Clinical Supervision in the Emergency Department: A Costly Inefficiency for Academic Medical Centers

DeBehnke, Daniel J.

doi:10.1111/j.1553-2712.2001.tb00215.x

Cited by 13 publications

(9 citation statements)

References 1 publication

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“…Many EM faculty members feel torn between their clinical and education duties believing that there is a trade off between efficient patient care and high quality bedside teaching 1. Supervision and teaching of novice practitioners takes time and nowhere in the hospital is the challenge of balancing the ‘joint product lines’ of clinical care and bedside teaching felt more acutely than in the emergency department (ED) 2. Emergency doctors are forced to allocate their most vital resource—their time—carefully, and different doctors choose to allocate this resource in different ways.…”

Section: Introductionmentioning

confidence: 99%

No relationship between measures of clinical efficiency and teaching effectiveness for emergency medicine faculty

Begaz

Decker

Treat

et al. 2010

Emergency Medicine Journal

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Section: Introductionmentioning

confidence: 99%

No relationship between measures of clinical efficiency and teaching effectiveness for emergency medicine faculty

Begaz

Decker

Treat

et al. 2010

Emergency Medicine Journal

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“…Others have previously reported that staff physicians are able to make shorter dispositions of patients than residents. 12 We were unable to demonstrate this.…”

Section: Discussionmentioning

confidence: 74%

The Effects of the Absence of Emergency Medicine Residents in an Academic Emergency Department

French

2002

Academic Emergency Medicine

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Objective: What are the quality effects of an emergency medicine (EM) residency, and the associated 24/7 supervision of residents by faculty, in an academic emergency department (ED)? The authors evaluated activity and quality indicators when there were no EM residents present. The hypothesis of the study was that there was no difference between the patient care provided by faculty supervising EM residents and that with an alternative model without EM residents (AbsenceEMResident). Methods: To support the weekly residency educational program (Thursday), EM residents are not scheduled clinically for a 24-hour period (ConfDay). Emergency medicine resident coverage (mean 62.7 hours) was replaced with incremental faculty and mid-level providers (mean 41.0 hours). This study was limited to adult patients (22,527 visits of 39,190 ED total) Emergency medicine (EM) is one of the very few specialties that require full-time, 24/7 faculty supervision for their residents. The founders of the specialty adopted this requirement because of the nature of emergency care and because they believed that residents should have direct supervision and education for all patients who present to the ED, regardless of the hour of presentation.How does this model affect patient care, which in many academic emergency departments (EDs) is largely provided by residents with supervision by faculty attending physicians (faculty)? Does supervision of EM residents result in the same quality when compared with an experienced clinician working without EM residents? Even hospital leaders question the equivalence of care when they specifically request faculty to treat some patients (e.g., VIPs) without resident involvement. There have been relatively few attempts to study and compare quality of care delivered by EM residents supervised by faculty compared with faculty working without EM residents. [1][2][3][4][5][6][7] In order to allow all residents to attend Thursday educational conferences and to also meet the Bell Commission work requirements, 8 our residency program chose to implement a weekly educational schedule that excused EM residents from ED staffing from approximately midnight Wednesday to approximately midnight Thursday. To meet the clinical demands of that period, we developed an alternative staffing model without EM residents (AbsenceEMResident), utilizing additional faculty and mid-level providers (MLPs). No other changes were made to accommodate this weekly educational period (i.e., triage, nurse staffing, off-service resident staffing, and clinical protocols remained consistent).This educational and staffing schedule presented us with the unique opportunity to compare, over a prolonged period of time, several activity and quality indicators of patient care for the two staffing models. Our hypothesis was that there would be no difference for the quality indicators between EM residents working with faculty supervision and the AbsenceEMResident model.

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“…One claim is that the presence of residents increases faculty staffing requirements, as attending physicians are required to spend time supervising and instructing the residents (DeBehnke, 2001). On the other hand, Knickman et al (1992) argue that teaching and treatment can occur simultaneously, meaning that residents can help to improve throughput.…”

Section: Literature Reviewmentioning

confidence: 99%

An empirical analysis of the effect of residents on emergency department treatment times

Anderson

Golden

Silberholz

et al. 2013

IIE Transactions on Healthcare Systems Engineering

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The residency teaching model is often cited as a possible source of inefficiency in hospitals. In this paper, we examine data from patients in the emergency department at the University of Maryland Medical Center. We compare treatment times from when residents were present to when they were absent, due to weekly research seminars. We show that residents lower treatment times and help increase emergency department efficiency.

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Clinical Supervision in the Emergency Department: A Costly Inefficiency for Academic Medical Centers

Abstract: Law XI: Show me a BMS (best medical student) who only triples my work and I will kiss his feet. 1

Cited by 13 publications

References 1 publication

No relationship between measures of clinical efficiency and teaching effectiveness for emergency medicine faculty

No relationship between measures of clinical efficiency and teaching effectiveness for emergency medicine faculty

The Effects of the Absence of Emergency Medicine Residents in an Academic Emergency Department

An empirical analysis of the effect of residents on emergency department treatment times

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