Innovation at the Intersection: The 2026 ACEP Dual Training Virtual Conference Recap

Joseph Lykins, MD

The 2026 American College of Emergency Physicians (ACEP) Dual Training Virtual Conference highlighted the breadth, adaptability, and growing influence of dual-trained physicians across emergency medicine and internal medicine. The conference brought together residents, students, fellows, and faculty from institutions across the country for a series of presentations focused on clinical operations, behavioral emergencies, home-based acute care, migrant health, systems innovation, and the unique value of physicians trained at the intersection of acute and longitudinal care.

The event also served as a reminder of the importance of the ACEP Dual Training Section itself: a professional home for emergency medicine/internal medicine (EM/IM), emergency medicine/internal medicine/critical care (EM/IM/CC), and other dual-trained physicians seeking collaboration, mentorship, scholarship, and advocacy. Throughout the conference, presenters repeatedly emphasized that dual training equips physicians to move fluidly between emergency stabilization, inpatient management, population health, systems design, and care transitions in ways that are increasingly valuable in modern healthcare.

Managing Agitation Across Care Settings

One of the conference’s featured presentations was delivered by Dr. Ronny Otero, vice chair of clinical operations at the Medical College of Wisconsin, who presented a practical and systems-focused discussion on the management of agitation in both emergency and inpatient settings.

Dr. Otero emphasized that agitation is not a singular diagnosis, but rather a broad clinical syndrome with diverse etiologies, including intoxication, withdrawal, psychiatric illness, delirium, infection, metabolic derangements, and medication-related syndromes. He underscored the importance of recognizing the spectrum of agitation severity and adopting standardized approaches to assessment and communication.

The presentation highlighted several key themes highly relevant to dual-trained physicians:

• The importance of careful history-taking in altered mental status evaluations
• Recognition of delirium and geriatric vulnerability in hospitalized patients
• The operational impact of agitation on emergency departments and inpatient units
• Non-pharmacologic de-escalation techniques and trauma-informed communication
• Judicious use of pharmacologic sedation and restraints
• System-level approaches to behavioral emergencies

Dr. Otero reviewed the evolution of pharmacologic management strategies, including the declining reliance on traditional “B-52” sedation approaches in favor of more targeted use of agents, such as ketamine, droperidol, olanzapine, and other atypical antipsychotics. He also discussed institutional protocols, behavioral emergency response teams, and the importance of standardized agitation scoring systems to improve communication and patient safety.

A major strength of the talk was its operational perspective. Dr. Otero described how multidisciplinary collaboration among emergency physicians, hospitalists, toxicologists, pharmacists, nurses, and behavioral emergency teams can improve agitation management across care settings. He repeatedly emphasized that agitation management should be approached with the same preparation and intentionality as any high-risk medical procedure.

The question-and-answer session that followed focused heavily on implementation challenges within inpatient environments, where staff may encounter behavioral emergencies less frequently than emergency clinicians. Participants discussed barriers to standardized agitation assessment, obtaining institutional buy-in, the role of rapid response and behavioral emergency teams, and the importance of leveraging hospital quality and safety data to support system-wide improvements. Dr. Otero encouraged participants to use behavioral response data to advocate for education, protocols, and interdisciplinary collaboration.

Reimagining Acute Care Through Hospital-at-Home Programs

Dr. Shilpa Raju, associate professor and vice chair for clinical operations at the University of Utah, presented a forward-looking discussion on “Heal at Home” and the future of home-based acute care delivery. Her presentation illustrated how dual-trained physicians are uniquely positioned to design and lead innovative care models that bridge emergency medicine, inpatient medicine, and population health.

Dr. Raju described the development of a hospital-at-home style program capable of delivering acute-level care in patients’ homes, including intravenous therapies, remote monitoring, and coordinated multidisciplinary care. She emphasized that EM/IM physicians possess a rare combination of skill sets ideally suited to these models: emergency medicine contributes expertise in acute stabilization, risk stratification, and operational efficiency, while internal medicine contributes longitudinal disease management, transitions of care, and understanding of chronic illness trajectories.

The discussion explored both the opportunities and operational realities of these programs, including patient selection, logistics, insurance coverage, staffing, home health partnerships, and the challenge of ensuring equitable access. During the Q&A session, attendees discussed practical barriers to home IV antibiotic administration and insurance-related financial concerns for patients. Dr. Raju described how the University of Utah program partnered with home health organizations and case management teams to proactively address medication coverage and reduce unexpected patient costs.

The presentation resonated strongly with conference attendees, because it highlighted a rapidly evolving care environment in which dual-trained physicians can play central leadership roles in redesigning healthcare delivery.

Emergency Department Utilization and Disease Burden in Migrant Patients

Another featured session focused on migrant health and emergency department utilization during a period of significant demographic and systems-level change in Massachusetts. Dr. Joseph Lykins, assistant professor of emergency medicine at Boston University, presented “ED Utilization and Disease Burden in Migrant Patients and Opportunities for Dual Training in a Migrant Crisis” alongside Boston University medical student Dylan Pryor.

Dr. Lykins introduced the project by framing the extraordinary healthcare pressures experienced during the migrant crisis in Boston between 2022 and 2024, noting that at certain points more than 200 patients were effectively living within emergency department waiting rooms because shelter systems lacked capacity. He emphasized that the crisis represented not only a humanitarian challenge, but also an opportunity for dual-trained physicians to address operational, public health, infectious disease, and primary care issues simultaneously.

Dylan Pryor discussed the team’s effort to characterize emergency department utilization patterns among migrant patients and to better understand the barriers shaping healthcare access in this population. The presentation examined how immigration status, insurance access, fear of identification, and structural barriers influence healthcare-seeking behavior.

The presenters highlighted several key themes:

• Migrant patients may have lower overall healthcare utilization despite substantial medical needs.
• Fear of legal consequences or identification may discourage emergency department presentation.
• Massachusetts’ MassHealth Limited program provides an important safety-net mechanism for undocumented patients.
• Emergency departments increasingly serve as major access points for primary care, infectious disease screening, and social services during humanitarian crises.
• Dual-trained physicians are particularly well suited to navigate the overlap between emergency care, chronic disease management, infectious diseases, systems operations, and public health.

The session also explored the “healthy migrant hypothesis,” the complex relationship between healthcare expenditures and immigrant status, and the operational impact of prolonged emergency department boarding and social disposition barriers.

Importantly, the presentation included preliminary clinical findings from the Boston Medical Center experience. The team discussed elevated rates of prolonged lengths of stay, significant rates of patients leaving without being seen, and concerns regarding fear, wait times, and healthcare access barriers. The presenters also described substantial infectious disease burden within the cohort, including tuberculosis, malaria, and neurocysticercosis. These findings highlighted the increasingly important intersection between emergency medicine, infectious diseases, immigrant health, and systems-based practice.

The subsequent discussion centered on how dual-trained physicians can contribute meaningfully during large-scale public health and humanitarian challenges. Participants discussed the need for stronger systems-level infrastructure, culturally informed care pathways, infectious disease screening programs, and multidisciplinary collaboration between emergency medicine, hospital medicine, primary care, infectious diseases, and community organizations.

The Value of the ACEP Dual Training Section

Across all presentations, several common themes emerged:

• Dual-trained physicians excel at navigating transitions of care.
• EM/IM physicians frequently occupy leadership roles in operations and systems redesign.
• Combined training provides unique advantages in complex patient populations.
• Dual-trained physicians are increasingly involved in population health, public health, observation medicine, and innovative care delivery models.
• The overlap between acute care and longitudinal care is becoming increasingly important in modern healthcare systems.

The conference showcased not only the diversity of career paths available to dual-trained physicians, but also the intellectual flexibility and systems-level perspective that define the field.

The ACEP Dual Training Section continues to provide an important professional community for physicians, trainees, and students interested in these intersections. The section supports mentorship, networking, advocacy, scholarship, conference programming, and collaborative research opportunities while highlighting the expanding role of dual-trained physicians within academic medicine and healthcare leadership.

Looking Ahead: A Call for Future Submissions

The 2026 ACEP Dual Training Virtual Conference demonstrated the tremendous breadth of scholarship, innovation, and leadership emerging from the dual-training community. From agitation management and behavioral emergency systems to hospital-at-home care models, to migrant health and infectious disease epidemiology, the conference highlighted how dual-trained physicians continue to shape the future of acute and longitudinal care.

The ACEP Dual Training Section encourages residents, fellows, medical students, and faculty to participate in future conferences and submit presentations, research projects, quality improvement initiatives, operational innovations, educational curricula, and case discussions. Projects that explore the intersection of emergency medicine with internal medicine, critical care, infectious diseases, primary care, population health, public health, systems operations, observation medicine, geriatrics, addiction medicine, and health equity are especially welcome.

As healthcare systems continue to evolve, the need for physicians capable of bridging emergency stabilization, inpatient management, systems thinking, and longitudinal care has never been greater. The ACEP Dual Training Section remains an ideal venue to share those ideas, foster collaboration, and build the future of dual-trained medicine.