An observational study of emergency department intern activities

Abstract

Objectives: To describe how intern time is spent, and the frequency of activities performed by interns during emergency department (ED) rotations. Design and setting: Prospective observational study of 42 ED interns from three Melbourne city teaching hospitals during 5 months in 2006. Direct observations were made by a single researcher for 390.8 hours, sampling all days of the week and all hours of the day. Main outcome measures: Proportion of time spent on tasks and number of procedures performed or observed by interns. Results: Direct patient‐related tasks accounted for 86.6% of total intern time, including 43.9% spent on liaising and documentation, 17.5% obtaining patient histories, 9.3% on physical examinations, 5.6% on procedures, 4.8% ordering or interpreting investigations, 3.0% on handover and 4.9% on other clinical activities. Intern time spent on non‐clinical activities included 4.2% on breaks, 3.7% on downtime, 1.7% on education, and 1.3% on teaching others. Adjusted for an 8‐week term, the ED intern would take 253 patient histories, consult more senior ED staff on 683 occasions, perform 237 intravenous cannulations/phlebotomies, 39 arterial punctures, 12 wound repairs and apply 16 plasters. They would perform chest compressions under supervision on seven occasions, observe defibrillation twice and intubation once, but may not see a thoracostomy. Conclusions: The ED exposes interns to a broad range of activities. With the anticipated increase in intern numbers, dilution of the emergency medicine experience may occur, and requirements for supervision may increase. Substitution of ED rotations may deprive interns of a valuable learning experience.

Designing and implementing a skills program using a clinically integrated, multi-professional approach: using evaluation to drive curriculum change

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Effect of clinician designation on emergency department fast track performance

“…Although junior medical staff are encouraged to consult with more senior colleagues for clinical advice to ensure a high standard of safe emergency care, the need for consultation can result in significant delays in treatment and/or disposition decisions,6 23 which is contradictory to the rapid throughput aim that underpins fast track systems. The unresolved tension of balancing the need for experience and training in the management of a variety of patient groups and the throughput aims of fast track systems remains a challenge for both emergency medicine and emergency nursing.…”

An observational study of emergency department intern activities

“…To the Editor : The study of intern activities in Melbourne emergency departments (EDs) highlighted gaps in the ED training of interns 1 . In particular, it was shown that interns undertake a low number of procedural tasks.…”