Impact of Learners on Emergency Medicine Attending Physician Productivity

Abstract

IntroductionSeveral prior studies have examined the impact of learners (medical students or residents) on overall emergency department (ED) flow as well as the impact of resident training level on the number of patients seen by residents per hour. No study to date has specifically examined the impact of learners on emergency medicine (EM) attending physician productivity, with regards to patients per hour (PPH). We sought to evaluate whether learners increase, decrease, or have no effect on the productivity of EM attending physicians in a teaching program with one student or resident per attending.MethodsThis was a retrospective database review of an urban, academic tertiary care center with 3 separate teams on the acute care side of the ED. Each team was staffed with one attending physician paired with either one resident, one medical student or with no learners. All shifts from July 1, 2008 to June 30, 2010 were reviewed using an electronic database. We predefined a shift as “Resident” if > 5 patients were seen by a resident, “Medical Student” if any patients were seen by a medical student, and “No Learners” if no patients were seen by a medical student or resident. Shifts were removed from analysis if more than one learner saw patients during the shift. We further stratified resident shifts by EM training level or off-service rotator. For each type of shift, the total number of patients seen by the attending physician was then divided by 8 hours (shift duration) to arrive at number of patients per hour.ResultsWe analyzed a total of 7,360 shifts with 2,778 removed due to multiple learners on a team. For the 2,199 shifts with attending physicians with no learners, the average number of PPH was 1.87(95% confidence interval [CI] 1.86,1.89). For the 514 medical student shifts, the average PPH was 1.87(95% CI 1.84,1.90), p = 0.99 compared with attending with no learner. For the 1,935 resident shifts, the average PPH was 1.99(95% CI 1.97,2.00). Compared with attending physician with no learner, attending physicians with a resident saw more PPH (1.99 vs 1.87, p<0.005). There was no statistically significant difference found between EM1: 1.98PPH, EM2: 1.99PPH, EM3: 1.99PPH, and off-service rotators: 1.99PPH.ConclusionEM attending physicians paired with a resident in a one-on-one teaching model saw statistically significantly more patients per hour (0.12 more patients per hour) than EM attending physicians alone. EM attending physicians paired with a medical student saw the same number of patients per hour compared with working alone.

Resident Supervision and Patient Care: A Comparative Time Study in a Community‐Academic Versus a Community Emergency Department

“…tracked EPs’ time expenditures on direct/indirect patient care and personal activities in academic versus community EDs, but did not specify the time spent supervising residents or performing other care‐related activities. Other studies only assessed aggregate effect of residents on departmental throughput . To the best of our knowledge, this is the first study to comprehensively quantify and compare the time EPs spend on resident supervision and care‐related activities in CAEDs versus community EDs.…”

Critical Appraisal of Emergency Medicine Education Research: The Best Publications of 2014

“…A total of 243 papers satisfied the search criteria, and 25 papers met the inclusion criteria . The 25 articles (22 quantitative, three qualitative studies) were critically appraised by each of six reviewers.…”

“…Observational studies predominated in 2014, with 13 (52%) employing this method . Three articles (12%) featured qualitative methods, and unlike previous years, all appeared in EM journals .…”

“…Medical student education was the central theme in five (20%) of studies, while residents were the target of study in 12 (48%) studies, and faculty were the primary group in one (4%) . Many studies targeted multiple learner groups: medical students and residents; medical students, residents, and faculty; medical students and faculty; and residents and faculty …”

Slow or swift, your patients’ experience won’t drift: absence of correlation between physician productivity and the patient experience

“…Finally, though it is well documented that other variables such as wait times, crowding, and interactions with non-physician ED staff all influence patient satisfaction, 5,10,12-15 we were unable to determine how Absence of correlation between physician productivity and the patient experience CJEM JCMU 2017;19 (5) variables such as learner involvement, illness acuity, and treatment outcome influenced our data. 30,40 Such a study would require significantly greater resources to determine the influence of these multiple variables. We recommend that future studies account for these potential confounders.…”