Are Emergency Room Physicians Prepared for ED Emergencies?

Nearly half felt their training was inadequate.

It may not happen each day but at some point an eating disorder patient may need emergency room care. Emergency department physicians are in a unique position to identify patients with eating disorders, and sometimes are the first clinicians to see such patients. Too often, however, emergency room physicians may not be prepared to care for ED patients, particularly those with more serious disorders such as AN. The results of a cross-sectional pilot study call for better educational preparation for emergency physicians who see and treat ED patients (J Eat Disord. 2021. 9:4).


In the first study to examine knowledge and perceptions of eating disorders and educational needs among emergency physicians in the US, Dr. Connie Ma and fellow researchers at   the Department  of Individual, Family, and Community Education  at the University of New Mexico, Albuquerque, examined how well prepared emergency room residents are for recognizing and treating emergency patients with eating disorders.  Results showed that only 1 in 50 had received specific training in eating disorders during residency training.

The study included 162 emergency room physicians and residents at numerous sites in the US. The authors measured the physicians’ knowledge about a variety of resources, treatment options, and eating disorder organizations for patients with suspected or diagnosed ED disorders after the patients visited their emergency departments. To assess education and training needs, participants were asked to indicate their agreement to questions using a Likert scale.



An overview of the respondents

The median age of the 162 study participants was 31 years (range: 25–65 years), and most were female and Caucasian (73%). Overall, they had practiced for fewer than 5 years in the emergency department.  Twenty-three states were represented and, based on the census bureau-defined regions, most (38%) practiced in the Midwest (38%).


Most felt their training was inadequate

Of those who did receive training about eating disorders in medical school, 68 (49.3%) felt their training in recognizing and managing patients with eating disorders was inadequate. Only three participants (1.9%) reported completing a scheduled or elective rotation on eating disorders during their residencies. The others noted that such training was not offered. Of those who did receive training about eating disorders, nearly half (68; 49.3%) reported they thought their training was inadequate. The majority (n = 152; 93.8%) reported they did not complete a scheduled or elective rotation on eating disorders during their residency; often such a course was not offered.


Most respondents (95) were not familiar with the American Psychiatric Association’s Practice Guideline for the Treatment of Patients with Eating Disorders (see:›).  And, few had heard of the publication on emergency care of patients with eating disorders by Trent et al. (Am J Emerg Med. 2013. 31:859). Respondents indicated that it was difficult for them to successfully screen and treat patients when they wereuncertain about the course of treatment or did not have sufficient previous knowledge and training on eating disorders.


What can be done?


Better knowledge of resources in the community for patients with EDs is essential in order for an emergency physician to recommend follow-up specialty care, say the authors.  Doing this requires little extra time by the emergency physician, and patients may be more likely to seek treatment after the physician makes his or her recommendations for further care. EM clinicians and nurses, social workers, and case managers should be aware of affordable and easily accessible resources.  Some of these resources can be found on the Internet, such as from the National Eating Disorders Association, or NEDA, and the Alliance for Eating Disorder Awareness ( sites.


A second suggestion is the need for a brief screening method for persons with suspected eating disorders. A number of respondents in earlier studies indicated their  need for a brief screening tool  to help them successfully screen and treat patients when they were unsure about the best course of treatment or did not have enough training  or previous knowledge about EDs.  One such screening tool is the SCOFF questionnaire, which has 5 questions specifically aimed at detecting eating disorders (Eat Disord. 2010.18: 110). A free copy of the SCOFF questionnaire is currently available on the NEDA website (

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