Computerized tracking of emergency medicine resident clinical experience

Langdorf, Mark I.; Strange, Gary R.; Macneil, Philip

doi:10.1016/s0196-0644(05)81700-7

Cited by 55 publications

(43 citation statements)

References 8 publications

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“…They found EM-1 residents averaged 0.73 PPH, EM-2 residents averaged 0.85 PPH, and EM-3 residents averaged 1.19 PPH. 8 Our volume data of 0.73, 1.11, and 1.05 PPH fit well within the range of previously reported literature (Table 1).…”

Section: Discussionsupporting

confidence: 91%

Progression of Emergency Medicine Resident Productivity

Brennan

Silvestri

Sun

et al. 2007

Academic Emergency Medicine

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Objectives: To evaluate the progression in productivity of emergency medicine (EM) residents by postgraduate year, as measured by hourly work in relative value units (RVUs).Methods: This retrospective study was conducted at an Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency with a postgraduate year (PGY) 1-2-3 configuration. A query of an electronic billing database composed of more than 230,000 visits from academic years July 2003 to December 2006, representing at least four classes at each PGY level, was conducted. The main outcome was change in productivity in RVUs generated per hour, compared by resident PGY level. This measure encompasses not only volume of patients seen but also patient acuity in terms of evaluation and management services and procedures provided and supported by documentation adequate for coding. Descriptive statistics and Tukey's test were used for data analysis.Results: Over the three-year study period, 70 EM residents were assessed at various levels of training. Productivity, as measured by mean RVUs generated per hour, was 2.51 (95% confidence interval [CI] = 2.20 to 2.82) for PGY-1 residents, 3.51 (95% CI = 3.12 to 3.90) for PGY-2 residents, and 3.61 (95% CI = 3.41 to 3.80) for PGY-3 residents (p < 0.001). Patient acuity (RVUs generated per patient) increased 5%-8% with each PGY progression: 3.05 (95% CI = 2.96 to 3.13) for PGY-1, 3.20 (95% CI = 3.09 to 3.31) for PGY-2, and 3.46 (95% CI = 3.42 to 3.50) for PGY-3 (p < 0.001). There was a statistically significant increase in productivity (p < 0.001) and acuity (p = 0.03) from PGY-1 to PGY-2, with acuity also increasing between PGY-2 and PGY-3 (p < 0.001).Conclusions: Hourly work productivity and acuity increased with experience within this ACGMEaccredited EM residency. The progression in workload and acuity by PGY is measurable and commensurate with the graduated level of responsibility desired in an EM program.

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Section: Discussionsupporting

confidence: 91%

Progression of Emergency Medicine Resident Productivity

Brennan

Silvestri

Sun

et al. 2007

Academic Emergency Medicine

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“…Langdorf and Strange published their experience in developing a computerized tracking system for EM residents. 5 Dire and Kietzman reported their experience tracking procedures with a computerized system for nine EM residents over a 36-month residency program. 6 Our results are similar to the experience reported by these authors.…”

Section: Discussionmentioning

confidence: 99%

Procedural Competency in Emergency Medicine: The Current Range of Resident Experience

Hayden

Panacek

1999

Academic Emergency Medicine

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Abstract. Objectives:To evaluate the recorded range of procedures tracked by emergency medicine (EM) programs, and to determine whether differences in procedural experience occur in various types of residency or hospital settings. Methods: The program directors of 112 approved EM programs were asked to send actual procedure logs. The requested information included the average total number of a given procedure per graduating resident, for all procedures that were tracked. Data were categorized by program format, hospital type, and ED volume. To assess the global procedural experience among programs, a set of 22 ''index procedures'' were identified; all procedures the EM residency review committee (RRC-EM) required to be tracked were included in this set. The means per graduating resident for each index procedure were added together to generate a ''mean index procedure sum'' (MIPS) per graduating resident for each residency program. These MIPSs for a residency were then compared by program format, hospital type, and ED volume. A similar analysis was performed for all resuscitations, and a ''mean index resuscitation sum'' (MIRS) per graduating resident was generated. Results: An overall response rate of 82% was achieved; a number of programs had not graduated a residency class and were not included. Sixtyfive of 85 eligible programs (76%) provided procedural data. The average number of a given procedure per graduating resident (95% CI in parentheses) for selected procedures is as follows: oral intubation 65 (46 to 85), intubation unspecified 75 (62 to 87), nasal intubation 6 (4 to 9), cricothyroidotomy 2 (1 to 2), subclavian catheter 23 (16 to 30), chest tubes 17 (14 to 20), intraosseous line 2 (1 to 3), thoracotomy 3 (2 to 5), and vaginal deliveries 17 (13 to 21). The only statistically significant differences in subgroup comparisons were in diagnostic peritoneal lavage, trauma resuscitations, and pediatric medical resuscitations when compared by postgraduate year format, and intubation-unspecified and cricothyroidotomy when compared by hospital type. There was no statistically significant difference when MIPSs were compared by format, hospital type, or ED volume. Conclusions: To the authors' knowledge, this is the first study of the range of EM resident procedure experience across the spectrum of EM residency types and settings. Overall, there are few statistically significant differences in procedure experience among different program formats. Similar experiences are recorded in a variety of different hospital types or ED volumes. However, some programs report very limited EM resident experience with selected critical procedures. There is a large variation in the types and numbers of procedures recorded by EM programs. Key words: emergency medicine; procedure; resident physician. ACA-DEMIC EMERGENCY MEDICINE 1999; 6:728-735 D OCUMENTING proficiency in procedural skills is becoming increasingly important for all physician training programs, including emergency medicine (EM). The core content in EM 1 contains 8...

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“…[1][2][3] Studies capturing resident experience have shown gaps in clinical exposure. [4][5][6][7][8][9][10] Many training programs incorporate simulation and online modules to standardize exposure. [11][12][13][14][15][16][17][18][19][20] Web-based modules and lectures can supplement clinical experience, most effectively when used in conjunction with face-to-face instruction.…”

mentioning

confidence: 99%

A Randomized Educational Interventional Trial of Spaced Education During a Pediatric Rotation

House

Monuteaux

Nagler

2017

AEM Education and Training

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Objective: Spacing of educational material over time has been shown to improve learning efficiency and long-term knowledge retention. We evaluated the impact of adding a spaced education curriculum to a month-long pediatric rotation.Methods: This was a randomized controlled educational intervention trial of residents on a rotation in a pediatric emergency department. Participants were randomized to the standard curriculum or the standard curriculum with integrated spaced education. The intervention used an automated platform to electronically deliver questions to user e-mail or mobile devices and provided instant feedback. Our primary outcome was proportion of correctly answered questions following the rotation. Our secondary outcomes included test performance at 3 months, change in clinical confidence, and satisfaction with the spaced learning. Learner opinion of the platform was assessed by postrotation survey.Results: Of 194 eligible trainees, 122 were enrolled and randomized. A total of 107 of the enrolled residents (88%) completed the immediate postrotation assessment, 48 of whom received spaced education. Sixty residents completed the 3-month follow-up. There were no differences between the control and intervention groups in baseline knowledge. The intervention group performed better than the control group on the postrotation assessment (mean difference = 5.4%, 95% confidence interval = 0.1-10.7) when controlled for didactic attendance and clinical exposure. Change in confidence did not differ between groups. Eighty-seven percent of spaced education learners would participate in a similar model in the future. Conclusion:Spaced education during a pediatric emergency medicine rotation is an effective adjunct to a standard curriculum. Participants showed improvement on postrotation knowledge performance and enjoyed this educational approach.T he standard residency education prescribed by the Accreditation Council for Graduate Medical Education (ACGME) incorporates bedside teaching and didactic curricula.1-3 Studies capturing resident experience have shown gaps in clinical exposure.4-10 Many training programs incorporate simulation and online modules to standardize exposure. [11][12][13][14][15][16][17][18][19][20] Web-based modules and lectures can supplement clinical experience, most effectively when used in conjunction with face-to-face instruction. 21 An alternative strategy is the use of spaced education, which is the interval presentation of educational material over a prescribed period of time. Studies of surgical residents and medical students have demonstrated that spaced education initiatives spanning months to years improve learning efficiency and longterm knowledge retention. [22][23][24][25][26][27][28] Web-based spaced education may be an effective approach for residents on an emergency medicine rotation with asynchronous clinical schedules.

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Computerized tracking of emergency medicine resident clinical experience

Cited by 55 publications

References 8 publications

Progression of Emergency Medicine Resident Productivity

Progression of Emergency Medicine Resident Productivity

Procedural Competency in Emergency Medicine: The Current Range of Resident Experience

A Randomized Educational Interventional Trial of Spaced Education During a Pediatric Rotation

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