Abstract
IntroductionResident productivity is an important educational and operational measure in emergency medicine (EM). The ability to continue effectively seeing new patients throughout a shift is fundamental to an emergency physician’s development, and residents are integral to the workforce of many academic emergency departments (ED). Our previous work has demonstrated that residents make gains in productivity over the course of intern year; however, it is unclear whether this is from experience as a physician in general on all rotations, or specific to experience in the ED.MethodsThis was a retrospective cohort study, conducted in an urban academic hospital ED, with a three-year EM training program in which first-year residents see new patients ad libitum. We evaluated resident shifts for the total number of new patients seen. We constructed a generalized estimating equation to predict productivity, defined as the number of new patients seen per shift, as a function of the week of the academic year, the number of weeks spent in the ED, and their interaction. Off-service residents’ productivity in the ED was analyzed in a secondary analysis.ResultsWe evaluated 7,779 EM intern shifts from 7/1/2010 to 7/1/2016. Interns started at 7.16 (95% confidence interval [CI] [6.87 – 7.45]) patients per nine-hour shift, with an increase of 0.20 (95% CI [0.17 – 0.24]) patients per shift for each week in the ED, over 22 weeks, leading to 11.5 (95% CI [10.6 – 12.7]) patients per shift at the end of their training in the ED. The effects of the week of the academic year and its interaction with weeks in the ED were not significant. We evaluated 2,328 off-service intern shifts, in which off-service residents saw 5.43 (95% CI [5.02 – 5.84]) patients per nine-hour shift initially, with 0.46 additional patients per week in the ED (95% CI [0.25 – 0.68]). The weeks of the academic year were not significant.ConclusionIntern productivity in EM correlates with time spent training in the ED, and not with experience on other rotations. Accordingly, an EM intern’s productivity should be evaluated relative to their aggregate time in the ED, rather than the time in the academic year.
Highlights
Resident productivity is an important educational and operational measure in emergency medicine (EM)
Our previous work has demonstrated that residents make gains in productivity over the course of intern year; it is unclear whether this is from experience as a physician in general on all rotations, or specific to experience in the emergency department (ED)
Our previous work has demonstrated that EM residents make steady gains in productivity over the course of their first year,[2] while the gains seen between subsequent years of residency are smaller and not evenly distributed over time, which has been well-established in prior studies of resident productivity.[3,4,5,6,7]
Summary
Resident productivity is an important educational and operational measure in emergency medicine (EM). The ability to continue effectively seeing new patients throughout a shift is fundamental to an emergency physician’s development, and residents are integral to the workforce of many academic emergency departments (ED). The ability to continue seeing new patients throughout a shift is fundamental to an emergency physician’s development, reflected in the multitasking (task-switching) milestone of EM training, and can be used as a means of evaluating an individual resident’s progress and competency.[1] the milestone charts a resident’s progress from managing a single patient amid distractions, to being able to manage multiple patients, and eventually to managing the patient volume of the emergency department (ED) itself.[1] Having a robust and quantifiable means of measuring progress along this milestone would allow educators to identify residents who would benefit from early, targeted interventions to hone their strategy for managing patients and workflow. Many non-clinical skills that might affect a physician’s efficiency, such as the ability to navigate a hospital’s electronic health record and computerized order-entry system, may generally improve when working across different areas of a hospital
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