363 A National Survey of Workflow Efficiency Education among Emergency Medicine Residency Training Programs

Abstract

Patient volumes in United States (U.S.) emergency departments (EDs) have been on the rise. Medical directors and employers seek emergency medicine (EM) physicians who have strong workflow efficiency (WFE) to help address high ED volumes without compromising patient care. Although WFE is a skill that EM residents should learn prior to graduation, it is not an Accreditation Council for Graduate Medical Education (ACGME) core competency, and there is no standard approach to measure and teach this skill during residency. Additionally, no studies have examined whether EM residency program leaders believe efficiency should be formally taught in EM residency programs. We sought to gain further insight into whether explicit teaching of WFE is important to EM residency program leadership, and the manner in which WFE is currently measured and taught to EM residents. We conducted a cross-sectional survey of all allopathic ACGME-accredited EM residency training programs in the U.S. The survey was conducted using SurveyMonkey® in the Fall of 2019. We invited all allopathic EM residency programs to voluntarily participate in the study, primarily by emailing their program directors (PDs). Assistant/associate program directors were invited subsequently if there was no response from the PD. We performed descriptive statistics on all survey data using SurveyMonkey® software. We received a total of 133 responses out of 190 total programs (response rate 70%) with proportionate representation from 3 & 4-year programs and all regions of the U.S. When asked “To what extent teaching efficiency should be a priority compared to other educational goals,” 65% of program leaders responded with “significant” or “moderate” priority. Most EM programs collect WFE data on their residents, either by tracking patients-per-hour (78%) or by written evaluations (59%). The top three methods for providing WFE data to residents were: individual data provided along with de-identified rank (35%), data provided only during private feedback meetings (26%), and no data or rank provided to residents (16%). Regarding targeted WFE teaching to residents, 88% reported utilizing general on-shift teaching, 48% reported teaching WFE during formal didactics, and 45% during dedicated private feedback sessions. WFE-focused simulations (15%), workshops (7%), and one-on-one observation shifts (14%) were uncommon. This national study of allopathic U.S. EM programs suggests that most EM program leaders value WFE teaching. However, we found no consistent approach among programs for tracking or distributing resident WFE data, and many programs lack a formalized way to teach efficiency to their residents. Given the importance of WFE to the clinical practice of EM, programs may benefit from devoting greater resources to teaching and tracking this essential skill set.