Comparison of Emergency Medicine Resident and Attending Physician Approval Rates in Online Medical Control: A 10-year Retrospective Analysis

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: > 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 physicians across a decade of real-world EMS consultations. This model provided a practical and efficient way to include residents in EMS medical direction roles, supporting both system capacity and residency education.