Objectives: We assessed whether emergency medicine residents, after completing a structured 4-hour training program and supervised proctoring, demonstrate decision making in online medical control comparable with that of board-certified attending physicians.Methods: This was a retrospective cross-sectional study of online medical direction calls to the University Medical Centre of El Paso, the emergency medical services (EMS) base station for the El Paso Fire Department.First-year residents completed a 4-hour curriculum covering EMS systems, protocols, ethics, communication, and simulation, followed by 5 supervised calls.We analyzed all online medical control encounters between August 2016 and August 2025.Calls lacking a binary approval outcome were excluded.Approval/disapproval rates were compared between residents and attendings using Fisher's exact test for small samples, chi-square tests for overall comparisons, and 2-proportion z-tests for large categories.Odds ratios (ORs) with 95% CIs were calculated.Equivalence testing applied a prespecified margin of 3%.Results: Of 10,492 calls, 8405 were eligible.Residents (n = 6589) approved 93.4% of requests versus 93.1% for attendings (n = 1816) ( 2 = 0.11, P = .74;OR, 1.04; 95% CI, 0.84-1.29).Category-level comparisons revealed no statistically significant differences, with Fisher's exact P > 0.05 for all subgroups.Patient refusals (99.5% vs 100%) and termination of resuscitation (98.0%vs 99.4%) were uniformly high across both groups.The 2 one-sided test procedure confirmed equivalence, with a 90% CI for the difference (-0.85% to 1.35%) falling entirely within the 3% margin.Conclusion: Emergency medicine residents trained with a focused 4-hour curriculum and limited supervised experience performed online medical control duties at a level statistically and clinically equivalent to attending
Baker et al. (Fri,) studied this question.