Educational Excellence in a Crowded Emergency Department: Consensus Recommendations From the Council of Emergency Medicine Residency Directors 2010

Background: In December 2019, a novel coronavirus (COVID-19) caused widespread clinical disease, triggering limited in-person gatherings and social-distancing guidelines to minimize transmission. These regulations led most emergency medicine (EM)residency training programs to rapidly transition to virtual didactics. We sought to evaluate EM resident perceptions of the effects of COVID-19 on their didactic and clinical education.Methods: We performed a cross-sectional survey study at seven EM residency programs using a mixed-methods approach designed to understand resident perceptions regarding the impact of COVID-19 on their educational experience. Quantitative data were presented as percentages with comparison of subgroups, while open-ended responses were analyzed using qualitative methodology. Results:We achieved a 59% response rate (187/313). The majority of respondents (119/182, 65.4%) reported that the COVID-19 pandemic had a negative impact on their residency education with junior residents disproportionately affected. A total of 81 of 182 (44.5%) participants reported that one or more of their clinical rotations were partially or completely canceled due to the pandemic. Additionally, we identified four themes and 34 subthemes highlighting the contextual effects of the pandemic, which were then divided into positive and negative influences on the residency experience. The four themes include systems experience, clinical experience, didactic experience, and wellness. Conclusion:Our study examined the impact of COVID-19 on residents' educational experiences. We found overall mixed responses with a slightly negative impact on residency education, wellness, and clinical rotations, while satisfaction with EM as a career choice was increased. Factors influencing this included systems, clinical, and didactic experiences as well as overall wellness.

Section: Clinical Experiencementioning

confidence: 99%

Beyond the emergency department: Effects of COVID‐19 on emergency medicine resident education

Ford

Fix

Shappell

et al. 2021

“…Such administrative curriculum should include teaching EM residents different ED operational strategies to manage patient flow (e.g., provider in triage, vertical flow models, or direct transfer patient to clinic among patients with nonemergency conditions) during their early EM residency training. Therefore, our study findings add some extra value to the current literature pool on how to enhance the administrative management of resident efficiency and provides future guidance on adjusting administrative didactics during EM residency training …”

Section: Discussionmentioning

confidence: 77%

Emergency Medicine Resident Efficiency and Emergency Department Crowding

Kirby

Robinson

Dib

et al. 2019

Objectives: Provider efficiency has been reported in the literature but there is a lack of efficiency analysis among emergency medicine (EM) residents. We aim to compare efficiency of EM residents of different training levels and determine if EM resident efficiency is affected by emergency department (ED) crowding. Methods:We conducted a single-center retrospective observation study from July 1, 2014, to June 30, 2017. The number of new patients per resident per hour and provider-to-disposition (PTD) time of each patient were used as resident efficiency markers. A crowding score was assigned to each patient upon the patient's arrival to the ED. We compared efficiency among EM residents of different training levels under different ED crowding statuses. Dynamic efficiency changes were compared monthly through the entire academic year (July to next June). Results:The study enrolled a total of 150,920 patients. A mean of 1.9 patients/hour was seen by PGY-1 EM residents in comparison to 2.6 patients/hour by PGY-2 and -3 EM residents. Median PTD was 2.8 hours in PGY-1 EM residents versus 2.6 hours in PGY-2 and -3 EM residents. There were no significant differences in acuity across all patients seen by EM residents. When crowded conditions existed, residency efficiency increased, but such changes were minimized when the ED became overcrowded. A linear increase of resident efficiency was observed only in PGY-1 EM residents throughout the entire academic year.

“…EM never "caps," there is no rounding, and patient volumes are ever increasing, so clinical shifts often focus on meeting immediate patient care needs, with limited time for bedside teaching. 5 Formal didactics and all other residency education-focused endeavors (e.g., mentoring, participation in resident development or wellness activities) in EM generally occur exclusively outside of regular clinical shifts, so that participation in these educational activities must be additive to clinical work hours for the faculty and factored into workhours for residents. These educational activities also usually occur during the day, which can further exacerbate sleep deprivation for emergency physicians working evening and night shifts.…”

Section: Unique Characteristics Of Emmentioning

confidence: 99%

Changes to the ACGME Common Program Requirements and Their Potential Impact on Emergency Medicine Core Faculty Protected Time

Greenberger

Finnell

Garg

et al. 2020

The Accreditation Council for Graduate Medical Education (ACGME), which regulates residency and fellowship training in the United States, recently revised the minimum standards for all training programs. These standards are codified and published as the Common Program Requirements. Recent specific revisions, particularly removing the requirement ensuring protected time for core faculty, are poised to have a substantial impact on emergency medicine training programs. A group of representatives and relevant stakeholders from national emergency medicine (EM) organizations was convened to assess the potential effects of these changes on core faculty and the training of emergency physicians. We reviewed the literature and results of surveys conducted by EM organizations to examine the role of core faculty protected time. Faculty nonclinical activities contribute greatly to the academic missions of EM training programs. Protected time and reduced clinical hours allow core faculty to engage in education and research, which are two of the three core pillars of academic EM. Loss of core faculty protected time is expected to have detrimental impacts on training programs and on EM generally. We provide consensus recommendations regarding EM core faculty clinical work hour limitations to maintain protected time for educational activities and scholarship and preserve the quality of academic EM.