Comparing Resident Procedures in Rural Versus Urban Emergency Departments

Abstract

Background: Rural rotations can be a valuable experience for emergency medicine (EM) residents. To date, there has not been a retrospective cohort study comparing procedures performed at urban versus rural emergency departments (EDs). Objectives: The purpose of this study was to compare procedures performed by EM residents in urban versus rural EDs, with the hypothesis that there will be no significant difference in the procedures performed. Methods: A retrospective cohort study was conducted comparing procedures performed by second- and third-year EM residents based on medical chart review. The procedures were counted at three locations in West Virginia, including a small rural ED, a large rural ED, and a tertiary care ED. Procedure notes were collected from September 2018 to September 2019. The final analysis included nine months, as three months did not have residents at all locations. Eight procedures were standardized based on the number of procedures performed per 100 hours worked by residents. A comparison of total procedures and complex versus simple procedures was performed. A Kruskal-Wallis H test was performed to compare resident hours for procedures between each of the three locations. To compare each of the hospitals to one another separately, Mann-Whitney U tests were performed. Results: The total resident hours worked included 1,800 at the small rural ED, 13,725.5 at the tertiary care ED, and 5,319 at the large rural ED. A p-value of 0.0311 for the Kruskal-Wallis H Test indicated a difference between at least two of the ED sites. A statistically significant difference exists (p-value = 0.0135) between the urban ED (95% CI: 0.15-0.62) and the large rural ED (95% CI: 0.54-1.53). There was no significant difference in complex versus simple procedures among the three locations (p-value = 0.4159). Conclusions: When compared with the tertiary care ED, residents performed more total procedures at the large rural ED and similar total procedure numbers at the small rural ED when standardized for hours worked. There was no significant difference when comparing complex and simple procedures among the three locations.

Defining the clinical and procedural opportunities available to residents during rural rotations

“…The results of this study can be compared to a recent study by Carey et al., 7 who also compared procedural exposures between academic and rural EDs. Their study showed increased frequency of exposure to procedures in general when residents worked at a large rural ED compared to an academic hospital and similar exposures when working at a small rural ED.…”

“…A small study by Wadman et al 6 (five total residents in the study) suggested that residents on a month-long rural rotation saw similar patient volumes to their academic center with significantly increased rates of exposure to fracture/dislocation reductions and pediatric trauma resuscitations. Another study by Carey et al 7 compared resident performance of "simple" and "complex" procedures at academic versus rural EDs and found no significant differences in procedural experiences. Other than these small studies, no other data have been published on this topic to date.…”

There is a need for a paradigm shift in laparoscopic surgical training: results of a nationwide survey among teaching hospitals in Switzerland

“…However, smaller hospitals provide invaluable support on the path to becoming a competent surgeon. They offer the opportunity to take on a higher degree of responsibility and develop greater autonomy at an earlier stage of training [ 24 , 25 ].…”