside tool for risk stratification in ED chest pain and following outcomes during hospitalization.

Prospective studies demand more coordination and usually a longer runway—ideal for multi-year planning (PGY-2 to PGY-4).

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3. Quality Improvement Projects With Research Rigor

Quality improvement is baked into both emergency medicine and internal medicine. As an EM-IM resident, you are a natural bridge for QI projects that cut across departments.

Examples:

• Reducing handoff errors between ED and inpatient medicine teams.
• Improving adherence to guideline-directed therapy for heart failure initiated in the ED and continued inpatient.
• Streamlining admission order sets to reduce duplication and medication errors.

To turn QI into publishable resident research projects:

• Use clear outcome metrics (e.g., 30-day readmission, time to antibiotic).
• Collect data before and after interventions.
• Use established QI frameworks (e.g., Model for Improvement, Lean, Six Sigma).
• Involve the hospital’s QI office and statisticians early.

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4. Education Research in EM-IM

Education scholarship is an excellent niche, especially if you lean toward an academic residency track or future program leadership.

Potential areas:

• Designing and evaluating an EM-IM boot camp for cross-covering inpatient and ED shifts.
• Studying simulation-based training for managing shock in both ED and ICU settings.
• Evaluating a longitudinal curriculum on diagnostic reasoning in undifferentiated patients.

You can:

• Implement new workshops or didactics.
• Collect pre/post assessments (knowledge, confidence, OSCE performance).
• Track downstream behaviors (e.g., documentation quality, clinical decisions).

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5. Multicenter and Collaborative Projects

Because EM-IM is relatively small, there is a strong culture of national collaboration.

Opportunities include:

• Joining multi-institution registries or studies on dual-boarded career outcomes.
• Participating in national EM or IM research networks (e.g., EM research consortia, hospital medicine collaboratives).
• Working with subspecialties like critical care, cardiology, or infectious disease on joint projects.

For residents, these collaborations often start through:

• National conferences (SAEM, ACEP, SHM, AHA, SCCM).
• EM-IM program director or faculty networks.
• Fellow-led or senior resident-led projects spanning multiple sites.

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Getting Started: Finding a Project and a Mentor

Step 1: Clarify Your Goals

Before committing to a project, ask yourself:

• Do I see myself in academic medicine, community practice, or something in between?
• Am I aiming for fellowship (and if so, which one)?
• Do I enjoy numbers and data, systems and QI, or teaching and curriculum more?

Examples of goal alignment:

• Future critical care–bound resident: Focus on ED-to-ICU transitions, sepsis, ARDS, or shock research.
• Future cardiologist: Work on ED chest pain pathways, high-sensitivity troponin algorithms, or heart failure management.
• Education-focused resident: Develop and study simulation or handoff curricula crossing EM and IM.

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Step 2: Identify the Right Mentor(s)

In EM-IM, you may benefit from dual mentorship:

• One mentor from emergency medicine
• One from internal medicine (or subspecialty)

Qualities of a good mentor:

• Has ongoing projects and a track record of publication or presentation.
• Understands the combined-training schedule and its constraints.
• Is responsive and provides clear expectations and timelines.

How to find them:

• Ask your EM-IM program director: “Who regularly mentors EM-IM resident research projects?”
• Attend departmental research meetings or grand rounds.
• Talk to senior EM-IM residents about who helped them succeed.

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Step 3: Start With a Feasible Question

A feasible resident project:

• Uses available data (ED EHR, inpatient data, clinic registries).
• Has a manageable timeline (usually 12–24 months from idea to submission).
• Matches your PGY level and schedule.

Refinements to make questions realistic:

• Too broad: “What factors influence sepsis outcomes?”
• Better: “Among adults presenting to our ED with suspected sepsis, is initial ED lactate measurement associated with ICU admission or mortality?”
• Even better: “In adults with suspected sepsis in our ED over 24 months, does initial lactate ≥4 mmol/L predict in-hospital mortality after adjusting for age and comorbidities?”

Bring this refined question to your mentor and research support staff (biostatistician, research coordinator) to confirm feasibility.

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Step-by-Step: From Idea to Publication

1. Develop a Study Plan

Create a 1–2 page brief that includes:

• Background and rationale
• Study question and primary outcome
• Inclusion and exclusion criteria
• Main variables to collect
• Basic plan for analysis (even if high-level)

This document becomes the blueprint for:

• Mentor feedback
• IRB application
• Presentations at your local research-in-progress meetings.

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2. Navigate the IRB Process

Most research during residency—especially anything beyond purely internal QI—will involve your IRB.

Key tips:

• Ask if there’s a template for ED or medicine chart review studies.
• Clarify whether your project is research vs. QI vs. exempt.
• Work with a research coordinator if your department has one.

Timeline expectations:

• Protocol drafting: 2–4 weeks
• IRB review: 4–12 weeks depending on type and institution

Build this into your project plan early.

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3. Data Collection: Work Smarter, Not Harder

Your time is limited, so efficiency is crucial.

Approaches:

• Automated data pulls from the EHR with IT support, followed by manual validation.
• Structured data collection tools (REDCap, Excel, or institution-approved platforms).
• Clear, written definitions for each variable to maintain consistency.

Strategies to stay on track:

• Set weekly or biweekly micro-goals (e.g., “Abstract 30 charts by Friday”).
• Use downtime on lighter rotations (ambulatory, elective, research blocks).
• Share data collection with co-residents or students; you can lead and coordinate.

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4. Basic Analysis and Working With a Statistician

Unless you already have a strong quantitative background, collaborate with a statistician or methodologist.

Before meeting:

• Clean your dataset (check for missingness, obvious errors).
• Prepare a data dictionary (variable names, definitions, coding).
• Be ready with your primary and 1–2 secondary questions.

Your statistician can help:

• Choose appropriate tests (e.g., chi-square, t-test, logistic regression).
• Plan for confounders and covariates.
• Interpret outputs for clinical meaning, not just p-values.

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5. Writing and Presenting Your Work

Aim for presentation before publication:

• Local/regional conferences: Great first step, lower barrier.
• National meetings: SAEM, ACEP, SHM, SCCM, ACP, AHA, depending on topic.

Abstract tips:

• Highlight the EM-IM relevance (e.g., transitions of care, multidisciplinary outcomes).
• Emphasize endpoints that matter clinically (e.g., mortality, LOS, readmission, patient-centered outcomes).

Manuscript strategy:

• Decide early whether you’re targeting an EM, IM, or general medicine journal.
• Follow a structured outline (Introduction, Methods, Results, Discussion).
• Request co-author contributions for sections (e.g., statistician for Methods, subspecialist for Discussion context).

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Balancing Research With a Demanding EM-IM Schedule

Understand Your Schedule Cycles

EM-IM residents face:

• Shift-based EM work: Nights, weekends, variable hours.
• Inpatient IM services: Long days with heavy clinical load.
• Continuity clinic and sometimes ICU rotations.

Planning strategies:

• Identify lighter months (electives, ambulatory, research blocks) for heavy research tasks: IRB, data collection, writing.
• Use non-clinical time around shifts for short, focused tasks: editing drafts, responding to co-author comments, formatting references.

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Time Management Tactics

• Block scheduling for research: Treat 2–3 hours like a meeting—put it on your calendar.
• Micro-tasks: Break big goals into small steps (e.g., “write 3 sentences in the introduction” rather than “write the introduction”).
• Protected research days: If your program allows, negotiate occasional “academic days” during elective months.

Consider tools:

• Task managers (Todoist, Trello, Notion) to track project stages.
• Reference managers (Zotero, Mendeley, EndNote) to store and format citations easily.

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Protecting Your Well-Being

Research should enhance—not erode—your residency experience.

Watch for red flags:

• Chronic sleep deprivation because you’re writing after every shift.
• Persistent guilt over “not doing enough” on your project.
• Conflict between research expectations and clinical performance.

Mitigation strategies:

• Have honest conversations with mentors about expectations vs. your bandwidth.
• Choose one primary project instead of many small, scattered commitments.
• Lean on team science—co-residents and students can share the load.

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Leveraging Research for Your Future Career

For Fellowship Applications

In many EM-IM career paths—especially critical care, cardiology, pulmonary, heme/onc, or academic ultrasound—research during residency can be a key differentiator.

What programs look for:

• Evidence of follow-through: Did you see at least one project to presentation or publication?
• Relevance: Does your work connect logically to your fellowship interest?
• Role: Were you first author or a driving force, or only a minor contributor?

To showcase this:

• Update your CV regularly with abstracts, posters, oral presentations, and manuscripts (even “submitted” or “in revision” status).
• Ask research mentors for strong, specific letters highlighting your role and growth.
• Be ready to discuss your project’s methods and limitations during interviews.

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For Academic and Hybrid Careers

If you’re targeting an academic residency track in your program or planning a faculty career:

• Consider longitudinal projects that can continue into fellowship or junior faculty years.
• Seek out institutional resources: Clinical and Translational Science Institutes (CTSI), formal research or educator tracks, or certificate programs (e.g., clinical research, medical education).
• Build a niche at the intersection of emergency medicine internal medicine—e.g., sepsis, hospital flow, complex multimorbidity, or diagnostic decision-making in the ED.

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For Community or Non-Academic Careers

Even if your goal is primarily clinical community practice:

• Research experience develops skills in critical appraisal, systems thinking, and QI, all of which translate into leadership roles (medical director, department chair, QI lead).
• Having a track record in QI or operational projects can help you stand out in job applications and contract negotiations.
• You can continue to collaborate on multi-center trials or registry work, especially if your institution participates in broader networks.

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Frequently Asked Questions (FAQ)

1. Do I need research to match into an EM-IM combined residency?

Research is not strictly required, but it is often advantageous—especially if:

• You are applying to more academically oriented EM-IM programs.
• You’re already interested in critical care, cardiology, or academic careers.

As an applicant, prior research shows you can handle scholarly work and might thrive in an academic residency track. That said, strong clinical performance, letters, and fit remain more important than sheer research volume.

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2. How many research projects should I do during EM-IM residency?

Quality matters more than quantity. A realistic and impactful goal is:

• One primary project where you are first author and see it through to presentation/publication.
• Optionally, 1–2 smaller collaborative projects where you assist (data collection, co-authorship).

Trying to lead many projects at once can dilute your efforts and increase stress, especially given the demanding EM-IM schedule.

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3. When is the best time in residency to start a project?

Ideally:

• Start exploring ideas and mentors in PGY-1 (mid to late year).
• Finalize a project plan and submit IRB by early PGY-2.
• Complete most data collection and preliminary analysis by late PGY-3.
• Aim for poster presentation and manuscript drafting in PGY-3–4 (and PGY-5, if applicable).

This timeline allows room for the inevitable delays (IRB review, data issues, schedule changes) while still positioning you well for fellowship or job applications.

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4. What if my program doesn’t have strong research infrastructure?

You still have options:

• Seek out individual faculty in EM or IM who publish regularly, even if there’s no formal research office.
• Partner with other departments (e.g., cardiology, hospital medicine, critical care) that may have more established research structures.
• Consider education scholarship or QI projects that require fewer institutional resources.
• Look for multi-center collaborations through national organizations and interest groups.

In some cases, you can also enroll in remote or online research methods courses or seek mentorship outside your institution (with your program’s support).

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Research during residency in Emergency Medicine–Internal Medicine is challenging but highly rewarding. By choosing feasible resident research projects, aligning them with your interests, and leveraging mentorship and institutional resources, you can produce meaningful scholarship that benefits your patients, advances the field, and opens doors for your future career—whether in academic medicine, fellowship training, or high-impact community practice.