Number of Patient Encounters in Emergency Medicine Residency Does Not Correlate with In-Training Exam Domain Scores

Abstract

Introduction: Emergency medicine (EM) residents take the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) every year. This examination is based on the ABEM Model of Clinical Practice (Model). The purpose of this study was to determine whether a relationship exists between the number of patient encounters a resident sees within a specific clinical domain and their ITE performance on questions that are related to that domain. Methods: Chief complaint data for each patient encounter was taken from the electronic health record for EM residents graduating in three consecutive years between 2016-2021. We excluded patient encounters without an assigned resident or a listed chief complaint. Chief complaints were then categorized into one of 20 domains based on the 2016 Model. We calculated correlations between the total number of encounters seen by a resident for all clinical years and their ITE performance for the corresponding clinical domain from their third year of training. Results: Available for analysis were a total of 232,625 patient encounters and 69 eligible residents who treated the patients. We found no statistically significant correlations following Bonferroni correction for multiple analyses. Conclusion: There was no correlation between the number of patient encounters a resident has within a clinical domain and their ITE performance on questions corresponding to that domain. This suggests the need for separate but parallel educational missions to achieve success in both the clinical environment and standardized testing.

Second‐ and third‐year medical students’ clinical encounters in the emergency department

“…Student exposure to the 10 core complaints outlined by the Clerkship Directors in Emergency Medicine (CDEM) M3 curriculum 12,18 was also summarized. Categories of chief complaints in our data set were collapsed by two evaluators when appropriate to best capture exposure to the core presentations 16,17,19 . Chest pain, abdominal pain, shortness of breath, and altered mental status are defined by CDEM as “must‐know” chief complaints 12,18 .…”

“…Patient records were included if they presented to the ED from January 8, 2018, to June 24, 2022, and were seen by a medical student, as defined by their chart containing a note written and signed by a medical student or a student assigning themselves to the patient's treatment team using the EHR. The chief complaint was used to identify the nature of the patient encounters 15–17 . Each complaint was categorized into one of 20 content domains from the American Board of Emergency Medicine (ABEM) Model of Clinical Practice using an expert consensus model 16 …”

“…The chief complaint was used to identify the nature of the patient encounters. 15 , 16 , 17 Each complaint was categorized into one of 20 content domains from the American Board of Emergency Medicine (ABEM) Model of Clinical Practice using an expert consensus model. 16 …”

“…Categories of chief complaints in our data set were collapsed by two evaluators when appropriate to best capture exposure to the core presentations. 16 , 17 , 19 Chest pain, abdominal pain, shortness of breath, and altered mental status are defined by CDEM as “must‐know” chief complaints. 12 , 18 Exposure to must‐know complaints, was also summarized.…”